14060 SW 112TH AVENUE rn
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14060 SW 112"' STREET
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 ---
LIP
Date Requested �'[,` AM PM B
- Lp --
Location (�1,�
_ I ( � L� � Sttr�'.�.-� MEC
Contact Person C( \,�,- -- � PO4•bleh PLM
Contractor ! SAY J� j-e C-40-i C Ph SWR _
BUILDING Tenant/Owner ELC ' CX ��-
Retaining Wall ELR
Footing Access: —
Foundation FPS _
Fig Drain --- SGN
Crawl Drain Inspection Notes: -
SlabSIT
--------- ----------- -----------
Post& Beam — -
Ext Sheath/Shear
Int Sheath/Shear
Framing _
Insulation —
Drywall Nailing - -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling —
Roof S � -- ------
M sc _ - �t-C --L LZCJ i1 —
Final -
PASS PART FAIL -----
PLUMBING
Post& Bearn - -- - - - - -- -------- ---
Under Slab
TopOut ------- -- - ------ --- -------------------------------
Water Service
Sanitary Sewer
Rain Drains
Drains
----- ---- - --------------------
Final - ---------------------
PASS PART FAIL
MECHANICAL
Post& Bean, _....---------- -------_ ..-.-
Rough In
Gas Line - ---- -- -.-_. -- - --- - ---
Smoke Dampers
Final _.._ _-- — ---- --- -- -- ---- ---------- --
PASS PARTFAIL
E
Service ----- ---- - - ------ -
Rough In
UG/Slab -- -- — —
Low Voltage
F ire --__-- — -_-�
PASS ART FAIL r -
BackfilhGrading -- ---
Sanitary Sewer
Storm Drain [ )Reinspection fee of$ —required before next inspection. Pay at City Ho;l, 1x125 SW Hall Blvd
Catch Basin
Fire Supply Line ( 1 Please call for reinspertion RE - [ Urable to inspect-no access
ADA
Approach/Sidewalk Date 7��Q" _ Inspector_ _ -� _ Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC93 01.02
DEVELOPMENT SERVICES DATE ISSUED: O2/18/99
13125 SW Hall Blvd., Tigard,OR 97223(50)639.4171
PARCEL: 2S 1 10AB-2101 00
SITE ADDRESS. , . - 14060 SW 1 J.2TH ST #25
SUBDIVISION. . . . : ZONING: R•-12
BLOCK,. . . . . . . . . . . LOT. . . . . . . . . . . . . JURISDICTION: TIG
Pr^o.jer_.t Descr-iption : Renconnect ion of service
_.__ RESIDENTIAL UNIT-- _.-- ---TEMP' SRVC/FEEDERS-...._ -- _._-._.-.-MISCELL_.ANEOLJS------
1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADD' L 5O0SF. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : V,
LIMITED ENERGY_ . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
MANF. HM/ SVC/FDR. . : 0 601+amps•-1000 volts. : 0 MINOR LABEL ( 1.0) . . . : 0
-_---BRANCH CIRCUIT'S-_-.---- -..--ADD' L INSPECTIONS-
0
NSPECTIONS-
0 - 200 <3mp. . . . . . : 0 W/SERVICE OR FEEDER: 2r IDER INSPECTION. . . . . 0
='01 400 amp. . . . . . . 0 1st W/O SRVC OR FDR. : 0 PER HOUR. . . . . . . . . . . : 0
401 - 600 amp. . . . . . : 0 EA ADD' L. BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : ID
601 - 1000 amp. . . . . : 0 - -_- -- _____._.-.-----Pit-AN REVIEW SECT ION-•-.---_
1.000+ amp/vol.t. . . . . : 0 ) =4 PEI; UNITS. . . . . . . . : > 600 VOLT NOMINAL.. .
Reconnect only. . . . . : 1 SVC/FDR > = 225 AMPS. . : CLASS AREA/SPEC OCC. :
Owner : --------------------------------------------------------- FEES __------------
JOHN R RICHES type amoUnt by date r^ecpt
:3598 ASTER ST NW P'RMT $ 50. 00 B 02/18/99 99-31 3054
SALEM OR 97304 SPCT $ 2. 50 B 02/ 18/99 99-013054
Phone #:
Cnntr^actor^: --------..-•--•-----____.._.._.____.._.___.___--•
JOHN RICHES E 5:'. 50 TOTAL_
3598 ASTER ST NW
------- REQUIRED INSP'ECTION5
SALEM OR 97304 Ror.rgh-in Elect ' l Final.
P'lione #: '332•-875`-, Elect' 1 Set-vice
Reg #. . .
