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Permit CITY OF T I G A R D ELECTRICAL PERMIT PERMIT #: ELC1999 -00607 40 1601A SERVICES DATE ISSUED: 10/13/1999 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110AD -90069 SITE ADDRESS: 14980 SW 109TH AVE SUBDIVISION: CANTERBURY WOODS CONDOMINIUM ZONING: R -12 BLOCK: LOT : 069 JURISDICTION: TIG Project Description: Installation of a 200 AMP service and four (4) branch circuits for an existing dwelling 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: 4 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+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: ANDERSON, DANIEL W FOUR STAR ELECTRIC CO 308 SW FIRST AVE STE 110 4230 SW 167TH AVE PORTLAND, OR 97204 ALOHA, OR 97007 Phone: Phone: 503 - 356 -0953 Reg #: ELE 34 -505C LIC 135048 SUP 3830S FEES Required Inspections Type By Date Amount Receipt Wall Cover PRMT DST 10/13/199c $85.65 99- 319053 Elect'I Service 5PCT DST 10/13/199 $6.86 99- 319053 Elect'I Final Total $92.51 ORIGINAL This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 OUNC at (503) 246 -1987. � PERMITTEE'S SIGNATUR = i LE I ISSUED BY: OWN R 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: `�''L/ 1 DATE: /() I LICENSE NO: 5530 S 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. Rec'd By TIGARD OR 97223 Date Rec'd Date to P.E. Phone (503) 639 -4171, x304 1-:I Date to DST Inspection (503) 639 -4175 Print of Type Permit #f c l4`�� -60609 Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development PA I c I /1-7'0(rdGrJ Number of Inspections per permit allowed Name (or name of business) Service included: Items Cost Sum 4 ' Address I 9 U S G..) f 0 9 / 4a. Residential - per unit hr0 2 Cs Z i, 1000 sq. ft. or less $ 117.75 4 City/State /Zip / 5 ( r Each additional 500 sq. ft. or portion thereof $ 26!75 1 Commercial ❑ Residential El Limited Energy $ 60.00 Each Manufd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2 (Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders information for COT data se). C I _ Installation, alteration, or relocation e/ � - Electrical Contractor ( U V f l L e-- �� �° , L (.%'. 200 amps or less ' $ 64.25 6f e l •� J 2 201 amps to 400 amps $ 85.50 2 Address 2 3 t) 5W % b7 Aye 401 amps to 600 amps $ 128.50 2 'City A L a i State RA Zip 17 001 601 amps to 1000 amps $ 192.50 2 °Phone No. S0 3 - 3 St' - 0 9 S ? Over 1000 amps or volts $ 363.75 2 Job No. Reconnect only $ 53.50 2 Elec. Cont. Lice. No. 3/1- Exp. Date /0' / - 60 a , 4c. Temporary Services or Feeders - OR State CCB Reg. No. / 3 5 6 if Exp.Date 441.Ot . Installation, alteration, or relocation COT Business Tax or Metro No. Exp. Date 200 amps or less $ 53.50 2 r 201 amps to 400 amps $ 80.25 2 , � 401 amps to 600 amps $ 107.00 2 Signature of Supr. Eled' Over 600 amps to 1000 volts, 4 ' ( .-- see "b" above. License No. 35305 Exp.D O • 41 • Of 4d. Branch Circuits Phone No. New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or feeder fee. � ll (� Print Owner's Name Each branch circuit Z 2 / / $ 5.35 ig/- / 2 Address b) The fee for branch circuits without purchase of service City State Zip or feeder fee. Phone No. First branch circuit $ 37.50 Each additional branch circuit $ 5.35 The installation is being made on property I own which is not 4e. Miscellaneous intended for sale, lease or rent. (Service or feeder not included) Each pump or irrigation circle $ 42.75 Owner's Signature Each sign or outline lighting $ 42.75 Signal circuit(s) or a limited energy panel, alteration or extension $ 60.00 3. Plan Review section (if required): * Minor Labels (10) $ 107.00 Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over 4 or more residential units in one structure the allowable in any of the above Service and feeder 225 amps or more Per inspection $ 50.00 Per hour $ 50.00 System over 600 volts nominal In Plant $ 59.00 Classified area or structure containing special occupancy as described in N.E.C. Chapter 5 5. Fees: G, 5a. Enter total of above fees $ /' ' * Submit 2 sets of plans with application where any of the above apply. �� ySAt; Surcharge ( 'X total fees) $ 4 Not required for temporary construction services. Subtotal 7a $ 5b. Enter 25% of line 5a for NOTICE Plan Review if required (Sec. 3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS ❑ Trust Account # .- AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $' �• ! / i:\dsts\forms\electric.doc CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested Z 2 AM PM BLD Location I 'c ( `'f - 7 - ti Suite * MEC Contact Person > Ph PLM Cif - --�- r r �' � 1' 0 c/c Ph ' 1 2 - 0 � 2 SWR BUILDING Tenant/Oner e i 7 (r L� ELC I ° i t c (n C 7 Retaining Wall C) 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 411e1 Q e `J S Firewall Fire Sprinkler Fire Alarm /ft Susp'd Ceiling � C (J �P_ 6 . ciP S — Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam k Under Slab D r, Top Out Water Service 'Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final FAIL ELECTRICAL ervice Rough In UG /Slab Low Voltage ` -- -� Fire Alarm 4 10 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 /a _2 2..-?? Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 lq BUP Date Requested /0 46 AM PM BLD Location /4°S0 5a) /D {' Suite MEC Contact Person Njyl 4 Ph SD 3l'70Cv /9) PLM Contractor Ph SWR BUILDING Tenant/Owner ELC / R 99 -40 (0Q 7 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 } lO one_ Fire Sprinkler �y 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 -PART FAIL (ELECTR See Rough In UG /Slab Low Voltage larm SS PART SITE Backfill /Grading Sanitary Sewer Storm Drain ( I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line call for reinspection RE: able to inspect - no access ADA >(Please / 6 — A Approach /Sidewalk Other Date A Inspector 0,4 Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date /D- Date Requested /&' q'7 AM V PM BLD Location / 0SO 1/ /09 Suite MEC Contact Person Ph PLM Contractor 1 4 � Ph 356 9S SWR q BUILDING Tenant/Owner ELC / q (- Q7 Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain h� SGN Crawl Drain Inspection Notes Jet& Slab SIT Post & Beam 7/1//�y Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler -7/6 °O—Q 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 PASS PART FAIL ELECTRICAL Service R2 ` . Rough In re& tne- UG /Slab Low Voltage Fire Alarm Final PASS PART tAly. 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 acc s ADA Approach/Sidewalk Other ther Date / /O� 9 Inspector /� Ext 9 Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.