Permit ELECTRICAL PERMIT
CITY
•
PERMIT #: ELC2001 -00454
11( DEVELOPMENT SERVICES DATE ISSUED: 9/11/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102CC -03600
SITE ADDRESS: 13995 SW 102ND AVE
SUBDIVISION: FRELEON HEIGHTS ZONING: R -3.5
BLOCK: LOT : 004 JURISDICTION: TIG
Project Description: Installation of 200 amp service and (2) branch circuits. Job 99.5495
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: 1 W /SERVICE OR FEEDER: 2 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
PECK, ALAN W TICE ELECTRIC
RATHBUN, ELIZABETH A PO BOX 15009
10255 SW MCDONALD ST 2139 SE BELMONT ST
TIGARD, OR 97224 PORTLAND, OR 97293 -5009
Phone: Phone: 233 -8801
Reg #: LIC 166
SUP 2586S
ELE 26 -126C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 9/11/01 $80.15 2720010000( Elect'I Service
Elect'I Final
5PCT CTR 9/11/01 $6.41 2720010000(
Total $86.56
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 of these rules or direct questions to
Permit Signature: 0 f fin% Issued By:
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:
ry) r��- �� -�'�'/ DATE:
LICENSE NO: —286 — 5
Call 639 -4175 by 7:00pm for an inspection the next business day
09/10/2001 13:28 503 -872 -8290 TICE ELECT.SERV.DEPT PAGE 02
10 /10 /oo TUE 09;00 FAX 503'598 1980 CITY OF TIGARD 14002
Electrica '`'e rmitAp lice ' n
T Date =erred: f Penult no.: '/ �// . 5
�,s'lII! City of Tigard ProJect/appi•no.: Bxpiredato:
co, of'Cgard Address: 13125 SW Hall Blvd, Tigard, OR 972 3 Date issued: 1'i Receipt no.:
Race: (303) 539 -4171 r ►
Pl
Fax: (503) 598-1960 - Payment type:
Land use approval;
• I1'1'E OF 114a011'1'• ,
' di & 2 family dwelling or accessory 0 Commercial/ii;dustrial 0 bland family 0 Tenant improvement
• 0 New construction Xl Additionfalterationfreplacement 0 Other: 0 Partial
JOB SITE IN1.OItl1IAJ'ION ' ' '
lob address: • • t • • Bid:. no.: Suite no.: rest tax lot/account ro.:
-. Lot: Block: Subdivision:
Project name: Alan Park Description and location of work on premises: 2UUamp circuit - •garage •OOr
Estimated date of corn a tetion/ins • don: • _ ; _
• (Y)N'I ll A(aV0lt Aki'I.IC, %II(IN ill: SCIlia)U1.L •
•
.lob not 9• a • Pl
-
Business name: - �" ' ion e
N tle • ; n rn -desk esia or auulrtdatally per
Address. 'Pill R - a a • „. - dwei it4111lt. i°dudeistuebedytrne.
City: . w _ .. ZIP: • • a e S 9errlceintiuded:
Phons:5I , :: 1. ax:: -: • 1 Littri 1000 ft, Of 160 4
CCi3 no.: 1 • . Elec bus. lac. no: • - • 13ec additional 500 • . ft or • • on thereof m� = —
Limited energy, residential
City /metro lic. no.: 201 4 • red energy, non•rotidc ztiel _
�' .,. .
