Permit CITY OF TIGARD' ELECTRICAL PERMIT
PERMIT #: ELC2001 -00446
DEVELOPMENT SERVICES DATE ISSUED: 9/5/01
�f I I 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: Electrical work in downstairs bedroom, (1) 200 amp service and (4) 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 HMI 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+ 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 WEBER ELECTRIC INC
12350 SW 124TH AVE 14524 SW CHARDONNAY AVE
TIGARD, OR 97223 TIGARD, OR 97224
Phone: Phone: 579 -5168
Reg #: LIC 44087
SUP 4028S
ELE 34 -442c
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 9/5/01 $106.90 2720010000( Elect'I Service
Elect'I Final
5PCT CTR 9/5/01 $8.55 2720010000(
Total $115.45
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 lbw ru dopted by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0 0. You may obtain pies of these rules or direct questions to
Permit Signature: / •
\—
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: - -Q t t &V -' DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Date received: ?/ 5 p/ Permit no.: el' !- Ge4/4
r t
-• 11: 1i City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 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 constructionddition /alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: / Z 3 .5 ',,,/ / 2A AvL Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: Subdivision:
Project name: I Description and location of work on premises: D[(7Lj ,a 6 eized +-i
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDLLE
Job no: Fee Max
Business name: 44 C�i1r- I -L t . L Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Address: Sir PO i3ole 231 /5 4 dwelling unit. Includes attached garage.
City: 7T5e,,-,,l I State: d-2 ZIP :9 7yJ _ / /5 Service included:
Phone: ( _ 1 iv !o I Fax6 20 _61 i 1 I E -mail: _ 1000 sq. ft. or less 4
¢ 0 4 2. C Each additional 500 sq. ft. or portion thereof
CCB no.: Zi 9 c) y 7 I Elec. bus. lic. no: 3
Limited energy, residential 2
City /metro 11C Q Limited energy, non- residential 2
�`�;_�1 ->eA. Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): «, *r i...)e e/- License no: / Z S Services or feeders — installation,
PROPERTY OWNER 2 0 er rn p sorless relocation: '° 2
200 am or less ) X 30 go<
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I 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, orrelocation:
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 A i J
Address: service or feeder fee, each branch circuit � d, ( Zb 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 ❑ 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
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 $ rob .1 to
❑ 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 %) .... $ < 6 • 5 5
Expires accepted as complete. TOTAL $ • 1 / .`; • N `�
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (Cv)O /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. fL or less $145.15 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Ti Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less / $80.30 2 n Vacuum Systems*
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2 n Other
601 amps to 1000 amps $240.60 2
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, n
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 n Clock Systems
feeder fee.
I
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 HVAC
Each additional branch circuit $6.65 ril
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 ri Landscape Irrigation Control
Minor Labels (10) $125.00 ❑
Medical
Each additional inspection over
the allowable in any of the above Nurse Calls
Per inspection $62.50
Per hour $62.50 ❑
In Plant $73.75 Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee * No licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
front of application.
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 9 0'� AM PM BUP
Location t � �� ( 14. Suite MEC
Contact Person Ph ( ) PLM 7 `'"
Contractor )") �.- L� G�21� Ph ( ) SWR ±�
BUILDING Tenant/Owner ELC a001-- O c
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam 1A "' C9 c/ rikc A s
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler ip ` ) k\D D r
Fire Alarm 11
Susp'd Ceiling , ( c�
Roof Other: 1J L O a, � Cp �
Final
PASS PART FAIL
PLUMBING
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
FAIL
ECTRICAL
Serve
Rough -In
UG /Slab
Low Voltage
Fire Alarm
P ASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA �"�
Approach/Sidewalk � /� Inspector � v a Ext
Other:
Final DO NOT REMOVE this inspection record from th Job site.
PASS PART FAIL