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Permit
° CITY OF ' T I G A R D ELECTRICAL PERMIT Alt° PERMIT #: ELC2002 -00381 DEVELOPMENT SERVICES DATE ISSUED: 8/9/02 A I -- i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 25111 CA -14200 SITE ADDRESS: 15025 SW 98TH AVE SUBDIVISION: ALDERBROOK FARM ZONING: R -3.5 BLOCK: LOT : 008 JURISDICTION: TIG Proiect Description: (13) BRANCH CIRCUITS FOR KITCHEN REMODEL. JOB NO. 21060 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: 12 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: ONNIS, DORIS A/ROBERTO ROSE CITY ELECTRIC CO INC 15025 SW 98TH AVE 4012 NE CULLY BLVD TIGARD, OR 97223 PORTLAND, OR 97213 Phone: Phone: Reg #: 20P-617S LIC 3567 ELE 26 -113C FEES Required Inspections Type By Date Amount Receipt Rough -in PRMT CTR 8/8/02 $126.65 2720020000( Elect'I Final 5PCT CTR 8/8/02 $10.14 2720020000( Total $136.79 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 thee egon\ity Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these r fps or direct questions to OUNC at (503) 246 -6699 or 1-800-332-2344. Permit Signature: !d-,�` -� Iss ed By: / , / • _ _.././ , 7 4 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: 1 1 "D - DATE: LICENSE NO: of 7 `J Call 639 -4175 by 7:00pm for an inspection the next business day V 'Electrical Permit � plication ,.. • .. . • v IC d gage. - eived: 4, �Od�• Permit no.: AAP, - CD.3S1 ,,, . ,� 1_ 1 1 , ' Ci ty of Tigard Project/appl. no.: d City ofTigard Address: 131 - • - . Blv • , Tigard, OR /927,,223 2 2OO /Da te i ssued: S : �)�) Receipt no.:...... . Phone: (5K) c) 639 -4171 Fax: (503) 5''- • •: CITY UI- TIGAF asefileno.: Payment type: PLANNING/ENGINEERING - Land use approval: L P . TYPE OF PERMIT 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement 0 New construction XAddition/alteration/replacement 0 Other. 0 Partial JOB SITE INFORMATION - Job address: • .1 Bldg. no.: Suite no.: Tax map /tax lot/account no.: I_,ot: Block: Subdivisio • !' Project name: 0 h n 1 S Description and location of work on premises: <— R G r , Estimated date of comple u s n/inspectio : CONTRACTOR APPLICATION - FEE SCHEDULE Job no: 0 I Fee Max Business name: ROSE (TTY • F,T .F ('TR T C CO T N C Description Qty. (ea.) Total no. insp Address: 4012 NE CULLY BLVD New re g uniL a ncludede e°rm s aaach� g attached City: PORTLAN State: OR 1 ZU'7213 serv r age. multi-family i D Ph5i@3 287 616 4 I ae 3 282 1 311aii: 1000 sq. ft or less 4 CCB no.: 3567 i Elec. bus. lic. no: 26 113C Each additional 500 sq. ft or portion thereof Limited energy, residential 2 City /metr 1' n O L y Limited energy, non - residential 2 7 j/ 0 Each manufactured home or modular dwelling Signature f e ing electrician (required) .. Dam Da Service and/or feeder 2 sup Sup. elect name (print): R L Gotham License no: 2127S Services orfeeders — installation, alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): 0 g A 3 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: 1 Q 3,6 S I • , 601 amps to 1000 amps 2 Cis., . ,I I ' G'.�t4 I State ZIP: q 70 Over 1000 amps or volts 2 cOf1 : (0 b' 4)^ 2.19 I Fax: I E -mail: Reconnect only 1 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 llaaon; alteration, orrelocation: 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 a • City: State :. ZIP: B. Fee for branch circuits without purchase / r P � of service or feeder fee, first branch circuit: 1 , � 4 Phone: • Fax E -mail: Each additional branch circuit: �A/��j jli PLAN REVIEW (Please check all that apply) Mlsc .(Service or feeder not included): • ❑ Service over 225 amps - ommercial . ; 0 Health -care facility Each pump or irrigation circle 2 - O Service over 320 amps- rating of 18z2 0 Hazardous location Each sign or outline lighting 2 • family dwellings _ 0 Building over 10,000 square feet four or Signal circuits) or a limited energy panel, , . , 0 System over 600 volts nominal more residential units in one structure alteration, or extensions 2 O Building over three stories _ 0 Feeders, 400 amps or more =Description: O Occupant load over 99 persons 0 Manufactured structures or RV panic Each additional inspection over the allowable in any of the above: - O Egress/lightingplan O Other. Per inspection I = I I • I " Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other - Not all juris ctions accept dt pt cre cards, please call jurisdiction for more information. , Notice: This permit application Permit fee $ I ! 