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Permit
C ELECTRICAL PERMIT CITY O F TIGARD G A R D PERMIT #: ELC2000 -00583 116. DEVELOPMENT SERVICES DATE ISSUED: 10/9/00 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136CA-04100 SITE ADDRESS: 11140 SW 79TH AVE SUBDIVISION: FRIENDLY ACRES ZONING: R -4.5 BLOCK: LOT : 007 JURISDICTION: TIG Project Description: Gas 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: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 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: JOHNSON, LEROY HALL + WESTMORELAND ELECTRIC BAERWALD, KENNETH FRED /LOIS MA 13150 S CLACKAMAS RIVER DR 11140 SW 79TH AVE OREGON CITY, OR 97045 TIGARD, OR 97223 Phone: • Phone: 557 -2220 Reg #: ELE 26 -1050C LIC 140551 SUP 4638S • FEES Required Inspections Type By Date Amount Receipt Rough -in PRMT CTR 10/9/00 $46.85 2720000000( Elect'I Final 5PCT CTR 10/9/00 $3.74 2720000000( Total $50.59 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 -$080. You may obtain copies of these rules ordirect questions to OUNC at (503) 246 -1987. PERMITTEE'S SIGNATU ISSUED BY: W 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: Permit no.: E243 8 2 c�'+r,t ?fl,h City of Tigard Projectlappl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt Phone: (503) 639 -4171 Fax: (503).598 -1960 Case file no.: Payment type: Land use approval: • TYPE OF PERMIT.. • 14 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION Job address: / /Lip Sw 7.q Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: I Subdivision: Project name: T014 03 S bk.) I Description and location of work on premises: CTA F..k.24/i8 -C E'_ 124� --E Estimated date of completion/inspection: 1 0 ( 0 C U • • • CONTRACTOR APPLICATION -) - FEE SCHEDULE . Job no: - / MLII . Fee Max s� Business name: / y /I ■ � !, ∎ # ♦ Description Qty. (ea.) Total no. insp L . �� � \ !� - New residential - single or multi- family per Address: i � I- A I ` . �; i� dwelling unit. Includes attached garage. City: '0',.5e'' ir , t ' 7 - %' Service included: Phone: S 7 2_0 I Fax E -mail: 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof CCB no.:�i I Elec. bus. lic. no: )..6. -/ 05-0 - Limited energy, residential 2 City /metro lic. no.: / 551 Limited energy, non - residential 2 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): Z- e.e O v - 60ssyl 201 amps to 400 amps 2 / tic C/ ` -7 401 amps to 600 amps 2 Mailing address: / f /1/0 9 1� _ 601 amps to 1000 amps 2 City: -2 /) I State: />/e_ ZIP: 9 733 Over 1000 amps or volts 2 Phone: 635 - :?3 :cam I Fax: 1E-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 20 ORS 447, 455, 479, 670, 701. 201 1 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: 'State: I ZIP: B. Fee for branch circuits without purchase r 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 orfeeder not included): ❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2 ❑ Service over 320 amps - rating of 1 &2 ❑ Hazardous location Each signor 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 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lightingplan ❑ 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 Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $ 3 . TTT 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: 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 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 n 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 I I Vacuum Systems 401 amps to 600 amps - $160.60 2 601 amps to 1000 amps $240.60 2 1 1 Other Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 . Temporary Services or Feeders Installation, altertion, or r 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 n 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 I I Data Telecommunication Installation without purchase of service or feeder fee. First branch circuit / $46.85 cj/ I-I Fire Alarm Installation L ( Each additional branch circuit $6.65 n HVAC Miscellaneous (Service or feeder not included) 0 Instrumentation Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 - Signal circuit(s) or a limited energy n Intercom and Paging Systems 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 n Per hour $62.50. Nurse Calls In Plant $73.75 n Outdoor Landscape Lighting Fees: / , ' Z S n Protective Signaling Enter total of above fees $ (p /�/, / I Other 8% State Surcharge $ / `) 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 $ .47' Fees: 0 Trust Account # Enter total of above fees $ 8% State Surcharge $ Total Balance Due $ is \dsts \forms\elc - fees.doc 10/09/00 • q/ DO CITY,OF TIGARD Electrical Permit Application Plan Chedr# 13125 SW HALL BLVD. Redd By Date Recd T {GARD OR 97223 Print of T Date to P.E. Phone (503) 6394171, x304 Date to DST . Inspection (503) 639 - 4175 Incomplete or illegible will not be accepted Permit # Fax (503) 598 =1960 Called 1. Job Address: 4. Complete Fee Schedule Below: 4/0 �j Number of Inspections per permit allowed Name of Development E' / ? 