Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00687
i DEVELOPMENT SERVICES DATE ISSUED: 12/14/00
II 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S136AA-02000
SITE ADDRESS: 10340 SW 69TH AVE
SUBDIVISION: FUR VALLEY ZONING: R -4.5
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Replace Furnace
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:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
DAVID GLASGOW WESTMORELAND ELECTRIC
10340 SW 69TH 13150 S CLACKAMAS RIVER DR
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone: Phone: 557 -2220
Reg #: ELE 26 -1050C
LIC 140551
SUP 4638S
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Final
PRMT CTR 12/14/00 $46.85 2720000000(
5PCT CTR 12/14/00 $3.75 2720000000(
Total $50.60
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 OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE im °A LA ISSUED BY:
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: DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
Electrical Permit Application
Date received: Permit no. 2077D pD 42g
w., o : I ,h t- Project/appl. no.: Ex
F,u. �•i I City of Tigard ��t ��;;c�wa�� Pro � pp Expire date: p
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171 r
Fax: (503) 598 -1960 {�°� y Z `'1' Case file no.: Payment type:
Land use approval:
i 'ER
•
�.,��.�+ se >!r��::
T�'PE.OF
,� IiT... . .
1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family ❑ Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other: ❑ Partial
' JOB SITE INFORMATION
Job address: /O34.4D _5 7 h Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: u ( bdivision:
Project name: I Description and location of work on premises: Li ga6 a
Estimated date of completion/inspection: , 1 4 - CU
CONTRACTOR APPLICATION' FEE SCIIEDULE
_ Job n Fee Max
Business uauae: ,,82 Lei w 14e • Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Address /3j5 ) .3, �,gUe erh43.5 al. dwelling unit. Includes attached garage.
City: 011151 ii Cj I State . I ZIP: 4 2 yr Serviceincluded
Phone: c i 767 ax: I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 1I,? S5 I Elec. bus. lie. no: �b,l4Yj,�"5`1 Limited energy, residential 2
City /metro lie. no. Limited energy, non - residential 2
1 ,4&4 140 12 7 _ cV Each manufactured home or modular dwelling
Signatre of supervising electrician (required) Date t Service and/or feeder 2
Sup. elect. name (print): , Or. License Services or feeders — installation,
alteration or relocation:
.. PROPERTY OWNER ? - ..- .. 200 amps or less 2
Name (print): r 7g) i,() (9 /4se.90Lt) 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: ;/k9 31..., /7j^ 601 amps to 1000 amps 2
City: 7_.q-7t2 I State: at ZIP: Q/72 3 Over 1000 amps or volts 2
Phone: q52-063,0 IFax: 1E-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 installation, alteration, orrelocation:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Addr service or feeder fee, each branch circuit / 2
Cit State: ZIP: B. Fee for branch circuits without purchase ,/1, g5
1
of service or feeder fee, first branch circuit: (-� , 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAIN REVIEW (Please check all that apply) . Misc .(Serviceorfeedernotincluded):
❑ Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
O 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
O B uilding over three stories 0 Feeders, 400 amps or more *Description:
O Occupant Toad over 99 persons 0 Manufactured structures or RV park Each additional inspection over die allowable in any of the above:
❑ Egress/lightingplan 0 Other. Per inspection I
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 $
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ 3 76_
Credit card number: / 1 within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $ �I � (J ,
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00 /COM)
• ry
•
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 ❑ 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 El Garage Door Opener*
Dwelling Service or Feeder $90.90 2
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 Vacuum 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
200 amps or less $66.85 _ 2 Fee for each system $75.00
201 amps to 400 amps $100.30 • 2 (SEE OAR 918-260-260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts. Check Type of Work Involved:
see "b" above.
Branch Circuits ❑ Audio and Stereo Systems
New, alteration or extension per panel ❑
a) The fee for branch circuits Boiler Controls
with purchase of service or �
feeder fee. 1 Clock Systems
Each branch circuit $6.65 2
b) The fee for branch circuits ❑ Data Telecommunication Installation
without purchase of service
or feeder fee.
( $46.85 `f //� O ? ❑ Fire Alarm Installation
First branch circuit (
Each additional branch circuit $6.65 ❑
HVAC
Miscellaneous .
(Service or feeder not included) ❑ Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑
Signal circuit(s) or a limited energy Intercom and Paging Systems
panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑ Landscape Irrigation Control*
Each additional inspection over . ❑ Medical
the allowable in any of the above
Per inspection $62.50
Per hour $62.50 n Nurse Calls
In Plant $73.75 ❑
• Outdoor Landscape Lightiiig`
Fees:
❑ Protective Signaling
Enter total of above fees $ /
8% State Surcharge $ ' % ,1 L > n Other
25% Plan Review Fee Number of Systems
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ SO ,DO Fees:
El Trust Account # Enter total of above fees $
8% State Surcharge $
Total Balance Due $
i:\dsts \forms \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 /- AM PM -
BLD
Location /6 7c/0 .5 Suite MEC
Contact Person Ph 5 } 3 -3 s7 2 2 2 0 PLM
Contractor Ph / / 9? ^ 7(i 2 SWR
BUILDING Tenant/Owner Lv�- 4 r2 7` 7 �m ELC 7
Retaining Wall Ply Cain/ 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
Firewall
Fire Sprinkler -&
Fire Alarm
Susp'd Ceiling
Roof Q
Misc:
Final
PASS PART FAIL •
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
-ELECTRICAII
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final / 1M '
PASS PART . FAIL
SITE
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 /O c� f Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 171
BUP
Date Requested / Z' AM PM BLD
Location / 3'/ V 5w G 9 Suite MEC •
Contact Person Ph .53 7 .- 22z 0 PLM
Contractor (i�.1. /A/20'r----4? - 7 , -/_9 Ph r2 T Sr Y36 Z SWR
BUILDING Tenant/Owner
ELC 7.vo L' " 7
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 L� /" �L�i� _ / /
Firewall
Fire Sprinkler
Fire Alarm `
Susp'd Ceiling a-r-e
Roof
Misc: � �� — _ /
. .�� � � yJ
Final
PASS PART FAIL
PLUMBING ✓` _ _ .a..
Post & Beam /
Under Slab _
" t4 '
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
(ELECTRI
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
ASS PART AIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: ] Unable to inspect - no access
ADA
Approach /Sidewalk Date /-- ,A Inspector / Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -dour Inspection Line: 639 -4175 Business Line: 63974171
BUP
bate Requested / Z -- ( 1 AM PM BUD-
Location /U 760 S -' OP et /¢(-'Q Suite MEC '
Contact Person Ph 172 — Z Z 7-0 PLM
Contractor (A l,eSt "M.-c'-r.c --1 4-7,/ 0 c Ph SWR
BUILDING Tenant/Owner ELC aG d" 7
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 e s-- \/ A/ 4,01,
i_er,_
Firewall /
. Fire Sprinkler OA/ -Si c//
Fire Alarm -
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers -
Final
PASS PART FAIL
L TRICA
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
•A ASS PART AIL
SITE
BackfilllGrading
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 Date /2- /f- eu Inspector / - _ Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -lour Iritpectton Line: 639 -4175 Business Line: 639-4 71 MST
I. bate Requested l — l AM PM BLD.
Location /0 3 1 -/ o S w ( r Suite MEC
Contact Person Ph 533- 5 -Z 1Z O PLM
Contractor L ji / / r-crv c/ fiepp ph SWR
BUILDING Tenant/Owner 17/-P4 ELC e.e.vu -c 0 64'7
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
Firewall
Fire Sprinkler • i
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
L CAL
service
Rough In p
UG /Slab
Low Voltage
Fire Alarm
anal
SS PA (—FAIL)
SITE
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 Date /2-- / r- 9-z) Inspector — - Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.