Permit • y' CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00019
A `.' ( DEVELOPMENT PMENa r S O ERV ACES 639 -4171 DATE ISSUED: 01/12/2001
PARCEL: 1 S 134CA -01200
SITE ADDRESS: 11490 SW 121ST AVE
SUBDIVISION: BURLWOOD ZONING: R -4.5
BLOCK: LOT : 005 JURISDICTION: TIG
Project Description: Installation of service and 11 branch circuits. Job No. 16680.
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: 11 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:
MILLER, LYMAN L ROSE CITY ELECTRIC CO INC
11490 SW 121ST AVE 4012 NE CULLY BLVD
TIGARD, OR 97223 PORTLAND, OR 97213
Phone: Phone:
287 -6164
Reg #: SUP 2127S
LIC 3567
ELE 26 -113C
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT CTR 01/12/2001 $153.45 2720010000( Elect'I Final
5PCT CTR 01/12/2001 $12.28 2720010000(
Total $165.73
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 OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE �,o e ,_ ioA/_ , /9-f1 ISSUED BY:
e ,ci2)4. z.ej -- j _ < ___
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: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
A
i r ,
A
• Electrical Permit Application
,, Date received: ///z/B Permit no.: / 400/9
,4, City of Tigard , -
� , Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, O (9'223 a � o® Date issued: By;,W ff{ Receipt no.: .
Phone: (503) 639 -4171 ■, --"
Fax: (503) 598 -1960 ,P� 0 ��,.OQ Case file no.: Payment type:
Land use approval: t: :\,�
v
1 t'1'E OF PERMIT
d 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: II q w L1 .Z.t Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: �I Subdivision:
Project name: kb i� S I Description and location of work on premises:
Estimated date of completion / inspectio .
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: 1, Fee Max
Description Qty. (ea.) Total no. insp
Business name: ROSE C T TY ELECTRIC C O T N C New Address: 4012 NE CULLY BLVD dwelling ngu ni t . Il clu eormal dgarage. a
e per
City: PORTLAND I State: OR I ZEP7213 S ded: es atfaehed
Ph51@3 287 616 4 I i:l0 3 282 1 31ilai1: 1000 sq. ft. or less 4
CCB no.: 3567 ///% Z} Elec. bus. lic. no: 26 113 C Each additional 500 sq. ft. or portion thereof
U L y Limited energy, residential 2
City/ , - .. s j i s .: / �O /Q / / Limited energy, non - residential 2
P �i .. —_� Each manufactured home or modular dwelling
r.� �� `
Signal of supervising electrician (required) Date i Service and/or feeder 2
Sup. elect. name (print): R L Gotham License no: 2127S Services or feeders— installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less / /�U � jf 2
Name (print): , Vi i LL L i, 201 amps to 400 amps 2
Mailing address: ( /[ �) 6 / L 401 amps to 600 amps 2
l t t- 1 amps to 1000 amps 2
City: — 7/i , / {,6 - %t-� I StaK:, )- I ZIP: V 2.- 60 Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner install ton: 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 installation, alteration, or relocation:
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
ENGLNEER Branch circuits - new, alteration,
or extension per panel:
Name:
A. Fee for branch circuits with purchase of S � �
Address: service or feeder fee, each branch circuit f i
_5
Address: 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc .(Serviceorfeedernotincluded):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ 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 jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ I'= ,
0 Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
Cardholder signature Amount 440 -4615 (6r00/COM)
Electrical Permit Fees: Limited Energy Fees: � `
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, 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 n Garage 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 U 2 El 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 n Other
Over 1000 amps or volts $454.65 2 .
Reconnect only $66.85 2
Temporary Services or F dens TYPE OF WORK INVOLVED - COMMERCIAL ONLY
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
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits n Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or f n Clock Systems
feeder fee. // "_ 1
Each branch circuit 1 1 $6.65 ) 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous Ti Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above ❑ Nurse Calls
Per inspection $62.50
Per hour $62.50 �
In Plant $73.75 iJ Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Enter total of above fees $ , n Other
8% State Surcharge $ 6 ' Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application.
��j Fees:
Total Balance Due $ ir �S
Enter total of above fees $
El Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts\forms\elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVIS ON 3 •-^
'24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested — 7 AM PM BLD
Location / / ¥ f U 5c /2/.5 Suite MEC
Contact Person Ph 2e'7 4/ � 7 PLM
Contractor D 3 Ph 233 -y 4'- j SWR
BUILDING Tenant/Owner L j - L/7-y z 4 '7 ELC 7 r
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 L r
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
` C€LECTBIGA --
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
ASS PART FAIL
SI -
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
Appr Date
oach /Sidewalk 04 Inspector �LQ/t Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.