Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00062
` 1 DEVELOPMENT SERVICES DATE ISSUED: 1/29/01
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S103BB -07100
SITE ADDRESS: 12475 SW 121ST AVE
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Temporary service for job shack for Kerr Contractors during intersection widening project.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 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:
HARBOUR, KELLY ALLIANCE ELECTRIC INC
12475 SW 121ST AVE 19590 SW 51ST
TIGARD, OR 97223 TUALATIN, OR 97062
Phone: Phone: 691 -2222
Reg #: LIC 78713
ELE 3 -310C
SUP 2021S
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT CTR 1/29/01 $66.85 2720010000( Elect'I Final
5PCT CTR 1/29/01 $5.35 2720010000(
Total $72.20
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 rul adopted by = Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. Yo may obtai copies of these rules = direct questions to OUNC at (503)
246 -1987. V 4111.
PERMITTEE'S SIGNATURE X �/ j�!� ∎! ISS D 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:
CONTRAC OR INST LLATION ONLY
SIGNATURE OF SUPR. ELEC'N: L /! -.4' :A� ' % aro DATE:
LICENSE NO: 5
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 Print or Type Date to DST
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit #
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) Kerr Contractors Service included: Items Cost Sum
Address 12475 SW 121St 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip T i g a r d Each additional 500 sq. ft. or
Commercial ® Residential ❑ portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor A1 1 i n c p F 1 e c t r i r Installation, alteration, or relocation
Address 19590 SW 51st 200 amps or less $60.o0 2
Cit Tualatin U K ZI p y / U b 'L 201 amps to 400 amps $80.00 2
CI State 401 amps to 600 amps $120.00 2
Phone No. 503-691-2222 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 3 - 310 C Exp.Date 10 - 01 - 01 Reconnect only $50.00 2
OR State CCB Reg. No._ 7 R 713 Exp.Date 1 2 - 2 4 - 0 2 4c. Temporary Services or Feeders tl
COT Business Tax or Metro • . I Exp.Date • _ _ a Installation, alteration, or relocation
200 amps or less 1 $50.00 ,5 2
Signature of Supr. Ele•' • ! �� /. _, 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
�� Over 600 amps to 1000 volts,
License Nc Exp.Date 1 n - n 1 see "b" above.
Phone Nc 503- 691 -2222
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting _ .i $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00 0�
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: &p.7<-
p 8
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ �-
NOTICE Subtotal $ 5 `S
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ 74
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24=Hour Inspection Line: 639 -4175 Business Line: 639 -4171 It -
BUP
Date Requested /—'3O AM PM BLD
Location / c (/ 75 ) 1. 1 /Z /S/ Av -( Suite MEC
Contact Person // Ph 4•1/" Z Z PLM
Contractor At? (4 4,./ cc E (ems- -tc___- Ph 7k/ - /40 U SWR
BUILDING Tenant/Owner ELC ■1O / ' - G 0 0 t✓ Z
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: 4_
Slab -/c6 SL r 4 SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler ...Laid 11 41
Fire Alarm
Susp'd Ceiling
Roof
Final ;
4 ".
PASS PA[S , FAIL
7:1
PLUMBING R.
Post & Beam /�
Under Slab s Vli'
Top Out
Water Service ,
Sanitary Sewer
Rain Drains
Final 1
i ' PASS PART FAIL
MECHANICAL
Pos ' Beam I
Rou In
Gas me -,
Smote Dampers _
Final •
PASS PART FAIL
Lt.LORICL
S Szeiii 7 ough In
UG /Slab _
Low Voltage
Fire Alarm
$ F i •
PART FAIL
17 ;6 )
E r' n
Backfill /Grading ) - I£
Sanitary Sewer
Qrm Drain [ ] Reinspection fee of $ required before next nspection. Pay at City Hall, t3125 SW Hall Blvt}
match Basin
I,''' Fire Supply Line , • [ ] Please call for reinspection RE: _ ] Unable to inspect - no access
.. ADA dir
Approach /Sidewalk
Date _
Other Vi d a/ Inspect /lam E x t
ii Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site
BUP - Building Permit ELC - Electrical Permit
J Inspection Description Date Passed By I 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 / —3c.) -o t (
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing -4 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 � Inspection Description Date Passed By
Post/beam mechanical
Suspended ceiling Gas line
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper
Concrete Lab Final Duct work
Bolting Lab Final Smoke detector
Fireproofing Lab Final Mechanical final
Structural observation
Final inspection
PLM - Plumbing Permit
4 Inspection Description Date Passed By
BUP — Fire Protection System Permit 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 fmal 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
ELECTRICAL PERMIT
P ERMIT #: ELC2001 -00062
,, 14' CITY OF TIGARD DEVELOPMENT SERVICES DATE ISSUED: 1/29/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S10366 - 07100
SITE ADDRESS: 12475 SW 121ST AVE
SUBDIVISION: ZONING: R - 4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Temporary service for job shack for Kerr Contractors during intersection widening project.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 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:
HARBOUR, KELLY ALLIANCE ELECTRIC INC
12475 SW 121ST AVE 19590 SW 51ST
TIGARD, OR 97223 TUALATIN, OR 97062
Phone: Phone: 691 - 2222
Reg #: LIC 78713
ELE 3 -310C
SUP 2021S
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT CTR 1/29/01 $66.85 2720010000( Elect'l Final
5PCT CTR 1/29/01 $5.35 2720010000(
Total $72.20
Codes a
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty od 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 rul adopted by : Oregon Utility Notification Center. Those
rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0080. Yo may obtai copies of these rules direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE x j ��! , !� ISS "D 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:
CONTRAC OR INST LLATION ONLY b
SIGNATURE OF SUPR. ELEC'N: 4.1# �' :C� DATE:
c11
LICENSE NO: 0°0 / 5
Call 639 -4175 by 7:00pm for an inspection the next business day