7 !� Service included: Items Cost Total + Name (or name of business) Jbe f "/V50 -ek.s Residential _per unit Address /// �O f '71 4-1-- 1000 sq. R or less • 5147.15 4 City /State/Zip TZG "21 q""7-7- 3 Each portion iti X 00 sq. ft. or 533.40 1 , Residential Limited Energy $75.00 Commercial ❑ Each Manufd Home or Modular • Dwelling Service or Feeder 590.90 2 • 2a. Contractor installation only: 41,, services or Feeders (Prior to permit issuance, applicants must provide contractor license Installation, alteration, or relocation Information for COT data b J - 200 amps or less 580.30 2 Electrical Contractor t �sr am 1/1/1/1). E r; 201 amps 10 400 amps $106.85 2 Address /3/50 Cii4cx4-m9F 11, Ver2 h z i 401 amps to 600 amps 5160.60 2 City e No. ✓ c.i fsf State !7,247, , vZip . 97e2 4 -S 601 amps to 1000 amps 5240.60 2 Over 1000 amps or volts 5454.65 2 Phone No. 5 y 1 76 7 Reconnect only 5 66 . 85 2 Job No. 4c. Temporary Services or Feeders Elec. Cont. Lice. No. .Q (o -/1750 c- Exp.Date /0 -CI- ° n Installation, alteration, or relocation OR State CCB Reg. No. 140 ss/ Exp.Date / -9G0 - 200 amps or less 566.85 2 / COT Business Tax or Metro No. Exp.Date 201 amps to 400 amps 5100.30 2 401 amps to 600 amps 5133.75 2 Signature of Supr. ©ec'n ?a,?rt<-1----, Over 600 amps to 1000 volts, see "b" above. License No. 4�.. s .Date /0 -c / -0 / 4d. Branch Circuits Phone No. Sit 3 4'98 - 7 *,7a New, alteration or extension per panel a) The fee for branch circuits with purchase of service or 2b. For owner installations: feeder fee. 56.65 2 Each branch circuit Print Owner's Name b) The fee for branch circuits Address without purchase of service • - or feeder fee. 17/6 g City State �P First branch 546.85 Phone No. Each additional branch circuit 56.65 4e. Miscellaneous The installation is being made on property I own which is not (Service or feeder not Included) -;+ , intended for sale, lease or rent. Each pump or irrigation dude 553.40 ••• Each sign or outline lighting 553.40 Owner's Signature Signal circuit(s) or a limited energy panel, alteration or extension 575.00 _ 3. Plan Review section (if required):* Minor Labels (10) 5125.00 4f. Each additional Inspection over Please check appropriate item and enter fee in section 5B. the allowable in any of the above 4 or more residential units in one structure Per inspection 562.50 $62.50 • • Service and feeder 225 amps or more In Plant Per hour $62.50 System over 600 volts nominal Classified area or structure containing special occupancy as 5.. Fees: . described in N.EC. Chapter 5 5a. Enter total of above fees $ ---� - 8% Surcharge (.08 X total fees) * Submit 2 sets of plans with application where any of the above apply. Subtotal $ Not required for temporary construction services. 5b. Enter 25% of line 5a for NOTICE Plan Review if required (Sec. 3) $ �---- Subtotal $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OR IF CONSTRUCTION OR ❑ Trust Account # O / _� WORK I5 SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS Total balance Due $ l � AT ANY TIME AFTER WORK IS COMMENCED. iAdststfonnsletectric rer.doc - 8/00 1 00(2 (1216 II AO .LLID 0061 9 6S COS YVd Z6 =90 IIH.L 00 /TZ /60 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested ( U -- / AM PM BLD Location // -I 7, Suite MEC Contact Person Ph 57Z - 5 O PLM Contractor Ph SWR BUILDING Tenant/Owner C 44,---/fry G 6/1/4 ELC fi�'� U -5T3 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 =PO 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 .ART FAIL .ELECTRICAI Service Rough In UG /Slab Low Voltage Fire Alar li�� #o •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 einspection RE: [ nable to inspect no access • ADA Approach /Sidewalk Date ` Q ,0 Inspector / I X Other - Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.