9/1 1 (1/01 /n1 .. �manufactured home or modular dwdling ■■
S• tile of isle: €litorteian( - • cited Dais $arvicasad/or 2
• + u F • } - :. • et - Amer I • srs- Installation,
aiteratlon or relocation:
11110'h :it1 I' ()1VIN1.lt - 200 • arlass II. 2
Name (prlfnt): 1.1 a 100 aloes
401 c m 600 emm .: �_
Ma)iio : address: to •:
..... .. ...... (i01 amps to) 000 amps 2
City: State: Over loco Amps or volro 2
Phone: Fax: 5-mall: Reconncetoniy _ 1
Owner Installation: The installation Is being made on property 1 own Temporary so^ioesor feeder! " .. •
which is not irretlded for sale, lease, rent, or exchange according to 'tg i ii 0 n , aber D ° . °erelocat
ORS 447, 455, -479, 670, 701. 200 an,paorleaa 2
3C1 :0100 amps
Owner's Si: awe: ........ _ - -. , Di": - 401 to 600 ern.. 2
• ENGIMilt Oran n -our, tore on,
o► extension per posit
Name: • _ - A. Pce for branch cirouits with parchaaeof II
Address: tervloe or feeder fee. each branch circuit 2
City: State: ?.1P: S. F'se roe • ranch cirai,ita without purchase ■■
Phone; Fax: E Gf m:vice or feeder fie, that branch a�ircuit
lie. add anal bre /what: sit MIIIIIIIIIMMIEMIN _
I'I,AI' It1;v11E'V (YltliNe (Merle all that alWh) lsc. (Service or feeder nottncituled)z
0 S r r e i e s over225 wr m d CI Health-care facility Each •um. orini orlon circle .� 2
Q Service over 320 amps.4atirti of i &11 O Havcdout iuoatloa Bach si • or outline it . Mies 111.1 _ EIMIN
family dwellings in Boi1ding over 14,1'1t0 square Let fouror 8I tI1Circuit alof5limited ff
0 Sys le m over 600 volts naming' more rwldcadal units is ono structure alien/don, or suasion* -_ - 1 2 — i
O Build in5 over Wee storlos ❑ Feeders, 400 amp( or more •Desctipdoa:,._- - I
0 O.:cup.nr load ovcr 99 parsec 0 Metwtscru:4d structures w RV park 1• 2441tIvnrd i,r ov.r Lisa aliawahls It say of the *bums ,
+Egre.Nltghdngplan 0 Other. , Yerinspection I 1 I I
Submit _ seta of plans with any of the above, . Invent • eclat! fee • The above are not applicable to temporary conatnac4on genies. Other -
rNot 4:1 Jurisdiaiona strap( emu; card•. p•zc call Iwi.d'scii•• for mo•.larormsdoa.' Notice: This penult application Permit fee $ Rn 1 5
C:1 visa c 3 MasterCard expires if a pengit Is riot obtained Plan review (at _ %) S
Ctrdi cud number: kr ` ,- within ISO days after it has bean Suite surcharge (896:) • - -- S x...4'1
p ° L
accepted :is complete. , TOTAL . $ - 8G . iG
— erne • •• • ew oa c ar ; Trust Acct
a • MA • - e tnuturo Amwnt - %Iv 440.4615 (e ThIVO/c.)
•
09/10/2001 13:28 503 - 872 -8290 TICE ELECT.SERV.DEPT PAGE 03
Tic E lect : Address OWNER Page 2
Tic B lectric Co. 13995 SW 102nd Alan Peck
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
----- Number 'of Inspections per permit allowed (FOR ALL SYSTEMS)
Service Included: Items Cost Total y
Check Type of Work Involved:
Residential - per unit
1000 sq. ft, or less • $145.15 4 - ❑ Audio and Stereo Systems
Each additional 500 so. ft or
portion thereof $33.40 1 I I Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑
°welling 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 fens 1 $ 80 2 n 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 Other
Over 1000 amps or volts $454.85 -- .. * 2 - - - - --
Reconnect only $66.85 2
Temporary Services or Feeders •
TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation
200 amps or less $66.85 2 Fee for each system $75.00
201 amps 10 amps $100.30 • 2 (SEE OAR 918- 260 -260) 1
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Cheek Type of Work involved:
•
see "b" above_
Branch Circuits [] Audio and Stereo Systems
New, alteration or extension per panel ❑
a) The fee for branch circuits Boller Controls
with purchase of service or
feeder fee. ri Clock Systems .
• Each branch circuit 2 - $6.65 13.30 2
b) The fee for branch circuits ❑ Data Telecommunication Installation
without purchase of service
or feeder fee. ❑ Fire Alaml Installation
First branch circuit $46.85 '
Each additional branch circuit $8.85 I HVAC
Miscellaneous
(Service or feeder not included) I I Instrumentation
Each pump or irrigatlon circle $53.40
Each sign or atitllne Lighting $53.40 _ ri Intercom and Paging Systems
Signal circuits) or a limited energy
. panel, alteration or extension $75.00
Minor Labels (10) 5125,00 ❑ Landscape Irrigation Control'
Each additional inspection over ❑ Medical
the allowable in any of the above •
Per inspection 562.50
Per hour $82.50 Q Nurse Calls -
•
in Plant $73.75 . ❑
Outdoor Landscape Lighting"
Fees: r
Protective Signaling
Enter total of above fees $ 8Q _ 1 5
Other
8% State Surcharge $ 6.41
Number of Systems
25% Plan Review Foe
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ 86.56 Fees:
Enter total of above fees $ •-••.
0 Trust Account # 26 -126C
ts
8•/. State Surcharge $ .
Total Balance Due $
:.i
i :ldsts\fomu\elc- fecs.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION nnsr
24 -Flour Inspection Line: 639 -4175 Business Line: 639 -4171
_ � BUD
Date Requested ,--�( 4 AM //PM BLD
Location /3 % _5 /6). Suite MEC
Contact Person Ph PLM
Contractor Ph fi -- - 7337 SWR
BUILDING Tenant/Owner CLea-P1 ELC -co
Retaining Wall g S 7 ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
M sc: • �� Y/ C' 'Qs Y !/e_ d
Final
PASS PART FAIL
PLUMBING
Post & abm / � / 14
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
ELECTRICAL
\ Serwce�
RoU0 In
UG /Slab
Low Voltage
Fire Alarm
F'.
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 ` L ? 1,
Other Date ^ — L/ / Inspector , L Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
BUP - Building Permit ELC - Electrical Permit
4 Inspection Description Date Passed By 4 Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final gr 1'f- No
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
Post/beam mechanical
Suspended ceiling
Engineered soils Gas line
Welding Lab Final Mechanical rough -in
Concrete Lab Final Fire damper
Bolting Lab Final Duct work
Structural observation Smoke detector
Mechanical final
Fireproofing Lab Final
Final inspection -
PLM - Plumbing Permit
BUP — Fire Protection System Permit Inspection Description Date Passed By
Plumbing underslab
4 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
/ 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 4 Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits
is \dsu \ forms \InspRecordBUP.doc 04 /17/01
CITY OF TI GARD ELECTRICAL PERMIT
A.
PERMIT #: ELC2001 -00454 •
- o li�;' DEVELOPMENT SERVICES DATE ISSUED: 9/11/01
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 102CC -03600
SITE ADDRESS: 13995 SW 102ND AVE
SUBDIVISION: FRELEON HEIGHTS ZONING: R -3.5
BLOCK: LOT : 004 JURISDICTION: TIG
Proiect Description: Installation of 200 amp service and (2) branch circuits. Job 99.5495
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: 1 W /SERVICE OR FEEDER: 2 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
PECK, ALAN W TICE ELECTRIC
RATHBUN, ELIZABETH A PO BOX 15009
10255 SW MCDONALD ST 2139 SE BELMONT ST
TIGARD, OR 97224 PORTLAND, OR 97293 -5009
Phone: Phone: 233 -8801
Reg #: LIC 166
SUP 2586S
ELE 26 -126C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 9/11/01 $80.15 2720010000( Elect Service
Elect'I Final
5PCT CTR 9/11/01 $6.41 2720010000(
Total $86.56
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 r i,
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions 1Ns
. _ .
Permit Signature: a 17
{ Issued By: _ ilibl,
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent. I
OWNER'S SIGNATURE: DATE; O
l eilo
CONTRACTOR INSTALLATION ONLY
- / ugilik
SIGNATURE OF SUPR. ELEC'N: • .i•- - - - - -a% DATE:
LICENSE NO: X5`&6 - 5 1.
Call 639 -4175 by 7:00pm for an inspection the next business day