Permit 4, . CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00639
VIII DEVELOPMENT SERVICES DATE ISSUED: 12/26/02
` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 101 AD -01300
SITE ADDRESS: 12750 SW 68TH AVE
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING. MUE
BLOCK: LOT : 033 JURISDICTION: TIG
Project Description: TI wire for dental office /training.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: 2
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 3 W /SERVICE OR FEEDER: 65 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 0 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
HAMPTON BUILDING, THE LLC COMMERCIAL ELECTRIC CORP.
PO BOX 94 1904 SE OCHOCO
CAMP SHERMAN, OR 97730 MILWAUKIE, OR 97222
Phone: 5541 - 595 -2495 Phone: 503 - 462 -5201
Reg #: LIC 6145
SUP 1940S
FEES ELE 26 -33C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/13/02 $823.15
[ELPLCK] ELC PIn Rev 12/13/02 $205.79 Ceiling Cover
[TAX] 8% State Tax 12/13/02 $65.85 Wall Cover
Underground Cover
Total $1,094.79 Low Voltage Inspection
Elect'I Service
Elect'I Final
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spec :Ity Codes and all • •plicabl laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 14.0 days of issua e, o work is uspended
for more than 180 days. _ ATTENTION: Oregon law requires you to follow rules adopted by the Oregon alit, Notifi f _ I. Cent- Those • Ies are set
forth in-OAR 952 - 001- 0010,through OAR 952 - 001 -0100. You may obtain copies of these rules or direct ;u: ions o 4 UN• . 503) 24r .699 or
1- 800 ?332 -2344.
Iss;ied By: L ola" , .A •/, Permit Signature: / f - 0
W
- -- OWNER INSTALLATION ONLY L i
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N• Q Le J am` - 1, `-t' DATE:
LICENSE NO: / 9 '
Call 639 -4175 by 7:OOpm for an inspection the next business day
•
": ElectricalPermitApplication .
Date received: /A - -/ — Permit no.:,,,,,, , i i... ; ie s ;, Via-
CRY of Ti ard
. - ' . t y RECEIV g Projecdappl. no.: Expire date: ‘,39
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By& Receipt no.:
Phone: (503) 639 -4171 DEC 13 2002
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: CITY OF TIGARD _stntotwerD}..v4810111__ '$
TYPE OF PERNIIT
O 1 & 2 family dwelling or accessory tjkCommercial/industrial ❑ Multi - family 0 Tenant improvement
O New construction f. Addition/alteration/replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: / 2:7 S 643 1, V`z- Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: :5 I Description and location of work on premises: Lj„ Fo ;0. ' -' -- ecc --/
Estimated d a t e of completion/inspection: - 77e '/A/ , CONTRACTOR APPLICATION - _ FEE SCI EDtill I'. _.:• _.
Job no: 5 Fe Max
Business name: �' pw,,�, e tq c �c �-t-QI Description Qty. (ea.) Total no. iasp �_
New residmtW - single or multi-family per
Address: 1901 5E tV _ .o i,.,
dwelling unit. Includes attached garage.
City: h/I, ,4ok 6 I StateniQI aP: 97Z ZZ Sallee included:
Phone. spa- t/(,2,..‘20 / I Fax :6,0. /%S I E - mail: 1000 sq. ft. or less 4
CCB no.: ( 445 I Elec. bus. lie. no: 24,-3 3c.
F additional 500 sq. ft or portion thereof
Limited energy, residential 2
i
City/rq@t 4 41' ^ /b / - / / Limited nu energy,
f a ct u red home or ml 2
, 0��\ (( ljj )) C� / 2 � 2 p 'Z Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print) : i t e,• asv eit License no: 94r Services or feeders installation,
alteration or relocation: .
PROPERTY OWNER
200 amps or less 3 Z70• 2
201 amps to 400 amps _ 2
Name (print): 401 amps to 600 amps 2
Mailing address:
601 amps to 1000 amps 2
City: I State: I aP: Over 1000 amps or volts 2
Phone: I Fax: 1_E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to i °SmBa>lon, alteration, orrelocation:
ORS 447, 455, 479, in 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 s 2
Branch circuits - new, alteration,
Name: or extension per panel •
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit ( & 136 2
City: I State: E-mail: ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Ise. (Service or feeder not included):
O Service over 225 amps - commercial O Health -cane facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1&2 0 Hazatduus 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,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2 7S /So — 2
O Building over three stories 0 Feeders, 400 amps or more •Description: EL el fe 5a 4 7 .CFF
O Occupant load over 99 persons 0 Manufactured structures or RV park Each addition over the allowable In any of the above:
O Egress/lightingplan 0 Other Per inspection I I I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Na au jurisdictions accept aeait cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ '23. /5
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at 21 96) $ 2aS 7 9
Credit card number: / / within 180 days after it has been State surcharge (8%) $ 65 8
E accepted as complete. TOTAL $ /O '4 7p
Named cardholder m shown on credit card
Cardholder signature Amount • 4404615 (6A0/COM)
Electrical Permit Fees: Limited Energy Fees: .
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
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 E. Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40. 1
Limited Energy $75.00 ❑ Burglar Alarm
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 - 2 1=I Gara a 9 Door Opener*
p er
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 El Vacuum Systems* 201 amps to 400 amps $106.85 2 •
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 Fire Alarm Installation
or feeder fee. ❑
First branch circuit $46.85
Each additional branch circuit $6.65 El HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
.Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40. D Intercom and Paging Systems
Signal circult(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: ❑ Protective Signaling
Enter total of above fees $ 1 1 Other
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 $
❑ Trust Account # 8% State Surcharge $
' Total Balance Due $
i:\dsts\forms\elc-fees.doc 10/09/00
CITY OF TIGARD _ 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIV SIONT 1 Business Line: (503) 639 -4171 MST
BUP
Received � Date Requested — AM eq � � � A PM BUP
Location a 8 Suite �✓ MEC
Y'"
Contact Person 1, Ph ( ) gd � -l S Z3 PLM
Contractor Ph ( } SWR
BUILDING Tenant/Owner vO ELC e ' o a 4 '3 f
Footing ELC
A ccess: x �(/
Foundation
a 6
Ftg Drain ELR
Crawl Drain _---
Slab SIT
Post & Beam � !
Shear Anchors
Ext Sheath/Shear / 1 ' 1 / m o • ...4.//24
Ci1 /20.e://
Int Sheath/Shear !/
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
BrvIC
ough -In
UG/Slab
Low Voltage
Fire Alarm
In Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk (Date Inspector A a. - Ext
Other:
Final DO NOT REMOVE this inspection record from the site.
PASS PART FAIL