Permit A CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC99 -0168
^ , l l„ 0/i � DEVELOPMENT SERVICES DATE ISSUED: 03/24/99 97223 (503)
PARCEL: 2S102BA- 03100
SITE ADDRESS...:12045 SW 95TH AVE
SUBDIVISION •DUBLIN PARK ZONING:R -25 PD
BLOCK • LOT •001 JURISDICTION: TIG
Project Description : Residential electrical alteration
- -- 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 • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 - 400 amp : 0 lst W/O SRVC OR FDR.: 1 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
MARIA ROJAS type amount by date recpt
12045 SW 95TH AVE PRMT $ 35.00 B 03/24/99 99- 313947
TIGARD OR 97223 5PCT $ 1.75 B 03/24/99 99- 313947
Phone #:
Contractor:
ALLWAYS ELECTRICAL 9 36.75 TOTAL
6032 SE BREWSTER PL
REQUIRED INSPECTIONS
MILWAUKIE OR 97267 Rough -in Elect'l Final
Phone #: 513 -6614 Elect'l Service
Reg #..: 004903
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 cork will be done in accordance with approved plans. This permit vill expire if work is not started within 188
days of issuance, or if work is suspended for more than 188 days. ATTENTION: Oregon law requires you to follov the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952401 -0010 through OAR 952 -801 -1987. You say obtain a copy
of these rules or direct qu by ling (583)246 -1987. ,�, n '!
Permittee Signat Issued By: - On j/6t4►l_
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 INST TION ONLY
SIGNATURE OF SUPR. ELEC DATE: X 3- c V 9
LICENSE NO'
tttttttttttttttttt+ ttttttttrtt+++tt+++ t++++++++ r +t + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CA11 629 by 7100 p.m. far an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CJTY OF TIGARD Electrical Permit Application Plan Check#
13125 SW HALL BLVD. Rec'd By g. t
TIGARD OR 97223 Date Rec'd - 3 '44' `1�
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type /
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # (= l-L°I� QI Lr?1S
Fax (503) 684 -7297 Called
1. Job Address: V\ AX Complete Fee Schedule Below:
�/`
Name of Development 1' AX t a RD JGIs Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum
Address / 29 : 3 5 /C/, , ..5 -- -- /]�L�' a 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip 174or' 0 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 u r= t li •e ses) 4b. Services or Feeders
/ Installation, alteration, or relocation
Electrical �� - 200 amps or less $60.00 2
Address / • r - i I '/-- 201 amps to 400 amps $80.00
City 'A State D Zip 4 401 amps to 600 amps $120.00 2
Phone No. - 7111'..._51 - 3 - - 44 / 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. --22 C Exp.Date - Reconnect only $50.00 2
OR State CCB Reg. No. ' ?- Exp.Date r 4c. Temporary Services or Feeders
COT Business Tax or Metro No. E .Date t - 1 Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Su • . - - ' _ , _ _ ..e 201 am to 400 am $75.00 2
401 amps to 600 amps $100.00 2
-4------- Over 600 amps to 1000 volts,
License No. 2. Exp.Date it r-) - 99 see "b" above.
Phone No. r 3-- 6 - [ _7 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 circ $5.00 2 -
City State Zip b) The fee for branch circuits
tY p without purchase of ,
Phone No. service or feeder fee. -
First branch circuit / $35.00 ' 'S - 2
The installation is being made on property I own which is not Each additional branch circuit $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: e
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ 3 / 7
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 7
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # S __'3 (�,
Total balance Due
1: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
�J $ 'd�7 1Os q( et P/L- BUP
Date Requested � '� / AM X PM ' :W BLD
Location I2O'S 'S' 1 - Suite MEC
Contact Person Y O✓ vu Ph (12o - o i c PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC g9'616A
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 • _ / . _ . 1 _ '
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
P ASS PART FAIL
C LECTRIM i
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Fi
S 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 7J ?1 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.