Permit CITY OF T1 GARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00224
I DEVE PMENT. SE R9 ICES 639 -4171 DATE ISSUED: 05/04/2000 Hall PARCEL: 1S125DB-03805
SITE ADDRESS: 09640 SW 74TH AVE
SUBDIVISION: BOULEVARD HEIGHTS ZONING: R -4.5
BLOCK: LOT : 026 JURISDICTION: TIG
Project Description: 200 amp service and 11 branch circuits
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: 11 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:
DEGROFF, PETER B + OWNER
MELANIE N
9640 SW 74TH AVE! . E.
TIGARD, OR 97223 a
Phone: Phone:
Reg. #:
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT BON 05/04/200C $123.10 MANUAL Elect'I Final ORIGINAL
5PCT BON 05/04/200C $9.85 MANUAL
- -
Total $132.95
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 • . / ISSUED BY:
OWNE''NSTALLATION ONLY
The installation is being made on propert wn which is not intended or sale, lease, or rent.
OWNER'S SIGNATURE: / 'C% � / DATE
CONTRACTO ` ' NSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE: •
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
CITY;OF TIGARD Plan Check
Electrical Permit Application
13125 SW HALL BLVD. Recd By
TIGARD OR 97223 Date Rec'd 5' "2 -&D(1
Phone (503) 639 -4171, x304 Date to P.E.
Date to DST
Inspection (503) 639 -4175 Print of Type Permit # F2.:2400 - CO zZy
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) (JE6R Service included: Items Cost Sum , i ,
Address 96 yo Sw 7'/ A/6 4a. Residential - per unit
r' 1000 sq. ft. or less $ 117.75 4
City/State /Zip / /CT 17� Each additional 500 sq. ft. or
portion thereof $ 2615 1
Commercial ❑ Residential iiig Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation �
Electrical Contractor 200 amps or less / $ 64.25 J S ,,,.2.5 2
Address 201 amps to 400 amps $ 85.50 2
City State Zj 401 amps to 600 amps $ 128.50 2
ty p 601 amps to 1000 amps $ 192.50 2
Phone No. Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. Exp.Date .4c. Temporary Services or Feeders
OR State GCB Reg. No. Exp.Date Installation, alteration, or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
see "b" above.
License No. Exp.Date
Phone No. 4d. Branch Circuits
New, alteration.or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
//�� /� feeder fee. c �i �j
Print Owner's Name ■ Pere, /e( ,,)f/ Each branch circuit 1 / $ 5.35 �O d GL 2
Address a450 SW 741 b) The fee for branch circuits .
without purchase of service
City --7 ,9 State /7ie... Zip 97,073 or feeder fee.
Phone No. 29'6 3 Fs // 407 0, 59-2 First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is being made on • operty I own which is not 4e. Miscellaneous 7b,-
Service or feeder not included Pll ea_ ED
intended for sale, ease or re / ' ,� ( g 9 c )
Each pump or irrigation circle $ 42.75
Owner's Signature __ _l _ -/ ' /� Eacn si nor outline li htin $ 42.75
Signal circuit(s) or a limited energy .
if required).. panL alteration or extension $ 60.00
3. Plan Review section
( Minor Labels (10) $
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over Zee .01)
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees: z a
5a. Enter total of above fees $ • _"✓ +
* Submit 2 sets of plans with application where any of the above apply. ok f Surcharge (.X total fees) $ _
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # a
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ a� 1 S
i : \d sts \forms \el ectric. doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171.
BUP
Date Requested P / I / 00 AM PM BLD
Location g LAD D — 7(! Au—es Suite MEC
Contact Person 1 Ph 4 /0 ZS 5Z PLM
Contractor Ph SWR
BUILDING" ` Tenant/Owner ELC ?0 O022
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 /� ' OF
Misc: ! f� r/ 11 / / /
Final
PASS PART FAIL D e..42
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 Pk�T FAIL •
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
F i
PA SS_ ART 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
Fire Supply Line [ ] Please call for reinspection RE: 4 A [ ] Unable to inspect - no access
ADA / Approach /Sidewalk ??11 9_ ,% ��
Other Date U Inspector ..1A Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.