This permit is issued subject to the regulations contained in the Tigard Winicipal Code, State of Oregon Specialtv Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will r.xpire if work is not started within 188
days of issuance, or if work is suspended for more than 188 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon !Jtility Notification Center. Those rules are set forth in DAR 952-801-8818 through OAR 952-801-1987. you may obtain a copy
of these rules or direct questions to DUNG by calling (583)246-1987. --7
-f-) -
Permittee Signati.rr-e: Issr.red By •r
INSTALLATION
The installation is being made on proper-ty I own which is not intended for
sale, lease, or, rent.
OWNS:R' S SIGNATURE: � L A4 _ DATE:
—CONTRACTOR INSTALLATION ONLY---_
9I GNATURE OF SUPIR. ELEC' N: _ DATE:
L I CENSE NO:
►++f++++++++++++++++++++++++++++++++++++++++f•+++++++++++++++++A•++++++++++++++*f
Call 639-41.75 by 7:00 p. m. for an inspection needed the next br-rsiness day
4 4 f++•1-4+++++-I•+4+++++++++f+++t++++++++++++++++f-++++f++++++++++h++++++++f•++++++++
CITY OF TIGARD Electrical Permit Application Plan Check#
13125 SW HALL BLVD. Rac'd By_ F -
TIGARD OR 97223 Date Rec'd !'
Date to P.E.
Phone (503)639-4171, x304 Print or Type Date to DST
Inspection (503) 639-4175 Permit# V LC U
Fax (503) 684-7297 Incomplete or illegible will not be accepted Called_
i, Job Address: l� 4. Complete Fee Schedule Below:
�. I
Name of Development !�CLJ0r i� 6a)o r AoIs . Number of Inspections per permit allowed
Name(or name of business)1_-jV 1Xr i> CC1. �)j A(41< Service included: Items Cost Sum
Addressr � 1
�,\) ,�t�/-\�•L _ .� � _ 4a. Residential-per unit
City/State/Zip-'t (0127 r4 i _ 1000 sq.ft.or less $110.00 _ 4
Each additional 500 sq.ft.or
Commercial ❑ Residential ® portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder __ $68.00
2a. Contractor installation only:
(Attach copy of all current licenses) 4b.Services or Feeders
Electrical ContractorInstallation,alteration,or relocation
200 amps or Inns $60.00
Address_.- 201 amps to 400 amps $80.00
City State_--_-Zip 401 amps to 600 amps $120.00 2
Phone No. 601 amps to 1000 amps i_ $180.00 2
Job No. _ Over 1000 amps or volts $340.00
Elec. Cont. Lice. No. _Exp.Date Reconnect ons $50.00 'T_�
OR State CCB Reg. No. _Exp.Date_ 4c.Temporary Services or Feeders
COT Business Tax or Ndtro No. Exp.Date� Installation,alteration,or relocation
200 amps or less $50.00 _
Signature of Supr. Elec'n _ 201 amps to 400 amps $75.00
401 amps to 600 amps $100.00
Over 600 amps to 1000 volts,
License No._ _ _ _ _ Exp.Date see"b"above.
Phone No.__
--- _ 4d.Branch Circuits
New,alteration or extension per panel
2b. For owner installations: a)The fee for branch circuits with
purchase of service or
Print Owner's Name C4`ti t', I C4 1,S feeder fee
Address,-2 1 1 L 0 `_-A N I,0 v Each hranch circuit $5.00 __ 2
Cit �7/�LL)y State 1� f+ b)The lee hr branch circuits
Y --� - - p without purchase of
Phone No. j441 `l:U service or feeder fee.
First branch circuit $35.00 _
ThP installation Is being made on property I own which is not Each additional branch circuit_ $5.00
intended for sale,lease or rent. 4e.Miscellaneous
Owner's SignatUft+ Cl rJ�_ _�{i O - r( ; Each(Serypump
or feeder not included) -
Each pump or irrigation circle $40.04 ?
Each sign or outline lighting $4n on
3. Plan Review section (if required):' Signal circuits)or a limited energy-
panel,alteration or extension $40.00
Please check appropriate item and enter fee In section 58. Minor Labels(td) $100.00
4 or more residential units In one structure 4f.Each additional Inspection over
Service and feeder 225 amps or more the allowable In any of the above
System over 600 volts nominal Per inspection $3500 ---
Classified area or structure containing special occupancy Per hour $55.00
as described In N.E.0 Chapter 5 In Plant $55 no
"Submit 2 sets of plans with application where any of the above apply. 5. Fees: ,�L'`
Not required for temporary construction services. 5a.Enter total of above fees $
5%Surcharge(.05 X total fees) $
NOTICE Subtotal $ -
5b.Enter 25%of line 6a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review It reguir (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account Ir
t
Total balance Due
I
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