Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00646
Azio 1
DEVELOPMENT SERVICES DATE ISSUED: 12/19/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S112BD -00100
SITE ADDRESS: 14640 SW 76TH AVE 072
SUBDIVISION: TIFFANY COURT APT. ZONING: R-12
BLOCK: LOT : 065 JURISDICTION: TIG
Project Description: Alteration of (5) branch circuits for 1 GFI circuit, 1 heater and 1 smoke detector. Work is being done in
Unit #72.
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: 4 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREAJSPEC OCC:
Owner: Contractor:
WASHINGTON CO. HOUSING AUTHORITY SYLVANIA ELECTRIC CO
111 NE LINCOLN ST 5328 SE 109
#200 -L, MS63 PORTLAND, OR 97266
HILLSBORO, OR 97124 -3082
Phone: 503 - 846 -4794 Phone: 503 - 762 -2714
Reg #: ELE 26 -1086C
LIC 110400
FEES SUP 4830S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/19/02 $73.45
[TAX] 8% State Tax 12/19/02 $5.88 Rough -in
Elect'I Final
Total $79.33
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.doneJn 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
forttyin OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1- 800- 332 -2344. -7
f�'
/ I /
Issued By: �� . p, // .� Permit Signature: V
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:
C9 TRACTOR4NSTALLATION ONLY
/
SIGNATURE OF SUPR. ELEC'N: X7 DATE:
LICENSE NO: g� �� �� G,
Call 639 -4175 by 7:OOpm for an inspection the next business day
i '-"' Electrical Permit Application , ,,
. Date received: '. /9/,eay- Permit no.: , ,,, ,.40 , t�)„
J .411 City of Tigard Project/appl. no • i' e date:
CityofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: t B, . , Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
e 3;:' s .. ,, w "t h . ±c wu 'TYP
- e ' OF PERMIT ' I7 r '' . ' ' - '
l 1 & 2 family dwelling or accessory ❑ Commercial/industrial CMulti- family ❑ Tenant improvement
❑ New construction ❑ Addition /alteration/replacement /(3 ljther: ❑ Partial
:::.„';,'7; - '-‘ . p ;k ,, t'f .,,
JOB SITE INFORMATION . :.4 . x ,.:,, ).,.
Job address: L , '` • j Bld no .: Suite no.: Tax map /tax lot/account no.:
Lot: Bloc' : Subdivision:
Project name: Description and location of work on premises: / , ZIP TAIIIIMIM
Estimated date of completion/inspection:
l < e1 ?tCONTRACTOR APPLICATION a- `' SCHEDULE i , t-.. '
' `� -"FEE SCHEDUL � . � '�
Job no: / Fee Max
Business name: 5 vA •
i Description Qty. (ea.) Total no. insp
�
_ • New residential - single or multi - family per
Address: a ; ,r,, 40 F i f (f l : dwelling unit. Includes attached garage.
OW 0 LOW, IP: ' , , Service included:
Phone: C / 3 — $ co i ip Co, q 54 E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof __
CCB no.: & O Q Elec. bus. lic. no: (' / 01, 6
• Limited energy, residential ___ 2
City /metro lic. no.: Limi ted energy, non- residential ___ 2
-� Each manufactured home or modular dwelling
Signature of supervi`quired) Date r / ..._0 " Service and/or feeder ■■■ 2
Sup. elect. name (print): I U FihrEl License no: A 1 Q Services or feeders – installation,
alteration or relocation: III
e , ; PROPERTY DOWNER „� 200 amps or l ess 2
Name (print): 201 amps to 400 amps ___ 2
401 amps to 600 amps ___ 2
Mailing address: 601 amps to 1000 amps ___ 2
City: State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: 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, or relocation:
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
3 ,w,,, 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: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: M■ 2
Phone: Fax: E-mail: Each additional branch circuit: ___—
PLAN REVIEW (Please -check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle ■■• 2
O Service over 320 amps - rating of 1 &2 ❑ Hazardous location Each sign or outline lighting ___ 2
family dwellings ❑ 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
O Building over three stories ❑ Feeders, 400 amps or more *Descri . tion:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other: Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other .
r
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ •
r
❑ 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 $ 7 J
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
•
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT 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 n 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 n Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders 0 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 0 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. [1 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 n Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
•without purchase of service n Fire Alarm Installation
or feeder fee. •
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over n Medical
the allowable in any of the above n
Per inspection $62.50 Nurse Calls
Per hour $62.50
In Plant $73.75 0 Outdoor Landscape Lighting
Fees: 0 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 $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms \elc- fees.doc 08/30/01
4V ••
CITY OF TIGA RD. - 4 ,-- T 24 -Hour ,,, •
BUILDING ,. - Inspection Line: (503) 639 -4175 - -=
INSPECTION DIVISION Business Line: (503) 639 - 4171 M ST
BUP „e
Received -� Date R / -- 2 ( AM -- Y'PM BUP
Location 7 l • 7loY° ' f ( Suite 1�� MEC
Contact Person � G � , 9 Ph ( ) G3 - F. 5 P LM
Contractor Ph.( ) , > SWR
BUILDING Tenant/Owner r ✓ ,aZ ) ELC — a 6 (9 ' o ' ;'
Footing
Foundation ELC
Access: -y ,
Ftg Drain Ft. - ELR `
Crawl Drain .. • - k
Slab Inspection Notes: _ r , SIT •
,
Post & Beam 7
Shear Anchors -~ :: t �
Ext Sheath/Shear - 2 ': ." t
Int Sheath/Shear :
�
Framing -
Insulation ;',;
Drywall Nailing 1 �4 s
Firewall - .
Fire Sprinkler •
Fire Alarm - - 4 �'
Susp'd Ceiling
-
Roof _
Other: , . •
Final , ' _ °
PASS PART FAIL ,
PLUMBING z
Post & Beam
Under Slab `
Rough -In
Water Service _ _ '
Sanitary Sewer -
Rain Drains '
Catch Basin / Manhole ,e
Storm Drain _ -
Shower Pan
Other:
Final '
PASS PART FAIL .
MECHANICAL • •
Post & Beam
Rough -In r
Gas Line '
Smoke Dampers ""
Final • r
PASS P AIL -
IrCECTRIC • -
Service
Rough -In ."
UG /Slab '
Low Voltage
Fire Alarm `
(dalA> El Reinspection fee,of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
erik PART FAIL
SITE 0 Please call for reinspection RE: • n Unable to ifi'spect — no access
Fire Supply Line
ADA 3 1
Approach /Sidewalk Date ! - t 1 03 Inspector do a _ Alk •. Ext ' A. ,
Other: _ ,
Final DO NOT REMOVE this inspection record -front the Jo ' site. ;o
PASS PART FAIL 1
&■ :. ,, . ,