Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00293
,,, 1 , DEVELOPMENT SERVICES DATE ISSUED: 5/26/2004
�^ � �� JI I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 25111 AA -02300
SITE ADDRESS: 14415 SW 86TH AVE
SUBDIVISION: GREENSWARD PARK ZONING: R -4.5
BLOCK: LOT : 015 JURISDICTION: TIG
Project Description: Installation of subpanel for hot tub & outdoor fountain.
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/ FOR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 2 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:
DEHN, STEPHEN L CHEROKEE ELECTRIC CO
14415 SW 86TH AVE PO BOX 230230
TIGARD, OR 97224 TIGARD, OR 97281
Phone: Phone: 638 - 1515
Reg #: L1C 35681
SUP 2616S
FEES ELE 3 -127C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/26/2004 $93.60
[TAX] 8% State Surcharge 5/26/2004 $7.49 Rough -
Elect'l Service
Total $101.09 Elect'l Final
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
suspend mor t 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility otification Center. Those
rules set forth in OAR 2- 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of th r or direct qu tions to OUNC at (503)
246 699 or 1 -800- 332 -23 . \
-
Issu d By: /i/ / Permit Signature: u
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or re .
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
Q/
LICENSE NO: /65
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Applicat
Date received: Permit no.: &C � yP 3
. _
1
-v, " l City of Tigard Project/appl. no.: Expire date:
City 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
c)1,1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: i `i (-t 15 i W S3 (G T'' 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: tt. MA 5-,t b -- I)acte( c / 7i4
Estimated date of completion/inspection: i C ,,t. - 1 .— wau4n./4....
CONTRACTOR APPLICATION FEE SCHEDULE f
Job no: Fee Max
Business name: C k eiiD L CC 1- \ ec t`(( L, 'Tot:. Description Qty. (ea.) Total no. insp
New residential - single or multi- family per
Address: P(] I,P/4 j( 2, h 027) 0 dwelling unit. Includes attached garage.
City: A i & % tfc5 I State: D I ZIP: C(17/ g 1 Service included:
Phone: 4 Z S- N 1-{ 5 V I Fax: a (&07I0 I E-mail: 1000 sq. ft. or less 4
CCB n • • 7 ,1 1 5U6 1 I Elec. bus. lie. no: 3 - (Li (°j Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City � troio.: /-(003 Limited energy non- residential 2
e"... _ X S - LAD- 0t4 Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
rint 5 S ` Li cense no: 261 Services or feeders elect. name (p ): i.y c_r^/ t E alteration or relocation:
PROPERTY OWNER 200 amps or less / 50:30 2
Name (print): ) fi-e4t, P G Y 1 VI 201 amps to 400 amps 2
Mailing address: t vi Lire) 6 tri (p 401 amps to 600 amps 2
601 amps to 1000 amps 2
T 1 A
Cit ad � I State: 0 Ad 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, 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 . — t, .0 13 3.. 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2
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
LI 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 LI 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/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
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ �f 3 60
❑ 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 %) $ f ?.- 1 1 q
/
Name of cardholder as shown on credit card Expires accepted as complete. TOTAL $ / c7�. 9
•
$
Cardholder signature Amount 440 -4615 (6100/COM)
r ---- • _ .
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 n 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
Services or Feeders IT Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 Ti 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 Ti 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 HVAC
Each additional branch circuit $6.65
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 Ti Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited ener gy
panel, alteration or extension $75.00 Landscape Irrigation Control
Minor Labels (10) $125.00 Ti
Medical
Each additional inspection over
the allowable in any of the above Calls
Per inspection $62.50 _
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: E Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ _ Number of Systems
25% Plan Review F ee 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
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested /� AM PM BUP
Location -ST . / = ) - Suite MEC
Contact Person l /" e Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 4' O'OV 3
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof /
Other:
Final
PASS PART FAIL ij
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
L
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Finale Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
`CRASS )ART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ^t ) I nspec t or 'v 3� Ext
Other:
Final DO NOT REMOVE this inspection r ord from the job site.
PASS PART FAIL