Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00155
6-" _ DEVELOPMENT SERVICES DATE ISSUED: 4/6/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4eR PARCEL: 2S102A6 00917
SITE ADDRESS: 12120 SW 92ND AVE ON
Y
SUBDIVISION: KIMBERLY ADDITION "1 L ZONING: R -7
BLOCK: OT 0
17 JURISDICTION: TIG
Project Description: Installation of one 200 amp service or feeder. Job No. 7789.
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:. 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:
STRUB, NORBERT G III + DEBORAH ATLAS ELECTRICAL CONTRACTORS
12120 SW 92ND AVE 4403 SE ROETHE RD
TIGARD, OR 97223 MILWAUKIE, OR 97267
Phone: Phone: 659 - 2212
Reg #: SUP 2581S
LIC 00001532
ELE 3 -
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT DEB 4/6/00 $64.25 0001220 Elect'I Final
5PCT DEB 4/6/00 $5.14 0001220
Total $69.39
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.
PERMITTEE'S SIGNATURE ISSUED B .
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: -p DATE:
LICENSE NO: ° J /
Call 639 -4175 by 7 :00pm for an inspection the next business day
CITY OF TIGARD Plan Che -------- Electrical Permit APPEeppD Recd B
13125 SW HALL BLVD.
TTGARD OR 97223 Date Recd 110 - D
APR 6 2000 Date to P.E.
Phone (503) 639 -4171, x304 Date to DST ----'
Inspection (503) 639 -4175 Print of TAMMUNITY DEVELOPME' Permit # ___40A, _ ___
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted P Called
• 1. Job Address: 4. Complete Fee Schedule Below:
Name of Development of Inspections per permit allowed
Name (or name of business) Norbert Strub' S ervice included: Items Cost Sum
Address 12120 SW 92nd 4a. Residential - per unit
City/State/Zip Tigard, Oregon 97223 1000 sq. ft. or less $ 117.75 4
ty p Each additional 500 sq. ft. or
portion thereof $ 26.75 1
Commercial ❑ Residential ® Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor Iicen §��/ 4b. Services or Feeders
information for COT data base). �� o Installation, alteration, or relocation
Electrical Contractor Atlas Electrical Contrar,tnrs 200 amps or less 1 $ 64.25 $64.75 2
Address 4403 SE Roethe Road 201 amps to 400 amps $ 85.50 2
Ci Miiwaukie State OR zip 97267 401 amps to 600 amps $ 128.50 2
ty p 601 amps to 1000 amps $ 192.50 _ 2
Phone No. 659 -2212 Over 1000 amps or volts $ 363.75 2
Job No. 7789 Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 3-2C Exp.Date 10/1/00 4c. Temporary Services or Feeders
OR State CCB Reg. No. 1532 Exp.Date 9/3/01 Installation, alteration, or relocation
COT Business Tax or Metro No 2432 Exp.Date 11 /1 /00 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Su r. Elec'n 401 amps to 600 amps $ 100.00 2
g p Over 600 amps to 1000 volts, •
25815 see "b" above. .
License No. Exp.Date
Phone No. 659 -2212 4d. Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous •
intended for sale, lease or rent. (Service or feeder not included)
' Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
(if required):* panL alteration or extension $ 60.00
3. Plan Review section
Minor Labels (10) $ 100.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Per inspection $ 50.00
Service and feeder 225 amps or more
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
5a. Enter total of above fees $ 64.25
* Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ 5.14
Not required for temporary construction services. Subtotal $ 69.39
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 69.39
is \fists \forms \electric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Date Requested 1 / 3 /()() , AM PM BLD
Location 1 ( 2.6 51)1,6t, Suite MEC
Contact Person ../N «t,v Ph 4 5 y - "ZO / / 2 PLM
Contractor Ph SWR
BUILDING ., Tenant/Owner ELC — OD J S S
Retaining Wall ELR •
Footing Access:
Foundation / FPS
Ftg Drain ;"7 ./✓ - fry -- 2.kt s--' 9/ 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
I LECTRIg
Service
Rough In °
UG /Slab
Low Voltage
Fire Alarm
SS PART 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 Date Inspector / Ext
Other
Final
PASS PART FAIL DO NO REMOVE this inspection record from the job site.