Permit CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00157
A ja DEV W H PMENq r SO R9 SERVICES (503) 639 -4171 DATE ISSUED: 3/20/01
PARCEL: 2S114AA -00300
SITE ADDRESS: 16295 SW 85TH AVE
SUBDIVISION: ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of one branch circuit.
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: 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:
BIRKEMEIER, BRENT T + K T ELECTRIC INC
JANET D, TRUSTEES P.O. BOX 7365
10573 SW NAEVE ST BEND, OR 97701
TIGARD, OR 97224
Phone: Phone: 541- 382 -0882
Reg #: ELE 9 -247C
SUP 4784S
LIC 145488
FEES Required Inspections
Type By Date Amount Receipt
Ceiling Cover
PRMT CTR 3/20/01 $46.85 2720010000( Wall Cover
5PCT CTR 3/20/01 $3.75 2720010000( Elect'l Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty Codes and all other applicable laves.
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 ISSUED BY:
4
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: ,, 1A'�"� 7 �— DATE: 3-Z' -Gt'
LICENSE NO: y `7t;`t r'
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Date received:3 /� / / Permit no.:�2� 2/ Dd /t 7
t ,.. ''I , City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: j::)
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory
)Ef Commercial/industrial ❑ Multi family ❑Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 2 5 S..) 35`*'‘ j4 \j E. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: Al 1 - 7 3 - L - . I Description and location of work on premises: / 8Ki4.ch C4(4441- 4J 0 t .1 alai. wvr f-
Estimated date of completion/inspection:
('ONTRA('TOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: / 1:7; ebdx, s ,Tt/• • Description Qty. (ea.) Total no. insp
New residential - single or multi- family per
Address: Re Z y- 73o 3 " dwelling unit Includes attached garage.
City:1?6,9 I Stater. I ZIP: q770 Service included:
Phone] W ' - GIpGc. I Fax0/.369- o' E -mail a4kAt, t o ,.eN press 4
Each additional 500 sq. ft. or portion thereof
CCB no.: i 4$9.bc.g I Elec. bus. lic. no:9 a4.-7 (p . Limited energy, residential 2
City/ etro lic. .. Limited energy, non- residential 2
r 3 -/ ! - b / Each manufactured home or modular dwelling
ignature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): , f /1! rf.„s.-' License no:47# f S. 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:
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 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):
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 ❑ 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 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or 1W park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan ❑ Other. Per inspection I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other p
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ t�S
❑ Visa O MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / within 180 days after it has been State surcharge (8%) .... $ 3. - 7 - S
Expires accepted as complete. TOTAL $ -..5:?) . (o O
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440 -4615 (6I00/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 sl, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 El Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 El Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Door Opener
Dwelling Service or Feeder • $90.90 2 El
Services or Feeders 0 Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 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
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 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
Each additional branch circuit $6.65
Miscellaneous 0 Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 I I 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
Medical
Each additional inspection over
the allowable in any of the above Ti Nurse Calls
Per inspection $62.50
Per hour $62.50 ❑
In Plant $73.75 Outdoor Landscape Lighting
Fees: Ell Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
* No licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
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
• ELECTRICAL PERMIT__
CITY TIGARD PERMIT #: ELC2001 -00157
" , DEVELOPMENT SERVICES DATE ISSUED: 3/20/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S114AA 00300
SITE ADDRESS: 16295 SW 85TH AVE
SUBDIVISION: ZONING: I -
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of one branch circuit.
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: 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:
BIRKEMEIER, BRENT T + K T ELECTRIC INC
JANET D, TRUSTEES P.O. BOX 7365
10573 SW NAEVE ST BEND, OR 97701
TIGARD, OR 97224
Phone: Phone: 541 - 382 -0882
Reg #: ELE 9 -247C
SUP 4784S
C
LIC 145488
FEES Required Inspections 1/
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 3/20/01 $46.85 2720010000( Wall Cover
5PCT CTR 3/20/01 $3.75 2720010000( Elect'l Final
Total $50.60
•
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 accoriance 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 ISSUED BY: 4,5:z.,
O
8
WNER 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:
"
DATE: 3` zr� — !x�
LICENSE NO: ?
Call 639 -4175 by 7:00pm for an inspection the next business day
BUP = Building Permit ELC - Electrical Permit
1/ Inspection Description Date Passed By 4 Inspection Description Date Passed By
_ Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service >/�
Crawl drain Electrical final ./ yam/ pZ (�'�,�dr
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing I Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry/Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
Drywall nailing Inspection Description Date Passed By
Suspended ceiling
Post/beam mechanical
Gas line
Engineered soils Mechanical rough -in
Welding Lab Final
Concrete Lab Final Fire damper
Duct work
Bolting Lab Final Smoke detector
Fireproofing Lab Final
Mechanical final
Structural observation
Final inspection
PLM - Plumbing Permit
4 Inspection Description Date Passed By
BUP - Fire Protection System Permit Plumbing underslab
Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final _ Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
I Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
I Sprinkler underfloor /slab
Catch basin/Manhole SWR - Sewer Permit
Engineered soils J Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR MEC SIT PERMITS
• .
.~ ♦ t 1
PR52 � I Cl
0 -4-16r-
Site Name: Durham
Site #: PR52
Address: 16295 SW 85th Avenue
Portland, OR
Pots Line:
Emergency Power Contact:
Special Notes:
Directions: I -5 south from Portland. Exit at South Lake Oswego
exit.
Proceed west on Bridgeport Road to SW Upper Boones Ferry Road and
turn right
(north). Proceed north to SW Durham Road and turn left (west). Pro
ceed west
to SW 85th and turn left (south). Tower and building of the Cable
TV facility
are visible one block south on the right.
Page 1
CITY OF TIGARD BUILDING INSPECTION DIVISION
g4 -Ho 4 r Inspection Line: 639 -4175 Business Line: 639 -4171 MST
// BUP
Date Requested Y' - Zj AM PM BLD
Location f ( i t ff 5 GJ kS ut Suite MEC
Contact Person Ph SW Of 94 L PLM
Contractor Ph SWR
BUILDING Tenant/Owner .oa ELC ZeO / "U "
Retaining Wall YpiGG/ /( / y 4J• /M , 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
Roof
Misc: ✓
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 a
Smoke Dampers
Final
PASS RT FAIL ,
'LEC�ICA
ervice
Rough In •
UG /Slab
Low Voltage
Fire Alarm
PASS ,ART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. 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 - . Inspector
Other Date p !' l /' //L f Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.