Permit A • ' CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2002 -00311
i o ,
1. DEVELOPMENT SERVICES DATE ISSUED: 7/11/02
13125 SW Hall Blvd.. Tigard, OR 97223 ( 639 -4171
PARCEL: 1 S136CB -02700
SITE ADDRESS: 11070 SW 82ND AVE
SUBDIVISION: RANCH VALLEY ZONING: R -4.5
BLOCK: LOT : 008 JURISDICTION: TIG
Project Description: Install 200a service, NC and garage plugs.
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: 3 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:
VAUGHN, MARVIN WESLEY + BETTY CHEROKEE ELECTRIC CO
11070 SW 82ND PO BOX 230230
TIGARD, OR 97223 TIGARD, OR 97281
Phone: Phone: 638 -1515
Reg #: LIC 35681
SUP 2616S
ELE 3 -127C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 7/11/02 $100.25 2720020000( Wall Cover
Elect'I Service
5PCT CTR 7/11/02 $8.02 2720020000( Elect'l Final
Total $108.27
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 .6699 or 1 -800- 332 -2344. fl •
Permit Signature: ! , , " / `}yi „ n , n Issued By: ��.Le__
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• c' j DATE:
LICENSE NO: c / to 5
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
1 R Date received: 7 _ / _ Permit no.: b7CafJUa 113 /
_.:71I'�.'���! City of Tigard A EC E I / "D Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Ti d, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171 11
Fax: (503) 598 -1960 9 2002 Case file no.: Payment type:
Land use approval:
�I <a �is
21 �LD I E\I "r D J ` i rG
TYPE OF PERMIT
yi 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction Jra- Addition/alteration/replacement ❑ Other: ❑ Partial
' JOB SITE INFORMATION -
Job address: /10 70 50 'F"2 . Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: I Description and location of work on premises: Cecil sp 5 k :e, A/G. v- 9Qvre p( .
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FCE SCIIEDLILE
Job no: Fee Max
Business name: Che.roV.e -'e E(�ec.'hr Description Qty. (ea) Total no. insp
New residential - single or multi- family per
Address: f'. 0, B&'c 0 dwelling unit. Includes attached garage.
City: Ti5 a '/Tt I State: Or I ZIP: 9'7/ Service included:
Phone: ggs ej 36 `/ I Fax: g- 8235-1 E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft or portion thereof
CCB no.: 3 ti, vol 3 — / Z. . �
O Elec. bus. lic. no: c— Limited energy, residential 2
City /metro lic. O.: 260 3 Limited energy, non- residential 2
`
,/1/0 Z Each manufactured home or modular dwelling
-.La
Signature of supervising electrician (required) Date Service and/or feeder 2
License no: 2_6 ( $ Services or feeders — installation,
Sup. elect. name (print): i oA) E, SC r'r ' vN e it
alteration or relocation:
PROPERTY OWNER 200 amps or less / 50.30 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 Lown Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am, 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 3 19, ?5 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 0 Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1 &2 0 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,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O 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:
0 Eg,essllghtingplan 0 Other. Per inspection
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 $ / O&, 2.S
O Visa CI MasterCard expires if a permit is not obtained Plan review (at _ %) $
credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ aF, 0 Z
Exp1G8 accepted as complete. TOTAL $ /0 O 8'r � 7
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00/COM)
I
Electrical Permit Fees: Limited Energy Fees: *
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
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 e
- portion thereof • - $33.40 • 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular El Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System"
Installation, alteration, or relocation
200 amps or less $80.30 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 ❑ 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, ❑
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 IT 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
Each additional branch circuit $6.65 III HVAC
Miscellaneous ❑ 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 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting*
Fees: ❑ Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ 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 $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts \forms\elc - fees.doc 10/09/00 •
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: ,(503) 639 -4175
INSPECTION DIVISION Business Line: (503 639 -4171 MST
�'� BUP
Received Date Requested 74 AM PM BUP
Location / / 7 g a 4 Suite MEC
• __Contact Person Ph ( ) "8s - / q 3( ' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
a— 6La-3/1
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
p LL , Dc� �4�
Post & Beam
Shear ea Anchors
Sh ear r R Gi 1.41A.
Ext Sheath/Shear � �
Int Sheath/Shear /
Framing
Insulation � '%>P yw (`.0
Drywall Nailing �\J V
Firewall 4Q\ fn \ \^ \f) J
Fire Sprinkler 1 � ,
Fire Alarm 1 *() 11
Susp'd Ceiling II
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
PASS PART FAIL •
ELECTRICAL
• S —
UG /S a•
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
<FPA�S PART FAIL
SI� TE 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA /
Approach/Sidewalk
Date 8 - �- " c 2- - Inspe ,_ ' Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
•