Permit C OF =L
M AJ IA , DEVELOPMENT SERVICES PERMIT #: ELR2001 -00206
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/08/2001
SITE ADDRESS: 12323 SW 66TH AVE PARCEL: 2S101AA -06400
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: C -G
BLOCK: LOT: 024 JURISDICTION: TIG
Proiect Description: Low voltage wiring /connection to rooftop A/C.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATAITELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TING, ELON + SYLVIA AMERICAN HEATING
BY WILLIAM R SOUTHARD 1339 SW GIDEON ST
603 SE VICTORY AVE STE 100 PORTLAND, OR 97202
VANCOUVER, WA 98661
Phone: Phone: 239 -4600
Reg #: LIC 00033135
ELE 26- 683CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
5PCT CTR 08/08/2001 $6.00 2720010000 Elect'I Final
PRMT CTR 08/08/2001 $75.00 2720010000
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in 0 • R
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or dire' .L.1' s ' • ns to • C at (503)
246 -1987.
Issued by G- 1/L Permittee Signature ��, . �� ,
1 I V OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale. lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N (T y\ C). ,v.,(.C(A- ( (ix- DATE:
LICENSE NO: ` J . LIC)? L f
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
ei'1i 0 / / ^OD
0 A Elec trical PermitApplication
Date received: i ® Permit no.: ,PL _e94(
.: ;'l_i! ,. City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: f / Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
I;YPE OF PERMIT .
& 2 family dwelling or accesso
• 1 1 y g accessory Commercial/ industrial CI Multi-family CI Tenant improvement
CI New construction 0 /alteration/replacement ❑ Other: CI Partial
JOB SI'11. INFOIt111A UO\
Job address: 1 _ W . T41 `, V Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: F . _ _ Description and location of work on premises: ! - • Al
Estimated date of completion/inspection:
..- CONTRACTOR APPLICATION •-` "`" ' •. FEE SCHEDULE E
Job no: Fee Max
-
• Description Qty. (ea.) Total no. insp
L. .... c New residential - single or multi- family per
Address: . f dwelling unit . Includes attached garage.
c . . _- State:0 ZIP: Senice included:
Phone: N , , , Fax: _ • ) 0 ' E -mail: 1000 sq. ft. or less 4
CCB no. • 3.3 1 _ -- 1, ... .1 . .: Z
` � r _
Each additional 500 sq. ft. or portion thereof __-
Limited energy, residential ___ 2
City /metro lic. no.: Limited energy, non- residential ___ 2
Mc ' t T ts1. D ' AN O Each manufactured home or modular dwelling ■■.
Signature of supervisin _�l . .. Service and/or feeder 2
Sup. elect. name (print): 5 License no: Z1a'I j/, ^ices or feeders – installation,
II
1'RO PI7t "CY : 0N1'!"LR alteration or relocation:
-' 200 am s p or less 2
Name (print): , •I[ 201 amps to 400 amps __ 2
Mailing address: 1 1 • 401 amps to 600 amps ___ 2
601 amps to 1000 amps ___ 2
In 132:L VI , , " Over 1000 amps or volts _ 2
Phone: , rt,U- E-mail:
L � �_
Reconnect only ___ 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
insta
which is not intended for sale, lease, rent, or exchange according to uation , alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps ___ 2
Owner's signature: Date: 401 to 600 am . s ME__ 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Nagle' A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
State: ZIP: B. Fee for branch circuits without purchase Eli
of service or feeder fee, first branch circuit: 2
City: a E-mail: Each additional branch circuit:
Phone: F __
': PLAN It V11,W (Please check all that - apply) Misc. (Service or feeder not included):
❑. Service over 225 amps- commercial 0 Health- carefacility Each pump or irrigation circle ■■ . 2
0 Service over 320 amps-rating of 1&2 0 Hazardous location Each sign or outline lighting ___ 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
0 Building over three stories 0 Feeders, 400 amps or mo *Descri , lion: = r " AT - L
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lightingplan Cl Other. Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ / 7Z) , 00
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ & . D°
Expires accepted as complete. TOTAL $ ?/ . 6
Name of cardholder as shown on credit card
$
Cardholder signature Amount
440-4615 (6/00 /COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: , Items Cost Total 4
Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40. 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage' Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 11 Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts • . • $454.65 2
Reconnect only • $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260) ,'.' . "'
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 • Check Type of Work Involved: . -
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel ❑ Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ . Clock Systems
feeder fee. ... .
•
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service - . ❑
or feederfee. Fire Alarm'Installation
First branch circuit $46.85 I �
Each additional branch circuit $6.65 I HVAC
Miscellaneous ❑
Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems, , , ,
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour • $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting*
Fees:
n Protective Signaling '
Enter total of above fees $ c Other / 'j'717 l.x) I, 7 D / t' �,�-
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $ •
Enter total of above fees $ 7 5 . eZ
❑ Trust Account # 8% State Surcharge $
• Total Balance Due $
i:\dsts\fom s\elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested 3 �i '/ AM PM BLD
Location 1 3 2 3 Co �_' Suite MEC
Contact Person ,. Ph ') cJ3 PLM
Contractor Ph SWR
BUILDING Tenant/Owner / S 1,414 c ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
. Framing
Insulation ,/
Drywall Nailing ° V O • W 1 r ,, - R,c,p � j p Z��f�
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: -•
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains 1
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In IIL' r.
Gas Line ,/—
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough „ /
R In � �:J
UG /Slab
Low Voltage
Fire Alarm
F ART FAIL
SIT
•
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk / / —
Other Date Ins Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •