Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00400
111i DEVELOPMENT SERVICES DATE ISSUED: 6/30/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 1S136AD
SITE ADDRESS: 10735 SW 69th AVE managment
SUBDIVISION: VILLA RIDGE ZONING: R-12
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Panel change with (1) branch circuit.
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: 1 W /SERVICE OR FEEDER: 1 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
MCKIBBEN -GETTYSBURG VENTURE ENDERS ELECTRIC
c/o KRICHMAR, JERRY + CAMILLE PO BOX 1661
790 HERMOSA WAY BEAVERTON, OR 97075
LAGUNA BEACH, CA 92651
Phone: Phone: 626 - 4813
Reg #: LIC 00026728
SUP 2028S
FEES ELE 34 -265C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/30/03 $86.95
[TAX] 8% State Tax 6/30/03 $6.96 Rough -
Elect'l Service
Total $93.91 Elect'I Final
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 -0100. You may obtain copies of these rules or direct questions to OUNC at (50 24. -6 :9 or
1- 800 - 332 -2344. /
Issued B /„( Permit Signature: er&F
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: Permitno.:f�(, O' 'IA :�y City of Tigard RECEIVED J PP p
Pro ect/a 1 no.: Expire date:
CiryofTrgnrd Address: 13125 SW Hall Blvd, Ti ard, OR 97223 Date issued: By a Receiptno.:
Phone: (503) 639 -4171 J�1 3 0 2003
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD
Land use approval: 3UI DI - ntt, Isitenst _
TYPE OF PERMIT
•
❑ 1 & 2 family dwelling or accessory l Commercial /industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: 10735 SW 69th Tigard Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: I Description and location of work on premises: Panel change
Estimated date of completion/inspection:
, CONTRACTOR APPLICATION . " , ti FEE SCIIEDU.E
Job no: Fee Max
Business name:Enders Electric Inc Description Qty. (ea.) Total no.insp
New residential - single or multi- family per
Address: P.O. BOX 1661 dwelling wit. Includes attached garage. •
CityBeaverton I State:OR I ZIP:97075 Service included:
Phone26 -48 13 I Fax646 -3871 1E-mail: p3 1000 sq. ft. or less 4
,
CCB no.: 26728 / -/ ° > -o 5 I Elec. bus. •c. no: 34 -265C Ion Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic. n., 5388 ,, „ j Limited energy, non- residential 2
11/41 I 'ff/ tr Each manufactured home or modular dwelling
Signature o supervising electrician (required) D 06/30/2003 Service and/or feeder 2 ate
Sup. elect. name (print): Allen G Robertson License no: , tl : Services or feeders — installation,
alteration or relocation:
ry ;' : PROPERTY OWNER 200 amps or less I gQ„ i 0 2
Name (print): Propert Management • 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address : ( i.; , L - yv g 7
601 amps to 1000 amps 2
City: 'State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I 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 installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit I 6 2
City: 1 State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1&2 O 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,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection 1 1 1 1
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 $ D
O 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 %) $ * i - ■
Expires accepted as complete. TOTAL $ igga
Name of cardholder as shown on credit card
Cardholder signature Amount 440-4615 (6/00 /COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERM FEES
V W" • ` l -.,.
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 n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 ri Garage Door Opener
Services or Feeders n 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 n Vacuum Systems*
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n 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. n 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 servlce n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 ❑
Each additional branch circuit $6.65 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 n Medical
the allowable in any of the above -
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ n 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 $
•
is \dsts \forms \elc- fees.doc 06/07/01
CITY OF TIGARD 24-Hour
BUILDING Inspection - Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
• BUP
Received Date Requested 7-2-3 AM PM BUP
Location 16 3,S (p 9 - .rV _- Suite MEC
Contact Perso _ • 410 Ph ( ) 7q 3 -5 PLM
Contractor r L • IOG'1'�iY1� 2 Ph ( ) a ficti -Lt i (p SWR
BUILDING Tenant/Owner - „&f.271 4 ELC 3 - ("a 4/0
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam _ •
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation lv � 1 (�Wct ` l
Drywall Nailing `` \ l�tV � V , v
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final C.../ P ASS PART FAIL (----
PLUMBING
j___:_,,,,,
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
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
' 'AS PART FAIL
0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date � 2 _ CI Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record om the Jo site.
PASS PART FAIL