Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00632
i �� DEVELOPMENT SERVICES DATE ISSUED: 11/15/00
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S125DA -08600
SITE ADDRESS: 09200 SW 70TH AVE
SUBDIVISION: KINGS VIEW ZONING: R -4.5
BLOCK: LOT : 066 JURISDICTION: TIG
Project Description: Installation of one branch circuit for replacement of 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: 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:
EMRICH, ROBERT K + SERVICE NOW OF OREGON
HEISLER, KATHRYN C 615 RAILROAD AVE
9200 SW 70TH AVE OREGON CITY, OR 97045
TIGARD, OR 97223
Phone: Phone: 655 -7558
Reg #: LIC 110214
PLM 3 -304PB
ELE 265LHR
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT CTR 11/15/00 $46.85 2720000000( Elect'l Final
5PCT CTR 11/15/00 $3.75 2720000000(
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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. ATTE ION: Oregon law requires you to follow rul op - bythe Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 t. 'ug h OAR 952 - 001 -0080. You may obtai copies of these rules or direct questions to OUNC at (503)
246 -1987. ` /
PERMITTEE'S SIGNATURE „ � � ISS D BY :k
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: / /5 • Permit no.: E 2 -090 • o
V City of Tigard Pro ecdappl. no.: • 're date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: I '�� Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
New construction 0 Addition/alteration /replacement ❑ Other: 0 Partial
JOB SITE INFORMATION
Job address: 1 ZOO s Le.) • 7, A 1)E Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: 1 " I Description and location of work on premises: whop - CC ePr -( 4A .,-7--
Estimated date of completion/inspection: 11 — 1 —&()
Job no: Fee Max
Business name: sell Z CE' ),..._tit.,... Description • Qty. (ea.) Total no. insp
New residential - single or multi- family per
Address: 11)4 'r3 p „d_ # 2 dwelling unit. Includes attachedgarage.
City: �t! 1 I State: Q ZIP: 9 7 D , Service included:
Phone: 4,56 I Fax: 455W," I E -mail: 1000 sq. ft. or less 4
1 1� I y Sort' L Each additional 500 sq. ft. or portion thereof
CCB no.: LEl bus. lic. no:
Limited energy, residential 2
City /metro lic. ep Limited energy, non- residential 2
11— /S " (94) Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders installation,
alteration or relocation:
- • PROPERTY OWNER 200 amps or less 2
Name (print): { /2 ICt-1 e my H 51,_ .- - 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 7 2po (a -, t 1/E 601 amps to 1000 amps 2
City: Ti6ifp.43 State: _I ZIP: [ 72ZJ ' Over 1000 amps or volts 2
Phone: 4„5 ' ?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 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
Address: service or feeder fee, each branch circuit 2
City: I 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: ttt
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial ❑ 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,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* • 2
❑ 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 ❑ Other Per inspection I 1 1
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other - �i • �-
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ CO
0 Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $ '
Name of cardholder as shown on credit card
Cardholder signature Amount 440 -4615 (6/00/COM)
,
Electrical Permit Fees: - Limited Energy Fees: „sr �'
Com lete Fee Schedule Below:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS) •
Service included: Items Cost Total y 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 I I Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ 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 Tess $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 T
Installation, alteration, or relocation TYPE OF WORK INVOLVED - COMMERCIAL ONLY
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. ❑ Clock Systems
Each branch circuit $6.65 2
b) The fee for branch circuits ❑ Data Telecommunication Installation
without purchase of service
or feeder fee. Fire Alarm Installation
First branch circuit $46.85 4,9 • g.<
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 ❑ Nurse Calls
In Plant $73.75
❑ Outdoor Landscape Lighting
Fees:
(61 ❑ Protective Signaling
Enter total of above fees $ (f
1�I Other •
8% State Surcharge $ 3, -25 '
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 $ 50. (co Fees:
❑ 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 MST
24 -Hour Inspection Line: ::639 -4175 Business Line: 639 -4171
• BUP
Date Requested "°2 - r ° ' AM PM BLD=
Location „lye - . Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC .2e7e3o - Kf;S3Z
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
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
E SS PART FAIL
ECTRICAIM
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm"
-- S PART FAIL
S
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
Other Date /2//e2 c2 e Ins xt
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.