Permit CITY OF TIGARD PERMIT
PERMIT #: ELC2001 -00306
j DEVELOPMENT SERVICES DATE ISSUED: 06/12/2001
A" c� 'l l 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136CA-00600
SITE ADDRESS: 11070 SW 78TH AVE
SUBDIVISION: FAIRVALE ZONING: R -4.5
BLOCK: LOT : 006 JURISDICTION: TIG
Project Description: Installation of 200 amp /less service. (2) 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: 2 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:
LARRY PRESTON WILLAMETTE ELECTRIC INC
1152 12TH AVE/ PO BOX 230547
ALBANY', OR 97321 TIGARD, OR 97281
Phone: Phone: 624 -3631
Reg #: LIC 75059
SUP 1965S
ELE 34 -283C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 06/12/2001 $93.60 2720010000( Elect'I Final
5PCT CTR 06/12/2001 $7.49 2720010000(
Total $101.09
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 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: CY1 (42 -I _ 44G''Z. --0Y' DATE:
LICENSE NO: I
Call 639 -4175 by 7:OOpm for an inspection the next business day
•
•
A i Electrical Permit Application
RECEIVED• Datereceived: /a _� Permit no.: ::/,_!'), 30G
` 1:1 : City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tig pp 972,101 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 •
COMMUNITY DEVELOPMEW
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
• 41 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family O Tenant improvement
O New construction 0 Addition/alteration /replacement O Other: O Partial
JOB SITE INFORMATION • • ;
. z,,t. •
Job address: // S(.,.J n /M-,--. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: f i 4 -,,,-` I Description and location of work on premises: ce,r ri, c e Cl.,, ,,,, e
Estimated date of completion/inspection: /o — 15 —O /
CONTRACTOR APPLICATION FEE SCIIEIitLE t :„ 3 4;: ; 1
Job norms / 3 O O Fee Max
r Description Qty. (ea) Total no. insp
Business name:
W , f l o g AA elk r /QC r /2 / •C /� New res id en ti a l - s or multi - family per
Address: e, & A Z3' p S i 7= dwellingunitlncludesattachedgarage.
City: , 5 bt ,. ` ,,,, I State:(J,k_ I ZIP: orr '? ( Service included:
Phone: 6 2q - g63t IFax: G2 K- ZS I E-mail: 100 sq. f or l ess 4
_
Each additional 500 sq. ft. or portion thereof
CCB no.: 7 S O 5 q I Elec. bus. lic. no: 34 - e.S. 3C_ Limited energy, residential 2
City /metro lic. no.: / S S G Limited energy, non- residential 2
�Oe.. �J k - b . o ( Each manufactured home or modular dwelling
Signature of supervisin a ectrician (required) Date Service and/or feeder 2
Sup. elect. name (print): 0)i F ( License no: /` S - S Services or feeders - installation,
i lc
alteration or relocation:
• • -. - • PROPERTY OWNER / 907.!--' 0 2 •
• Name (print): : (t } i , 201 amps to 400 amps 2
Q 401 2
to 600 amps
Mailing address: . 1 i r 1--... t o c -4 E c , VJ) , 601 amps to 1000 amps 2
City: rg, /,_ /bi,t 'State: [ZIP: 9 —7 3,-./ Over 1000 amps or volts 2
Phone: • 6 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,orreloeation:
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 6 G? ( 3 — ?O 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:
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 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 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:
❑ Egress/lightingplan 0 Other. Per inspection 1 I 1 I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. . Other
Permit fee $ 9
4-c—
Not all jurisdictions accept credit cards, please calf jurisdiction for more information. Notice: This permit application Plan review (at _ %) $ _
❑ Visa ❑ MasterCard expires if a permit is not obtained $ cj
Credit card number: / / within 180 days after it has been TOTAL charge (8 %) .... $ / O / -
Expires accepted as complete.
Name of cardholder as shown on credit card
$
Cardholder signature Amount , 440-4615 (6/00/COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number`oflhspections 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 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 n Burglar Alarm
Limited Energy $75.00 i
Each Manuf'd 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 I I Vacuum Systems
201 amps to 400 amps $106.85 2
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
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. ICI
Branch Circuits " — - 1 t -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. n Clock Systems .
Each branch circuit $6.65 2
b) The fee for branch circuits n Data Telecommunication Installation
without purchase of service
or feeder fee. .
Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65
HVAC
Miscellaneous
(Service or feeder not included) n Instrumentation
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
Minor Labels (10) $125.00 n Landscape Irrigation Control
Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50
Per hour $62.50 n Nurse Calls
In Plant $73.75
Outdoor Landscape Lighting`
Fees:
-- - n - Protective- Signaling -. -
Enter total of above fees $
F Other,
8% State Surcharge $
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
•
Total Balance Due $ Fees:
Enter total of above fees $
El Trust Account #
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 —, AM PM BLD
Location // U 0 � 41--( J--e Suite MEC
Contact Person K Ph 2 2 5 3 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC " D e -063e
Retaining Wall 6 7 a 7 7 Z ELR
Footing Access:
Foundation / O0- G q
S— 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
ELECTRICAL
Service
Rough In 7„ C,
UG /Slab
Low Voltage
Fire Alarm
M SS PART 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other Date g gInspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
2,(/7/
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24rNourinspection Line: 639 -4175 Business Line: 639 -4171 •
BUP
Date Requested ( — AM PM BLD
Location // 7 d 2p `" Suite MEC
Contact Person Ph w z 1 ( 3/ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC eUGI -0 U 31 6
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 �e r I/1 P
Susp'd Ceiling
Roof �� / 1 LS7
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
CT -
ervic-
- .ug In
UG /Slab
Low Voltage
. Fire Alarm
414
4 PART 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: AIS [ ] Unable to inspect - no access
ADA � A roach /Sidewalk
Other Date 6 ` �� / Inspector - �� i 41/1 A Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.