Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00216
� Al l� ..
DEVELOPMENT P ITigard, � ) 639 -4171 DATE ISSUED: 05/02/2000
13125 SW
PARCEL: 2S112CC -04600
SITE ADDRESS: 15830 SW 80TH AVE
SUBDIVISION: BOND PARK NO. 3 ZONING: R -12
BLOCK: LOT : 074 JURISDICTION: TIG
Project Description: Residential electical alteration
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: 1 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:
CAROL ZIELINSKI (GARY) COOPER ELECTRIC
15830 SW 80TH AVE 11845 SE 34TH ST
TIGARD, OR 97223 MILWAUKIE, OR 97222
Phone: Phone: 653 -8803
Reg #: SUP 2965S
LIC 00042918
ELE 3-191C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT BON 05/02/200C $42.85 0001840 Elect'I Final
5PCT BON 05/02/200C $3.42 0001840
Total $46.27 ORIGINAL
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 l lo(kodevi L ISSUED BY:
KAMA,'
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: /mil r CG2/V• DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
08/01'89 MUN lib: 4U P PU3 ba iabLJ 4111 ur 11J:u\U
CITY OF TIGARED Plan Check*
- '13126 SW i HALL BLVD. Electrical Permit Application Recd By
TEGAE1t® OR 97223 RECEIVED Date Recd - z -
Phone (503) 839.4171, x304 Date to P.E.
inspection (503) 639 -4175 MAY 2 2000 Date to DST
Print of Type Permit l# - 0zl(u
Fax (503) 598.1960 COMMlifilifY IDEv,Eippgmlete or illegible will not be accepted Called
1. Job Address: 1 4. Complete Fee Schedule Below:
Name of Development 1 • Number of Inspection per permit allowed
Name (or name of business) CaJ2oL Z- /eL i9V.5Ki Service Included: Items Cost Sum 4
Address /5 Sc/-- gO ?F 2 4a. Residential • per unit
City/State/Zip , 7_ ' _ __. �%Ft . 9 7 2- 2 `J - 1000 eq. ft, or ism 5 117.75 4
�-� ej Each additional 500 sq. ft. or
portion thereof 5 28105 i
Commercial ❑ Residential Limited Energy S 90.00
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 passe). .. Installation, ettaration, or relocation
Electrical Contractor Gp % - 200 amps or lose S 64.25 2
Address //,- r 4 •yL C -. �i , sr/ (�� 201 amps to 400 amps S 85.50 2
Y� �� p ' '7,Z� � 401 amps to 1 00 amp $ 128.50 2
City i,LNJI[ o / l State Zl 601 amps to 1000 amps $ 102.30 2
Phone N0. " - �� 1� / / Over 1000 amps or volts $ 363,76 2
Job No. Reconnect only $ 63.60 2
Elec, Cont. Lice. No.,./- /WC. Exp.Date !D/ / /O 4c. Temporary Services or Feeders
OR State CCB Reg. NO. 9/ Exp.Date '7 7 D/ Installation, alteration, or relocation
COT Business Tax or Metro No, ewe •339 Exp. D ; -- - / -D/ 200 amps or less 5 53.50 2
2 01 amps to 400 amps 3 80.25 2
Signature of Supt. Elea'n - 401 amps to 600 amps $ 107.00 2
//�� / Over 800 amps to 1000 volts,
License No. dJ Exp, Date / / / / / see "b" above;
Phone No, �3 - /� 4d Branch Circuits
New, atteration,or extension per panel
a) The fee for branch circuits
2b. For owner Installations: with purchase or sa ace or
feeder fee.
Print Owner's Name Each branch circuit $ 6.36 2
fi) The fee for branch afciiits
Address without purchase of service
City . State Zip or feeder lea
Phone No. • First branch dreuii 5 37,50 ,.'-'47 ✓ "
Each additional branch circuit / $ 5.35 ..
The installation is being made on property I own which is not 4o. MUrceilarraoua
intended for sale, lease or rent. (Servioo or feeder not included)
Each pump or irrigation circle _ $ 42.75
Owner's Signature • Each sign or outline lighting $ 42.75
Signal ciroult(s) or a limited energy
n If required):* panel, e leratton or extension $ 80.00
3. Plan Review section i Minor Labels (10) 3 107.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional Inspection over
4 or more residential units In one structure the allowable In any of the above
Service and feeder 225 amps or more Per inspection $ 57.00
Per hour $ 50.00
System over 800 volts nominal in Plant $ 50.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees: g •
Enter total of above fees $ •
* Submit 2 sets of plans with application where any of the above apply. Itb Surcharge (.25TX total fees) $ • z
Not required for temporary construction services. Subtotal ✓t
Ob. Enter 25% of line ea for
NOTI 2 Plan Review If aw'(gg, {Sec. 3) S
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED StrbtOta! $
MI
IS NOt COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD.OF 180 DAYS ❑ Trust Account*
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due if/6'
i:\dsis\forms\clectric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested (.012-0/00 AM PM BLD
Location 19% b Suite / MEC 7�cr —Z90
Contact Person fal,t� --r Ph S 1 p - & —9 1 / 7 PLM
Contractor te90p Ph Cp53-28`O3 SWR
BUILDING Tenant/Owner ELC 7J -- 'CDZ J (p
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain �� Jl.'Y 11/ �
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
•
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation r"
Drywall Nailing C 2 t )tI)
Fire wall 1j4 Lr e"—E9
Fire Sprinkler � � i` L
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
FAIL
ECHANICAL,)
Pos & 6eam
Rough In
Gas Line
Smoke Dampers
Final
S PART FAIL
RICd�L
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
t11i
'ASS 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 rei ∎ spection RE: nable to inspect - no access
Fire Supply Line
ADA -
Approach /Sidewalk
Other Date ?.J - Ins Ext
• Final
PASS PART FAIL D • NOT REMOVE this inspection record from the job site.