Permit A ... CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00528
\ DEVELOPMENT SERVICES DATE ISSUED: 9/5/00
A` 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 25111 CB -01714
SITE ADDRESS: 15215 SW 100TH AVE
SUBDIVISION: HOOD VIEW ZONING: R -3.5
BLOCK: LOT : 013 JURISDICTION: TIG
Project Description: Installation of one branch circuit for furnace
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:
ROGER LONDBERG OWNER
15215 SW 100TH AVE
TIGARD, OR 97224
Phone: 670 -7053 Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT CTR 9/5/00 $46.85 2720000000( Elect'l Final
5PCT CTR 9/5/00 $3.75 2720000000(
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 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 • - - les or direct questions to OUNC at (503)
246 -1987. /
PERMITTEE'S SIGNATURE /(----- ISSUED BY: k • �� • 41;
OWNER INSTALLATION ONLY
The installation is being made on pr erty I own w ich is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: k DATE:
I` °rr Z-
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application plan Check#
13125 SW HALL BLVD. Recd By
T ;3R 97223 Date Recd
Phone (503) 639 -4171, x304 Print of Type Date to P.E.
Date to DST
Inspection (503) 639 - 4175 Incomplete or illegible will not be accepted Permit # AJ_t/ iZ
Fax (503) 598 -1960 Called
1. Job Address: a 4. Complete Fee Schedule Below:
++ Number of Inspections per permit allowed
Name of Development old /..r9 h d get
Name (or name of business) __' Service included: Items Cost Total
Address /6 /, - 5 c /00 (3- 4a. Residential - per unit
1000 sq. ft. or less $147.15 4
/
City/State /Zip 7 t{all� . c < 70-247 Each additional 500 sq. ft. or
J / Q portion thereof $33.40 1
F IT Commercial ❑ Residential Limited Energy $75.00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 . 2
2a. Contractor installation only:
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation
200 amps or less $80.30 2
Electrical Contractor 201 amps to 400 amps $106.85 2
Address 401 amps to 600 amps $160.60 2
City State Zip 601 amps to 1000 amps $240.60 2
Phone No. Over 1000 amps or volts $454.65 2
Job No. Reconnect only $66.85 2
Elec. Cont. Lice. No. Exp.Date 4c. Temporary Services or Feeders
OR State CCB Reg. No. Exp.Date
Installation, alteration, l or relocation
9 p 200 amps or less $66.85 2
COT Business Tax or Metro No. Exp.Date 201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2
Signature of Supr. Elec'n Over 600 amps to 1000 volts,
see "b" above.
License No. Exp.Date 4d. Branch Circuits
Phone No. New, alteration or extension per panel
a) The fee for branch circuits
ons: fee der fee.
purchase of service or
2b. For owner installations:
l/ / Each branch circuit $6.65 2
Print Owners Name e,-er- (SON �!� e/ b) The fee for branch circuits
Address LS 2 /S S, ea /, /(Y) ? without purchase of service _
City "T! q ✓ State 40'i Zip G} 7 2 2 y or feeder fee. / f,/ g
First branch circuit / $46.85 4 ,
Phone No. 5'3) 70 - 70 ? Each additional branch circuit $6.65
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent.
(Service or feeder not inducted)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40
Owners Signature Signal circuit(s) or a limited energy
panel, alteration or extension $75.00
3. Plan Review section (if required):* Minor Labels (10) $125.00
item and enter fee in section 5B. the Each additional inspection over
Please check appropriate the allowable in any of the above
4 or more residential units in one structure Per inspection $62.50
Service and feeder 225 amps or more Per hour $62.50
System over 600 volts nominal In Plant $73.75
Classified area or structure containing special occupancy as 5. Fees: / l
, I
described in N.E.C. Chapter 5 5a. Enter total of above fees $ tP
* Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ 7 5
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
Subtotal $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR ❑ Trust Account #
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS 0
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ b0
is \dsts \forms \electric rev.doc - 8/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / � 2/ AM PM BLD
Location l S 2 -1> .S C,✓ / (i J Suite 3a
Contact Person Ph .) / / 1/ PLM
Contractor Ph SWR
.
BUILDING Tenant/Owner 1 0 . 0°526
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
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
P T FAIL
M
Post & Beam
.uirn,uu
Smoke Dampers
FAIL
ICAL
Service
Rough In
UG /Slab
Low Voltage
Fire m
SS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk l D V ,\
Other Date (1 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.