Permit A, CITY OF TIGARD- ELECTRICAL PERMIT
PERMIT #: ELC2000 -00657
tic DEVELOPMENT SERVICES DATE ISSUED: 12/1/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S103BB -07901
SITE ADDRESS: 12350 SW 124TH AVE
SUBDIVISION: LAKE TERRACE ZONING: R -4.5
BLOCK: LOT : 008 JURISDICTION: TIG
Project Description: Installation of (1) one 200 amp or less service and (6) six branch circuits.
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: 6 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:
HINDS, TOM M + JUDY G RVC ELECTRIC
12350 SW 124TH AVE 2420 GIBSON WOODS CRT NW
TIGARD, OR 97223 SALEM, OR 97304
Phone: Phone: 503 - 364 -7818
Reg #: ELE 27 -45C
LIC 55208
SUP 3432S
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 12/1/00 $133.50 2720000000( Elect'I Service
5PCT CTR 12/1/00 $10.68 2720000000( Elect'I Final
Total $144.18
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 o - - or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE ISSUED :Y: •
OW ' - INSTALLATION ONLY
The installation is being made on property"l own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
` ONT - „ CTOR I ST LLATION ONLY
e ",
SIGNATURE OF SUP R. ELEC'N: � / 1 — DATE d �
LICENSE NO: �2 ,
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Date received: Permitno.: et4 Pe00 - to( ps
.. .
,_
L ,..1 il' City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction E Addition/alteration /replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: /9- .6 ,‘) j rte -' .. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: Subdivision:
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: 7v'! ez C. lE� Description Qty. (ea.) Total no. insp
�
, l ' —"c° New residential - single or multi- family per
Address: 6 CdF dwelling unit. Includes attached garage.
City G tate: CA ZIP: q7 Serviceincluded:
Phone: G , ' _- I Fax: I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: ,g_j I Elec. bus. lic. no: a-'7,�.l -b l Limited energy, residential 2
City /metro lic. no.: a.-/ V-O
Limited energy, non- residential 2
/e't4". I Each manufactured home or modular dwelling
Signature of supervising e . trician (required) Date i / Op Service and/or feeder 2
Sup. elect. name (print)� License no: Services orfeeders — installation,
: �
PROPERTY OWNER alteration or relocation:
200 amps or less / 2
Name (print): .4 —1.--2-41 4S 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
■
City: #4,-b I State:' ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: 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
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6 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. (Service or feeder not included):
❑ Service over 225 amps - commercial 0 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 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other.
Per inspection
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 $ JSZ . so
El Visa CI MasterCard expires if a permit is not obtained Plan review (at _ %) $ !d . 6
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $ /0V.
Name of cardholder as shown on credit card
$
Cardholder signature Amount
440 -4615 (6/00 /COM)
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
Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n 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 El 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 less $80.30 ' 2
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems
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 Feeders 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
New, alteration or extension per panel n Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee. y �-,,�{
Each branch circuit $6.65 ✓ d ' 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50 n Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: Q ❑ Protective Signaling
Enter total of above fees $ / . SO n Other
8% State Surcharge $ /0 1" 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.
gib �g Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts\forms\elc- fees.doc 10/09/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection,Line ; (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested I q 1)4 AM PM BUP
Location )c Sim (/` T�,l A Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR cc
BUILDING Tenant/Owner 3` � 1 \A O S ELC MO0 - 0t5 631
Footing J �Y� V £
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _( (� \ �}- �r
Roof °� �- R'��J � �1 1.� tiR1) TA" I 0 �' 14
Other:
Final C I
� 14) Q \ A \) lrp � in Yl 4$1
PASS
PLUMBING FAIL 1 1 N
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PART FAIL
ELECT
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SIT El Please call for reinspection RE: Li Unable to inspect — no access
Fire Supply Line
ADA Date 9) O Inspector \ � 0 ti \1 4 Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL