Permit A CITY OF T ELECTRICAL PERMIT
� DEVELOPMENT SERVICES DATE I ISSUED: C98-0720
/08/98
PARCEL: 1S135DB -04100
SITE ADDRESS...:11330 SW 92ND AVE
SUBDIVISION.... :DOGWOOD RIDGE ZONING:R -4.5
BLOCK. LOT .............:014 JURISDICTION: TIG
Project Description: Installation of a 200 AMP service.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS ° 0 0 - 200 amp ° 0 PUMP /IRRIGATION ° 0
EACH ADD'L 500SF...: 0 201 - 400 amp.......: 0 SIGN /OUT LINE LTG..: 0
LIMITED 'ENERGY ° 0 401 - 600 amp 0 • SIGNAL /PANEL ° 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS - - - - -• -- -ADD'L INSPECTIONS - --
. 0 - 200 amp . 1 W /SERVICE OR FEEDER: 0 PER INSPECTION.....: 0
201 - 400 amp......: 0 1st W/0 SRVC OR FDR.: 0 PER HOUR ° 0
401 - 600 amp 0 EA ADD'L BRNCH CIRC: 0 IN PLANT...........: 0
601 - 1000,amp.....: 0 PLAN REVIEW SECTION
1000+ amp /volt ° 0 > =4 RES UNITS........: ) 600 VOLT NOMINAL..:
Reconnect only 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: -- FEES
. JOSEPH H BUI type amount by date recpt
11330 SW 92ND PRMT $ 60.00 GEO 12/08/98 98- 311378
TIGARD OR 97223 5PCT $ 3.00 GEO 12/08/98 98- 311378
Phone #:
Contractor:
ALFA ELECTRIC $ 63.00 TOTAL
13365 SW BARLOW RD
REQUIRED INSPECTIONS ---
BEAVERTON OR 97008 Rough -in Elect'l Final
Phone #: 626 -0325 Elect'1 Service
Reg #..: 121141
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 sore than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 -001 -1987. You may obtain a copy .
of these rules or direct questions to OUNC by sr ling (503)246-1987. ---
Permittee Signature: L j Issued By- I '
OWNER INSTALLATION ONLY
The installation is being made an property I own which is not intended for
sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTR; -TOR I STALLATION ONLY -• - --
SIGNATURE OF SUPR. ELEC'N: • A A �i DATE: /0
• LICENSE NO: 5 O —
+ +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+ +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
•
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
Date Rec'd
TIGARD OR 97223
Date to P.E.
Phone (503) 639 -4171, x304 Print or Type Date to DST
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit# b S - 67ad
�
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development _goo A ',re Cp! /P,'a.., Number of Inspections per permit allowed
Name (or name of business) � - (i / Service included: Items Cost Sum
I
Address / / ?3e 56) 471f`1 �/ !'9/ 4a. Residential - per unit
9F---O'9___ 1000 sq. ft. or less $110.00 4
City /State /Zip / Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial ❑ Residential
Li mited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all c rrent licenses) 4b. Services or Feeders
Electrical Contractor a . - ,a II. ' , Installation, alteration, or relocation
200 amps or less $60.00 6
..4.._. o
2
Address e"/ 4GcY ir 201 amps to 400 amps $80.00 2
City - r State Oie Zip ,...-,`' 401 amps to 600 amps $120.00 _ 2
Phone No. - 62 6 -n ? S 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. _ ?L f -I.1 ?C Exp.Date 4U2
OR State CCB Reg. No. /2/14' Exp.Date R1 / 9 /Gt) 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
ac,/,--,,i,„.---------- 200 amps or less $50.00 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 00 2
Over 600 amps to 1000 volts,
License No. J/3 2c7p Exp.Date /a/G /4/ see "b" above.
Phone No. 626 h --n-32 S
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: j _ �_
Not required for temporary construction services. 5a. Enter total of above fees $ Ce
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $ .------
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
,•
(�
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96
CITY-OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 �` 7
/ BUP
/72.1 Date Requested / c -1()Ii AM PM BLD
Location /1330 ?QA) ?c Suite MEC
Contact Person - 1 Ph quo - 19 3 ? PLM
Contractor Ph /OWL. SWR
BUILDING Tenant/Owner dap c f7 7,
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: _ SGN
� uLy
Slab ���� ,,,, / L A � � � - � ,y� SIT
Post & Beam
Ext Sheath/Shear Ow /Q.12, Cali. . L L 1 GV (/La
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler ��✓I:'
Fire Alarm
Susp'd Ceiling
Roof /i 6
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 v.
ELECTRICAL -
eMce
UG7S1a
Low Voltage
F - larm
'ASS 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
Other Date / 2_/ 7 1 3 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.