Permit A. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00279
A.Wrk DEVELOPMENT SERVICES DATE ISSUED: 5/30/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134DB -06000
SITE ADDRESS: 11027 SW 110TH PL
SUBDIVISION: JEFFREY ESTATES ZONING: R -4.5
BLOCK: LOT : 019 JURISDICTION: TIG
Project Description: Install one branch circuit SF 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: 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:
HANSON, FRED R + VICKI L WEST SIDE ELECTRIC CO INC
11027 SW 110TH PLACE 1834 SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214 `
Phone: Phone: `►
231 -1548 0‘‘G‘‘
Reg #: LIC 13306
SUP 1556s
ELE 26 -135c
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT SS 5/30/00 $37.50 0002520 Elect'l Final
5PCT SS 5/30/00 $3.00 0002520
Total $40.50
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE Yv` ISSUED BY: 4.6411—
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: (S\ 4 p((<<.tt��►. DATE:
LICENSE NO: /575L3
Call 639 -4175 by 7:00pm for an inspection the next business day
05 -26 -00 11:09AM FROM WEST SIDE ELECTRIC P01
Co!TY Or TIGARD Plan Check M
Electrical Permit Application
13125 SW HALL BLVD. R ead By SSC
TIGARD OR 97223 RECEIVED I� ar Date Recd 3" -2U -Oo
Phone (503) 639 -4171, x304 Z Jo � . Date to P.E.
`C Date to DST 279
Inspection (603) 639-4175 MAY 2 6 2000 Print of Type Permlt �
Fax (503) 598 -1960 COMMUNIt?D' 1. A lly illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) r a _ Service included: Items Cost Sum I
Address to,... , ��, p 4a. Residential - per unit '
• 1000 eq. ft, or less $ 117.7 4
City /State /Zip . / 4 i Of Each additional 500 sq. ft, or -
Commercial 0 • esidential portion thereof $ 26.25 1
Limited Energy S 80,00
Each Manurd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder 3 72.75 2
(Prior to permit Issuance, applicants must provide contractor license 4b. Services or Feeders
Information for COT data base). < ,/ Installation, alteration, or relocation
Electrical Contractor (,' f f g-Z- J/ - 7e' /"i L 200 amps or lass $ 84.25 2
Address / f / _ � Z.-E' 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
City / ee / Stale Zip /7a / 4/ 601 amps to 1000 amps $ 192,50 2
Phone No. 7 3/ - / S ,c- Over 1000 amps or •olte , $ 383.75 2
Job No. 5 is+ ") 1p I Reconnect only $ 63.60 2
Elec. Cont. Lice. No. ,7L,- / 3 Src Exp.Dete /0/1 I C'c) 4c. Temporary Services or Feeders
OR State CCB Reg. No. / ? ,70 h Exp.Date ,S'/? `/lO Installation, alteration, or relocation
COT Business Tax or Metro No. q 7 Exp.Date Z lilt r 200 amps or less 5 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 800 amps $ 107.00 2
- Over 800 amps to 1000 volts,
/ (
-J sea "b" above.
/
License No, ,C - Exp.Date /Oh 0
Phone No. ,23/— /�- ./,..(' ad. Branch Circuits
. New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of aervlce or
Bader fee.
Print Owner's Name Each branch circuit $ 5,35 2
Address b) The (es for branch circuits •
without purchase of service
City State Zip or /seder fee, II ^ 4 5" 0
Phone No, Flret branch circuit ) 5 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
Owners Signature , Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
3. Plan Review section (if required):* panL alteration is (10) or extension $ 80,00
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 struglure the allowable In any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour 5 50,00
System over 600 volts nominal In Plant $ 69.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
6a. Enter total of above fees 3 7.
• Submit 2 sets of plans with application where any of the above apply, ki(Surcharge ( X total lees) 53 $ 3, p
Not required for temporary construction services. Subtotal $
eb. Enter 25% of line 6a for
NOTICE Plan Review if required (Sec. 3) 5
PERMITS BECOME VOID IP WORK OR CONSTRUCTION AUTHORIZED sub $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR /3 /�
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS UUU Trust Account # 3 (,J ( .
AT ANY TIME AFTER WORK IS COMMENCER Total balance Due $ 1),
i ,
i:161911ormsleleciric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
B
Location r . ; i�_ ; d�
I e ' / MEC v— DOAD
Contact Person l agEla . t� Ph 7 f `7 S 7Z PLM
Contractor 1A1�i g! , 1c 4-6_ Ph SW
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: FPS
Foundation tion
Ftg Drain
Crawl Drain Inspection N tes:/ r SGN
Slab ((��` SIT
Post & Beam v/�
Ext Sheath /Shear 4 �C (sC f
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler 7./t---7A —
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 RT FAIL
- 4DECHANI
Post & Beam
Rough In
Gas Line
Smoke Dampers
atk RT FAIL
L
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
in
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 7 /V Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.