Permit CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00595
DEVELOPMENT SERVICES DATE ISSUED: 10/19/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 112BC -02400
SITE ADDRESS: 14690 SW 84TH CT
SUBDIVISION: HAMBACH PARK ZONING: R -4.5
BLOCK: LOT : 008 JURISDICTION: TIG
Project Description: Replace existing damaged panel and hot tub.
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: 1 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:
HOGENKAMP, KENNETH DEAN, SR ALL ELECTRICAL SERVICE
AND RUTH ANN PO BOX 68712
14690 SW 84TH COURT OAK GROVE, OR 97268 -0712
TIGARD, OR 97223
Phone: Phone: 626 -6831 •
Reg #: SUP 4313S
LIC 124045
ELE 26 -963C
•
FEES Required Inspections •
Type By Date Amount Receipt
Elect'l Service •
PRMT CTR 10/19/00 $86.95 2720000000( Elect'l Final
5PCT CTR 10/19/00 $6.96 2720000000(
Total $93.91
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. I
PERMITTEE'S SIGNATURE o`', 7 / ISSUED BY:
_
, OWN • - I TALLATION 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 7:00pm for an inspection the next business day
Electrical Permit Application
Date received: /0// Vero Permit no.: Ete ZOO'QS9
�, -,
_,,j.:.14 City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
\c) & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 016 9 (' S W D L-f c7r Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision: { 1 '– b
Project name: Description and location of work on premises: j' / p , .: • N / #
IN date of completion/inspection: A ,, ' « c
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: I �7 r O d�l�, Description Qty. (ea.) Total no. insp
��� P� ,` J C� New residential- sin g te ormulti- family per
Address: r , 0 o r n 7 / °. dwelling unit Includes attached garage.
City: 6 S t ate: �+ ZIP: q 7 �� Service included:
y. po � f�A ,� � I a
Phone: 4(9, 4,A011 Fax. I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: t p 0Z./ Elec. bus. lic. no: 3 Limited energy, residential 2
City /metro lic. no.: Limited energy, non- residential 2
J� > 7
q�x Each manufactured home or modular dwelling
i�A.! Serviceand/orfeeder 2
Signature of supervising '�ctrician . uired) Date
Sup. elect. name (print): a , / License no: Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less M 2
Name (print): 1 < A f j/ fl :N 4 m f ,201 amps to 400 amps 2
��- ` 401 amps to 600 amps • 2
Mailing address: )y.6 CI 0 Z t J 'Pk 71A., � d ' 601 amps to 1000 amps 2
City: 774-7,4- k? 1J7 I State: OR I ZIP: 9 729 Over 1000 amps or volts 2
Phone: / 2 O + 7,. q t}I Fax: 1E-mail: l 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
ORS 447, 455, 479, 670, 701. 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 1 2
City: '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):
O Service over 225 amps - commercial O Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1&2 U 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
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other: Per inspection
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ c t (G 9
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8 %) $ Q ' 9
Ex accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 (6100/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 Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less ' $145.15 4 ❑ A udio and Stereo Systems
. Each additional 500 sq. ft. or •
portion thereof $33.40 1 0 Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular 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 a), 10 2 ❑ t
- 201 amps to 400 amps $106.85 2 V S
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
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. - . .
El
Branch Circuits " 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 4.1, 2 • '
b) The fee for branch circuits n Data Telecommunication Installation
without purchase of service .
or feeder fee. ❑ • Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit - $6.65
HVAC
Miscellaneous •
(Service or feeder not included) I 1 Instrumentation
Each pump or irrigation circle $53.40 .
Each sign or outline lighting $53.40. ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy . - •
panel, alteration or extension $75.00 f '�' I
Minor Labels (10) $125.00 I I . Landscape Irrigation Control
Each additional inspection over Medical
the allowable in any of the above . .
. . Per inspection $62.50 111 Per hour • $62.50 Nurse Calls
•
' In Plant $73.75 ❑
/ Outdoor Landscape Lighting*
Fees: • q
�( /, Y 5 P rot ective Signaling
Enter total of above fees. • $ V`-t'
n 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 •. .$ • Fees: -
El Trust Account # Enter total of above fees .$
• 8% State Surcharge $
. Total Balance Due $
•
i:\dsts \forms \elc- fees.doc 10 /09/00 • . .
•
CITYrOF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested • /0_ 30 AM PM BLD
Location / 1.(6 O 5(49 f `f Suite _ MEC
Contact Person Ph 5 " -Sfj `'-) PLM
Contractor Ph C 200 71 / SWR
BUILDING Tenant/Owner ELC AID-a 7
_ 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 — 4c_efrie,e4/
Fire Alarm 771/,,61
Susp'd Ceiling / (/ '
Roof
Misc:
Final R ��
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab c ' 3 ®� 0'0
Top Out
Water Service l..
Sanitary Sewer
Rain Drains •
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
r'�F TRIGgL�
ennce
Rough b b �
i t
UG/Slab ( �l
Low Voltage
Fire
F - - -
PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain • [ ] Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date /t - 36-0 0 Inspector 4_An Q � Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
•
24 Hour Inspection,Line: 639 -4175 Business Line: 63 171
BUP
Date Requestedp — AM PM BLD
Location / 5 w y Suite MEC
Contact Person Ph f &O / PLM
Contractor Ph SWR _ 3 _
BUILDING Tenant/Owner ELC 2Gu '- GO 39
Retaining Wall ELR
Footing Access -
F Dration ain u % ctv�-4 _ 24 , FPS
F tg Dr 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
Misc: A Final _/ D D Nl P ht l 1 / • /31`1
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
CELECTRICA )
Service /
Rough In f' 4. >-
UG /Slab
Low Voltage
Fire Alarm
Final
PASS 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 reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date /19,Z3 — o a Inspector E xt
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.