Permit CITY � OF TIGARD
PERMIT #: ELC2002 -00496 ELECTRICAL PERMIT
a'll D EVELOPMENT SERVICES DATE ISSUED: 9/23/02
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
_ PARCEL: 2S112BD -02800
SITE ADDRESS: 14665 SW 79TH AVE
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Reconnect.
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA /SPEC OCC:
Owner: Contractor:
MATRIX DEVELOPMENT OWNER
12755 SW 69TH AVE #100
TIGARD, OR 97223
Phone: 620 -8080 Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Elect'I Final
5PCT CTR 9/23/02 $5.35 2720020000(
PRMT CTR 9/23/02 $66.85 2720020000(
Total $72.20
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
Permit Signature/ Iss ued By: Ad �� G�G('�l�/
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: OWin/C1k. DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
.xI3?1
-. Electrical Permit Application
Datereceivedrt ?3 01 Permit no.0 c ,..../.. _ 00 9&
,,,,,V AL City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: B
Phone: (503) 639 -4171 Y Receipt no.:
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval:
. TYPE OF PERMIT
•
N iz,1 & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi- family 0 Tenant improvement
O New construction 0 Addition/alteration /replacement O Other: O Partial
JOB SITE INFORMATION
Job address: I Lt 6 GS'- cW "7 /Eh Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: ISubdivision:
Project name: 67L lot Y I Description and location of work on premises: ,�'9 (t 0 ,,i n re c t •
Estimated date of completion/inspection: I'`�
' CONTRACTOR' APPLICATION _ : " ' FEE SCHEDULE
Job no: :NI l 0 //; Me0 \ Fee Max
Business name: Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Address: dwelling unit. Includes attached garage.
City: I State: I ZIP: Service included:
Phone: I Fax: I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: I Elec. bus. lic. no:. Limited energy, residential 2
City /metro lic. no.: 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): r I v-_I i pQ d 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 63 Ski 61 lec S'- € 10 0 601 amps to 1000 amps 2
City: eor-k k A.,,, pl I Stater ZIP: 1 — ip s g.: - s 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 or feeders -
which is not intended f ale, lease, rent, or exchange according to installation, alteration,orrelocation:
ORS 447, 455, 479, 6 O 1. 200 amps or less 2
201 amps to 400 amps 2
ii Owner's signatur • - , Parr* Date: a 3 G 401 to 600 amps 2
-`71,:.i..:7 , - • ENG1NrER • . , 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: 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) Mise. (Service orfeeder 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,
0 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:
O Egress/lightingplan 0 Other: Per inspection 1 1 I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ 6'. :L
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application \
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) 35
Expires accepted as complete. TOTAL 70. 1
Name of cardholder as shown on credit card
Cardholder signature Amount 440 -4615 ( OM) .
•
r
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: •
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: 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
Limited Energy $75.00 n Burglar Alarm
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 n 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 n Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n Other
Over 1000 amps or volts $454.65 2
Reconnect only / 85� /alp, �.
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. • n Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n 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
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous ❑
(Service or feeder not included) 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 n Landscape Irrigation Control*
Minor Labels (10) $125.00
Each additional inspection over n Medical
1 the allowable in any of the above
Per inspection $62.50 • n Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees:
n Protective Signaling
Enter total of above fees $ 66 RS n Other
8% State Surcharge $ 5 2, 5 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 $ 7. _ ,)-(y
Enter total of above fees $
❑ Trust Account #
8% State Surcharge $
All New Commercial Buildings require 2 sets of plans.
Total Balance Due $
i:\dsts \forms \elc- fees.doc 08/30/01
CITY OF TIGARD 24 -Hour
• BUILDING - Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7/ PM BUP
Location 9 Suite MEC
Contact Person Ph ( ) 6- — 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 6 ' 1 — 4 9
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ,�' /„ _,, ti p� .4 SIT
Post & Beam ''`�'`'
Shear Anchors �
Ext Sheath/Shear CJ` Be / r4-4" 6 BQ
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
.Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
T FAIL
CTRIC L
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
$I El Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA ' ' 4 ✓� �� C-29)A-----
Approach /Sidewalk Date Inspector Oct
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL