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Permit
CITY OF TIGARD ELECTRICAL PERMIT • PERMIT #: ELC2000 -00631 L ,I,� DEVELOPMENT SERVICES DATE ISSUED: 11/15/00 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135DC - 02500 SITE ADDRESS: 11775 SW 91ST AVE SUBDIVISION: ZONING: R - BLOCK: LOT : JURISDICTION: TIG Project Description: Installation of one (1) 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: JOHNSTON, MARIE OWNER 11775 SW 91ST TIGARD, OR 97223 Phone: Phone: Reg #: FEES Required Inspections Type By Date Amount Receipt Elect'l Service PRMT CTR 11/15/00 $46.85 2720000000( Elect'l Final SPOT CTR 11/15/00 $3.75 2720000000( EXPIRED Total $50.60 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 SIGNATU' ' ISSUED BY: - •- • 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: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day ° . .• Electrical Permit Application 41,,. Date received: // // Q Permit no.: �fe Zpa — i t i 06 / ,,., ,I City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receiptno.: Phone: (503) 639 -4171 . Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: . , i ; , 1 €; TYPE OF PERMIT _❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family 0 Tenant improvement ❑ New construction n Addition/alteration /replacement 0 Other: ❑ Partial • JOB SITE INFORMATION • • Job address: //925 ,54 9/ /9j/rr Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: '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: Description Qty. (ea.) Total. no. insp New residential - single or multi- family per Address: dwelling unit. Includes attached garage. City: I State: I ZIP: Service included: Phone: I Fax: • I E -mail: 1000 sq. ft. or less . 4 Each additional 500 sq. ft. or portion thereof CCB no.: I Elec. bus. 11C. no: Limited energy, residential 2 City /metro lie. no.: 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 orfeeders - installation, alteration or relocation: - . - - - PROPERTY OWNER • -- - 200 amps or less 2 Name (print) w S _g IA H -2/ LC _ 201 amps to 400 amps 2 �+ 401 amps to 600 amps • 2 Mailing address: // 7 ? 5 . Lr .S „ 7/ 41 601 amps to 1000 amps 2 City: T yct d I State:Or I ZIP: 9) Z z 3 Over 1000 amps or volts 2 Phondb 3 9' - e is 7 3 I Fax: I E -mail: Reconnect only • I Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, ease, rent, o e i ange accord'ng to installation, alteration, or relocation: 200 amps or less 2 ORS 447, 455, 4 ° ° 0, 701.. % =/, " �,i+_ _ �, , ,/^ ^ 20 amps o 400 amps 2 Owner's signatur-. , 4 01/r � ANF / 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 ❑ Health -care facility Each pump or irrigation circle 2 ❑ Service over 320 amps- rating of 1&2 O Hazardous location Each signor outline lighting 2 family dwellings O 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: ❑ 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 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 $ yl . � .5 0 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 %) .... $ 3. 25 Expires TOTAL $ _—(5 . to D accepted as complete. Name of cardholder as shown on credit card �� Cardholder signature $ Amount Ei�s E® 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 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 n Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 Vacuum Systems 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 o r r Feeders Installation, alteration, relocation TYPE OF WORK INVOLVED - COMMERCIAL ONLY on, r 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. Branch Circuits n 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 2 b) The fee for branch circuits IT Data Telecommunication Installation without purchase of service or feeder fee. !� ` Fire Alarm Installation First branch circuit / $46.85 / trp . Z✓ Each additional branch circuit $6.65 HVAC Miscellaneous (Service or feeder not included) n Instrumentation Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 • n Intercom and Paging Systems Signal circuit(s) or a limited energy panel, alteration or extension $75.00 Minor Labels (10) $125.00 n Landscape Irrigation Control Each additional inspection over n Medical the allowable in any of the above Per inspection $62.50 n Per hour $62.50 Nurse Calls In Plant $73.75 n Outdoor. Landscape Lighting . Fees: u �yC n Protective Signaling Enter total of above fees $ u6 , P. 8% State Surcharge $ 3 , / �7 � n Other • Number of Systems 25% Plan Review Fee See "Plan Review" section on $ front of application. * No licenses are required. Licenses are required for all other installations Total Balance Due $ ©, 4, ® Fees: El Trust Account # Enter total of above fees $ 8% State Surcharge $ , Total Balance Due $ • is \dsts \forms \elc- fees.doc 10/09/00 • CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-1-144-inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested //-2-e AM PM BLD Location // 2 7; 5 w 9 /s I /A? Suite MEC Contact Person / r/' Ph 4 y3 "3 PLM Contractor O cJ &fere— Ph SWR BUILDING Tenant/Owner ELC , o e' (rte 3 / Retaining Wall ELR Footing Access: 11 �� / Foundation � 71: �k 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 Smoke Dampers Final PASS PART FAIL (LECTRICA> EXPIRED ED Rough In UG /Slab Low Voltage Fire Alarm AS 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 Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date 1/ r)?--c9 (917 Inspector � , Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.