Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00265
ATAV11�4' DEVELOPMENT SERVICES DATE ISSUED: 05/22/2001
13125 SW Hall Blvd., Tioard, OR 97223 (503) 639 -4171 PARCEL: 2S113A6 -01201
SITE ADDRESS: 16505 SW 72ND AVE BLDG F 16505 -16035
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (4) branch circuits. Job #40402s
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: 3 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:
PACIFIC REALTY ASSOCIATES STONER ELECTRIC
15350 SW SEQUOIA PKWY #300 -WMI 1904 SE OCHOCO STREET
PORTLAND, OR 97224 MILWAUKIE, OR 97222
Phone: Phone:
Reg #: 1O -46063
SUP 4025S
ELE 26 -122C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 05/22/2001 $66.80 2720010000( Wall Cover
Elect'I Final
5PCT CTR 05/22/2001 $5.35 2720010000(
Total $72.15
•
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)
246-6699 or 1 -800.332 -2344.
Permit Signature: Issued B
r l l_ r►� /n 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: l a'fja/""" f'c' DATE:
LICENSE NO: 3({96 5
Call 639 -4175 by 7:OOpm for an inspection the next business day
^'e
~ Electrical Permit Application
Alli
RECEIVED Date received: RIM Permit no.: f '
4, .j 1 Il City of Tigard Project/appl. no.: Expire date:
Cit y of �' � Ti and Address: 13125 SW Hall Blvd, t ORi
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 COMMUNITY DEVELOPMEN) Case file no.: Payment type:
Land use approval:
~ .TYPE OF PERMIT .
❑ I & 2 family dwelling or accessory Commercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ►' Addition/alteration/replacement ❑ Other: ❑ Partial
JOBSITE INFORf%IATION .
Job address: /locos Sc..) 72,„D Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: (Subdivision:
Project name: L R,.. I Description and location of work on premises: yyl,se_ E, . 46 - ,
Estimated date of completion/inspection:
_ „CONTRACICLI :APPLICATION_ ..,:__ ._ -.�.�. T_ .-FE E-SCIIEDULE._r_- .-- - = --
Job no: 2 5 Fee Max
Business name: ��ct-ie , C._
Description Qty. (ea) Total no. insp
Address: !9 o 4 p� o e- c:::. N welling residential cl ft or chedgarage. attached •
City: M,Lwq,vrg - 1 State:p,e I ZIP: j 7 z z 2. Service included:
Phone;.03 - e1,42-c,9 t I Fax:6s9-'/90 I E -mail: 1000 sq. ft. or less 4
r 2_2_
Each additional 500 sq. ft_ or portion thereof
CCB no.: 4,4,92 I El ec. bus. tic. no 24, -
Limite,d energy, residential 2
City /metro Iic. no.: 44/ 4 Limited energy, non - residential 2
57/• 4/ Each manufactured home or modular dwelling .
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): MI get t74t..ca,v License Services or Feeders - installation,
ie
: I'ROPERTY O11'NER - alteration or relocation:
_ 200 amps or less - 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: I 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 orfeeders-
which is not intended for sale, lease, rent, or exchange accordinz to Installation, 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 amps 2
ENGINEER - - Branch circuits - new alteration,
Name: or extension per panel:
A. Re 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
Phone: Fax: E-mail: of service or feeder fee first branch circuit: l � 2
Each additional branch circuit: 3 9 5
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 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet our 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 R V 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
Na all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ 46 ': go
O visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / 1 within 180 days after it has been State surcharge (8 %) .... $ ..13,
Expires TOTAL $ 72- /5
accepted as complete.
Name of cardholder as shown on credit card
S
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 ❑ 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 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 ofservlce or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑
orfeederfee. Fire Alarm Installation
First branch circuit $46.85
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. ❑ 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: ❑ Protective Signaling
Enter total of above fees $ ❑ 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:\dstskforms\elc- fees.doc 10/09/00
GITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested S - Z 7 AM PM BLD
Location /G.5 54.) 72 r-a' 1'' C (7l Y Suite (F) MEC
Contact Person A4 ° 4 y Ph $ 4,) // PLM
Contractor / Ph SWR
BUILDING Tenant/Owner ELC 2€A/-ed 0 z GS
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
PASS PART FAIL
CTRI6
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
1 111i-P-
- ART FAIL
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: 411 [ ] able to inspect - no access
ADA
Otheoach /Sidewalk Dated 9 - / Inspector Qe � ' Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.