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Permit
CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2001 -00028 1' DEVELOPMENT r o SERVICES (503) 639 -4171 CES DATE ISSUED: 01/17/2001 r 13125 SW Hall PARCEL: 2S112BC -00700 SITE ADDRESS: 14980 SW 81ST AVE SUBDIVISION: DURHAM ACRES ZONING: R -4.5 BLOCK: LOT : 045 JURISDICTION: TIG Project Description: 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: 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: CRISMAN, ALLEN BRUCE CHEROKEE ELECTRIC CO 14940 SW 81ST AVE STE 1504 PO BOX 230230 TIGARD, OR 97224 TIGARD, OR 97281 • Phone: Phone: 638 -1515 Reg #: LIC 00035681 SUP 2616 -S ELE 3 -127C FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT CTR 01/17/2001 $80.30 2720010000( Elect'I Final 5PCT ' CTR 01/17/2001 $6.42 2720010000( • Total $86,72 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 44 G- (Mkt ISSUED BY: OWNER INSTALLATION ONLY The installation is being ma.- o' 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 7:00pm for an inspection the next business day a A. Electrical Permit Application Date received: 1 7 1 pv Permit no.: ,2 0 / - 00O ,..1 I City of Tigard Project/appl. no.: Expire date: Ciry of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 ' Case file no.: Payment type: • Land use approval: • TYPE OF PERMIT 0 I & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi- family ❑ Tenant improvement . ❑ New construction ❑ Addition/alteration /replacement 0 Other: 0 Partial • JOB SITE INFORMATION Job address: [1-(� g � (,() f ` Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: Hit I Subdivision: Project name: I Description and location of work on premises: • Estimated date of completion/inspection: CONTRACTOR APPLICATION .. • • FEE SCHEDULE • Job no: Fee Max Business name: kt✓bVV -.LC (i(,c,trai Description Qty. (ea.) Total no. insp New residential - single or multi - family per Address: ' ' 0 49) 0 x 2:j 0 Z- O dwellingunit. Includes attached garage. City: ' i t (ArrC I State: OR I ZIP: 41 241 Service included: Phone: 5o - q 61- (p Cl I Fax: I E -mail: 1000 sq. ft. or less 4 � ,1Z CCB no.: • (p I Elec. bus. lic. no: '�( / Each additional 500 sq. ft. or portion thereof Limited ener gy, residential 2 City /metro lic. no.: 2.- (e 03 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): 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: 601 amps to 1000 amps 2 City: I State: I ZIP: 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 for sale, lease, rent, or exchange according to installation, alteration, or relocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 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 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): ❑ 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 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 ❑ 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 ' I 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 %) $ • 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: 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 4, Check Type of Work Involved: Residential - per unit 1000 sq. ft. or less $145.15 4 ❑ 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 S ervices or Feeders n Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less t $80.30 Q' 27 © 2 n 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 n 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, n see "b" above. Audio and Stereo Systems Branch Circuits n Boiler Controls New, alteration or extension per panel 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 n Each additional branch circuit $6.65 HVAC Miscellaneous n Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 n Intercom and Paging Systems Each sign or outline lighting $53.40 Signal circuit(s) or a limited energy panel, alteration or extension $75.00 0 Landscape Irrigation Control • Minor Labels (10) $125.00' Each additional inspection over n Medical the allowable in any of the above n Nurse Calls Per inspection $62.50 Per hour $62.50 � In Plant $73.75 I I Outdoor Landscape Lighting Fees: n Protective Signaling Enter total of above fees $ 1) n Other 8% State Surcharge $ le. 'f 2_ 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 s4 7 2 Enter total of above fees $ El Trust Account # 8% State Surcharge $ Total Balance Due $ i:\dsts\forms \elc- fees.doc 10/09/00 • ciTY..O� TIGARD Electrical Permit Application Plan Check# 13125 SW HALL BLVD. Recd By TIGARD OR 97223 Date Recd Date to P.E. Phone (503) 639 -4171, x304 Date to DST Inspection (503) 639 -4175 Print of Type Permit # Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections per permit allowed Name (or name of business) a ea,cb e_ C..el Service included: Items Cost Sum sl' r Address .J x 1(51 �'O S9ui � 4a. Residential - per unit 1000 sq. ft. or less $ 117.75 4 City /State /Zip i ea a. Each additional 500 sq. ft. or portion thereof $ 26.75 1 Commercial ❑ Residential ip Limited Energy $ 60.00 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 base). Installation, alteration, or relocation Electrical Contractor C.k•emok EQ•t_e.. 'it_ 200 amps or less / $ 64.25 6 Y. zs 2 Address P.9, CtSr»e 2.302_3 201 amps to 400 amps $ 85.50 2 401 amps to 600 amps $ 128.50 2 City - rs'oate4 State e9r Zip C17,2.'Sd 601 amps to 1000 amps $ 192.50 2 Phone No So3- 93 `F- t ? ?/ Over 1000 amps or volts $ 363.75 2 Job No. Reconnect only $ 53.50 2 Elec. Cont. Lice. No. 3 -1 z? t'.. Exp.Date Leh/o0 4c. Temporary Services or Feeders OR State CCB Reg. No. 3.sL T l Exp.Date W/7 tO 7- Installation, alteration, or relocation COT Business Tax or Metro No. 2,03 Exp.Date 1 `9 0 IoZ 200 amps or less $ 53.50 2 Q 4. 201 amps to 400 amps $ 80.25 2 Signature of Supr. Elec'n ,Xrt -- -1.. 401 amps to amps to amps $ 100.00 2 volts, License No. Z6/6 Exp.Date /v / / see "b" above. Phone. No. S07 - `73 9- 699/ 4d. Branch Circuits New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or feeder fee. Print Owner's Name Each branch circuit $ 5.35 2 Address b) The fee for branch circuits without purchase of service City State Zip or feeder fee. Phone No. First branch circuit $ 37.50 Each additional branch circuit $ 5.35 The installation is being made on property I own which is not 4e. Miscellaneous - intended for sale, lease or rent. (Service or feeder not included) Each pump or irrigation circle $ 42.75 Owner's Signature Each sign or outline lighting $ 42.75 Signal circuit(s) or a limited energy 3. Plan Review section (if required):* panel, alteration or extension $ 60.00 Minor Labels bels (10) $ 100.00 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 Per inspection $ 50.00 Service and feeder 225 amps or more Per hour $ 50.00 System over 600 volts nominal In Plant $ 59.00 Classified area or structure containing special occupancy as described in N.E.C. Chapter 5 5. Fees: 5a. Enter total of above fees $ * Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ Not required for temporary construction services. Subtotal $ 5b. Enter 25% of line 5a for NOTICE Plan Review if required (Sec. 3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ 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 $ is \fists \forms \electric.doc CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 - 31 0 BUP Date Requested AM PM BLD Location / i� JO fit.) 4'f Suite MEC Contact Person �� W //Zh 93.19f/ 6 PLM Contractor C�.tkl Ph SWR BUILDING • Tenant/Owner ELC ON — 069Z-T‹ ' 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 r Misc Misc: _ YI/ � 1 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 ICAL ice Rough In UG /Slab Low Voltage Fir : -. rm PASS 'ART FAIL Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before n= spection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk (9 1 _ / ?' -0 � �, /. other Date Inspector s _ ∎ / Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.