Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00189
DEVELOPMENT SERVICES DATE ISSUED: 4/11/01
��' „�I 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2 S 114AB -02900
SITE ADDRESS: 16405 SW 93RD AVE
SUBDIVISION: KNEELAND ESTATES ZONING: R -4.5
BLOCK: LOT : 016 JURISDICTION: TIG
Project Description: Installation of one branch circuit for new a/c unit. Job No. 7840.
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 IN
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:
CAPPELLI, CHERYL J BOONES FERRY ELECTRIC INC
16405 SW 93RD • PO BOX 628
TIGARD, OR 97224 WILSONVILLE, OR 97070 •
Phone: Phone:
682 -4936
Reg #: SUP 3170S
LIC 88482
ELE 3 -223C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 4/11/01 $46.85 2720010000( Elect'I Final
5PCT CTR 4/11/01 $3.75 2720010000(
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 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 ruls•ad bythe.Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtaiw pies of these rules o� irect questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE / 1 ISSUED BY: , � ' I
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:
d
LICENSE NO: / 70 S
Call 639 - 4175 by 7:00pm for an inspection the next business day
r ' Electrical Permit Application
Date received: 94A/ Permit no.: & ice/ -iv/ g9
+4N� l . t I IA '
L ,..��_ City of Tigard Project/appl.no.: Expire date:
itynjTigard Address: 13125 SW Hall Blvd, Tigard, OR 9722
Date issued: By Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
-4 I & 2 family dwelling or accessory O Commercial/industrial ❑ Multi- family O Tenant improvement 1
O New construction ❑ Addition/alteration/replacement O Other: ❑ Partial
• . `" JOB SITE INFORMATION • .
Job address: / 6 0 S $ W 9 3 r 4 f) v • Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: ISubdivision:
Project name: Co, pp el i i I Description and location of work on premises: I cr k. t. •('o,/, AC vo) `1
Estimated date of completion/inspection:
- :` .. -. CONTRACTOR APPLICATION: ` -• ' ' :. FEE SCHEDULE
Job no: 7 $ O Fee Max
Business name: Boones Ferry Electric Description Qty. (ea.) Total no. Insp
Address: P , Q . Box 628 New residential - single or multi - family per
dwelling unit Includes attadned garage.
City: Wilsonville IStateOR IZIP: 97070 Service included:
Phone:6 8 L t 4 9 3 6 I Fax6 8 2- 7 9 4 g E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.:. R pi 411 7 I Elec. bus. lie. no:' _ 92.1r Limited energy, residential 2
Ci ,� etro lic. no.: 51 Limited energy, non- residential 2
iii%. 1— 1 1. 1 Each manufactured home or modular dwelling
:flat re of supervising elec ' an (required) Date Service and/or feeder 2
Sup. le t. name (print): JAN Herron License no:317 0 S Services or feeders– Installation,
alteration or relocation:
- . • PROPERTY OWNER ` 200 amps or less 2
Name (print): C her}, I Cap 6� ,p '-// i 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 571 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: 'Fax: I E -mail: Reconnect only )
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 ins tatlat ion,alteration,orretocation: •
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps . 2
Owner's signature: Date: 401 to 600 amps 2
-?'• ENGINEER Branch circuits - new, alteration,
Name:
or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: - ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: / t}6;85 2
Phone: Fax: E -mail: Each additional branch circuit:
••PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial O Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1 &2 0 Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension" 2
O Building over three stories 0 Feeders, 400 amps or more 'Description:
0 Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan 0 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
I Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ 9 6 . 8 S
sa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
.t card number: / / within 180 days after it has been State surcharge (8%) .... $ 3 . 7 5
Expires accepted as complete. TOTAL $ S o , 6 6
Name of cardholder as shown on credit card
$
. [ Cardholder signature Amount 440-4615 (61170 /COM)
si l'v';r' y`.';q ?,nrk•4^ ''i� 4: - •;./.4 kf:: `Y- : ■•• ' ''''4,i1.0011,0,0, '' � • . .
•
Elect ,... ::::F.::
ic al Permit 'Fee .Limited Ener Fe es:
Complete Fee Schedule Below: TYPE OF WORK INVOLVE RESIDENTIAL ONLY
ors 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. R or less $145.15 4
❑ Audio and Stereo Systems
Each additional 500 sq. tt or
•
portion thereof $33.40 1
Limited Energy $75.00 ❑ Burglar Alarm
Each Manuf'd Home or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener*
Services or Feeders ❑ 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 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" t above. n Audio and Stereo Systems
Branch Circui
New, alteration or extension per panel ❑ Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee. •
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee. .
First branch circuit 1 $46.85 .
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous
(Service or feeder not included) ❑
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging System
Signal circuit(s) or a limited energy .
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control`
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling -
Enter total of above fees $ ❑ Other
•
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review' section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $ .
Enter total of above fees • $
0 Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts \forms\elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST •
; • ° 24 -Hour Inspection Line: 639 -4175 • Business Line: 639 -4171
BUP
- i X Date. Requested /r AM PM BLD
Location /(9 c 3 Suite MEC
Contact Person Ph &g �'i`C3 %7 PLM
Contractor `j �y �h (c%' 3 ? - 6 2 3 SWR
BUILDING Tenant/Owner - 62f,/g7
Retaining Wall 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 4
Fire Alarm
Susp'd Ceiling
Roof � v
Misc:
Final
• PASS PART FAIL
PLUMBING; e e . ':.
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 • •
PAT FAIL
� e - rvice_
Rough In
UG/Slab.
Low Voltage
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 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
BUP - Building Permit ELC - Electrical Permit
I i Inspection Description Date Passed By Inspection Description Date Passed ! By
Footing /S;i`t ack Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing
� 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 4 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
Structural observation Mechanical final
Final inspection
—
PLM - Plumbing Permit
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
Sprinkler underfloor /slab
Catch basin/Manhole SWR - Sewer Permit
Engineered soils I Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
INSPECTION RECORD - BUP PLM SWR, ELC ELR MEC SIT PERMITS
CITY OF TIGARD ELECTRICAL PERMIT
t PERMIT #: ELC2001 -00189
ts;,i.ir 'DEVELOPMENT SERVICES DATE ISSUED: 4/11/01
I
'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: '2S1 i 4AB -02900
SITE ADDRESS: 16405 SW 93RD AVE
SUBDIVISION: KNEELAND ESTATES ZONING: R -4.5
BLOCK: LOT : 016 JURISDICTION: TIG
Project Description: Installation of one branch circuit for new a/c unit. Job No. 7840.
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:
CAPPELLI, CHERYL J BOONES FERRY ELECTRIC INC
16405 SW 93RD PO BOX 628
TIGARD, OR 97224 WILSONVILLE, OR 97070
Phone: Phone:
682 -4936
Reg #: SUP 3170S
LIC 88482
ELE 3 -223C
I ii
FEES Required Inspections ir
Type By Date Amount Receipt Wall Cover
PRMT CTR 4/11/01 $46.85 2720010000( Elect'l Final
5PCT CTR 4/11/01 $3.75 2720010000(
Total $50.60
' ii i'
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 ruler 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 o irect questions to OUNC at (503)
246 -1987. /
i
PERMITTEE'S SIGNATURE ;r "A ISSUED BY: )
OWNER INSTALLATION ON
(.
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
0
CONTRACTOR INSTALLATION ONLY ftrit
SIGNATURE OF SUPR. ELEC'N: . Ali `,e4 v-y
ck. DATE:
d
LICENSE NO: / 70 5
4
Call 639 -4175 by 7:00pm for an inspection the next business day