1 0 Visa 0 MasterCard - expires if a permit is not obtained Plan review (at _ %) $ ' Credit card Bomber: / / within 180 days after it has been State surcharge (8%) $ ©� Name of cardholder as shown on credit card S accepted as complete. TOTAL $ /1___,../'1 7 v, Cardholder signature Amount / 440.4615 ( • :Ele Permit Fees: - Limited Energy Fees: ,,, TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Co mplete 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 ❑ Audio and Stereo Systems Each additional 500 sq. ft. or ❑ . portion thereof - $33.40 1 Burglar Alarm Limited Energy - $75.00 • Each Manufd Home or Modular Door Opener Dwelling Service or Feeder $90.90 2 Services or Feeders ❑ Heating, Ventilation and Air Conditioning System* '. Installation, alteration, or relocation 200 amps or less $80.30 2 Vacuum Systems 201 amps to 400 amps $106.85 2 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 El Other Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 TYPE OF WORK INVOLVED - COMMERCIAL ONLY Temporary Services or Feeilers 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 Check Type of Work Involved: , 401 amps to 600 amps $133.75 2 Over 600 amps to 1000 volts, El .Audio and Stereo Systems see "b" above. Branch Circuits ❑ Boiler Controls New, alteration,or extension per panel a) The fee for branch circuits El Clock Systems with purchase of service or feeder fee. Each branch circuit . $6.65 2 ❑ Data Telecommunication Installation b) The fee for branch circuits without purchase of service / f ❑ Fire Alarm Installation or feeder fee. / ,/( $ a First branch circuit $46.85 7 ❑ HVAC Each additional branch circuit /,9 $6.65 7? .to " Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems Each sign or outline lighting $53.40 Signal circuit(s) or a limited energy Landscape Irrigation Control panel, alteration or extension $75.00 Minor Labels (10) $125.00 0 Medical Each additional inspection over the allowable in any of the above Calls Per inspection $62.50 Per hour _ • $62.50 � In Plant $73.75 IJ Outdoor Landscape Lighting Fees: , n Pr otective Signaling Enter total of above fees $ . , _ ❑ Other 8% State Surcharge • $ Number of Systems • 25% Pian Review Fee * No licenses are required. Licenses are required for all other installations See "Plan Review" section on $ front of application. Fees: . • Total Balance Due $ Enter total of above fees • $ ❑ Trust Account # • 8% State Surcharge $ Total Balance Due $ i:\dst `.vrms\elc- fees.doc 10/09/00 •. CITY OF TIGARD 24 -Hour BUILDING , • Inspection Line: (503) 639 -4175 ' INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP r� Received Date Requested - < < AM PM BUP ° � -60,3,, 3 Location l 5 a °�' S / � Suite MEC 0 r 60 350. Contact Person Ph ( ) PLM Contractor C-19-f1-41.0 Ph ( ) Z3�- SWR Tena t/ jj (0/1 4\j- // \l � 2a) 2 — 3d / Footing 13 C( -5315" e) ( ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof - Other: _; PART FAIL P I MBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PAS$„ PART FAIL �1 HANICAL- ) Post & Beam Rough -In Gas Line Si oke Dampers ZEW T FAIL ;ELECTRICAL) Service Rough -In UG /Slab Low Voltage Fir- ' larm PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SI 0 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA D 71///03 Inspector Ext Approach/Sidewalk P Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST /7S- BUP Received Date Requested AM PM BUP Location l 5D ' Suite MEC Contact Person Ph ( ) Z3 3 4 1 8V PLM Contractor Ph ( ) ) ' 7 - 401(.4- SWR �? BUILDING Tenant/ g ELC J67 3 v Footing J d- C O p ELC Foundation Access: Ftg Drain " (` 5 , 'j ELR Crawl Drain // �' & Slab Inspection Notes: SIT Post & Beam Shear Anchors a ) EQJ y0 A ■ Ext Sheath/Shear V►' J �l J Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm \A/ I i)65‘,Sf Susp'd Ceiling J �f Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Serv'. e i'ou• - 111I•- UG /Slab Low Voltage Fire Alarm Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. c*S" FAIL SITE ❑ Please call fgrp� inspection RE: El Unable to inspect — no access Fire Supply Line // 44�° ADA Approach/Sidewalk Date � Inspe or /1 �'��'� Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST 1/A / 7 7 1 6 3 BUP Received Date Requested PM BUP • Location / � b a 5 Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) 2 (17 6/6 SWR BUILDING Tenant/Owner 2 3 - 9 S ELC oZ — Dz7 71 Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm PASS PART FAIL Reinspection fee of $ required before next inspection. Pa t Ci all, 13125 SW Hall Blvd. SITE ri Please call for reinspection RE: nable to inspect — no access Fire Supply Line ADA Date / J / 7/0 2/ 7Z3121 Approach/Sidewalk In spector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL