Permit y CITY OF TIGARD
ELECTRICAL PERMIT
. �,� DEVELOPMENT SERVICES PERMIT ISSUD O
C8 7 / 9/98
PARCEL: 19133DD -10700
SITE ADDRESS...:11932 SW 125TH CT
SUBDIVISION •VILLAGE AT SUMMER LAKE PARK 4 ZONING:R -4.5
BLOCK • LOT •144 JURISDICTION: TIG
Project Description : Alteration of electrical service to single fasily dwelling.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 — 400 amp • 0 1st W/O SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 1 IN PLANT • 0
601 — 1000 amp : 0 PLAN REVIEW SECTION
1000+ amp /volt : 0 > =4 RES UNITS • > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
ROBBIE KING type amount by date recpt
11932 SW 125 CT PRMT $ 40.00 DLH 07/29/98 98- 307815
TIGARD OR 97223 5PCT $ 2.00 DLH 07/29/98 98- 307815
Phone #:
Contractor:
PREMIER ELECTRICAL CONTRACTORS $ 42.00 TOTAL
115 NICHOLAS WAY
REQUIRED INSPECTIONS
NEWBERG OR 97132 Rough —in Elect'1 Final
Phone #: 259 -1305 Elect'1 Service
Reg #..: 001264
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 f sore than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Th rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You may obtain a copy
of these rules or direct questions to DAC , calling (583)246 -1; 7.
Permittee Signature: / �� Issued 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: /v//9 DATE:
CONTRACTOR INSTALLATION ONLY �`
SIGNATURE OF SUP R. ELEC' N : i�,k.-i 9 7d7iJ" DATE: T AP
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Electrical Permit Application Plan Check # W A
13125 SW HALL BLVD. Date Recd#X7_i
TIGARD OR 97223
Phone (503) 639 -4171, x304 c . Date to P.E.
Print or Type / / �l C' � Date to DST
Inspection (503) 639 -4175 Incomplete or illegible will not b ed Permit # E-e-V -D y3/
be acce
P 9
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development hiL �
B '7� S14 // Number of Inspections per permit allowed
Name (or name of business)) /V A/6, £038/ l Service included: Items Cost Sum
9
Address // / 32 c5, a. 42,T � CI. • 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip (((G' �4r4/ "
O / � Each additional 500 sq. ft. or
Commercial El Residential/Ll� Limited thereof $25.00 1
mited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of urrent licenses) I 4b. Services or Feeders
Electrical Contracto i E. iC E (er f r i e rt( Ow u f r4cJ s Installation, alteration, or relocation
200 amps or less $60.00 2
Address I I N; e 1.0 As S t-J09. 201 amps to 400 amps $80.00 2
City n1f✓,,J5E.: c State n4e Zip 9 7 sZ 401 amps to 600 amps $120.00 2
Phone No. 2 S - 9 - (3 OS. 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. .3 /e) - 79 C Exp.Date /d
OR State CCB Reg. No. /.,21,e/6/ Exp.Date ,,-- 4c. Temporary Services or Feeders
COT Business Tax or Metro No Exp.Dat Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n 4-- 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 4 7 E xp.Date /0`i 9 ✓ see "b" above.
Phone No. 6,9 31 ok
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 circ $5.00 2
City State Zip b) The fee for branch circuits
ty p without purchase of
Phone No. service or feeder fee. v d
( First branch circuit / $35.00 _� 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 m 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 $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
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: i/d / re
Not required for temporary construction services. 5a. Enter total of above fees $ a `
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $
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 # c . in
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96
k...) lAio - 12_ fit a., ceniram,. / h,em
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST Mena-
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
7 p G O- p BUP
ie. Date Requested c � — / (/ AM PM I � 3p /I ' (, BLD
Location I I - Ql 3 2_ 5 60 12-5
ff 12- 5� Or Suite MEC
Contact Person F Ph R - / 0 /3 PLM
Contractor Ph G' SWR
BUILDING Tenant/Owner `�.{/i� 2��.QQ1Qe , LC
Retaining Wall f - -!. ` ? #1 0
Footing Access:
Foundation /M l n ; "met FPS
Ftg Drain / xr [ SGN
Crawl Drain Inspection Notes: h
Slab -t �'' ' �L, SIT
Post & Beam P C !, [_ /D Ext Sheath /Shear (.�
Int Sheath /Shear
Framing
Insulation
Drywall Nailing . i_ _ Aims.
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling �A G
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 FAIL
ECTRICAL
Service
Rough In
UG /Slab
Low Voltage g
Fir- •larm
4 '�"� PART FAIL
6
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 Date �• /j - Inspector v t Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
-- g-t z - c. +.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
" BUP
1,31 r0 `f Datl Requested P/ /7" / 7/ AM PM f" LD
Location //7 3 2- J /est/ Pt Suite MEC
j �
Contact Person / - r& - Ph q'-/O /3 PLM
Contractor x,.111 � r --FE 57 5- 97 I SWR
BUILDING Tenant/Owner 2�(l �(/h / 5 F?7 12,ejle , ELC ?el- g,3 /
Retaining Wall t/ ELR
Footing Access:
Foundation 6tij (4t QG��f'� t ce FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: /1 ��,
Slab . Qi SIT
Post & Beam / +� /�* / mA - . ,�
Int Sheath /Shear `vYt v / !'l.( G�J�ZC/
Int Sheath /Shear
Framing
Insulation
Drywall Nailing ii0 B12A, r71
Firewall
Fire Sprinkler A _ - - _/ _ -A"-
Fire Alarm / f
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
PA FAIL
LECTRICAL
Service
Rough In
UG /Slab ,,IC)
Low Voltage CN `
Farm
anal
- PASS PART
SITE tt
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 [4..kf ease call for reinspection RE: ZZ—C P - d 7/ [ ] Unable to inspect - no access
ADA 04/....6./t /Sidewalk
Other D a t e F~ 9k I nspec t or E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
' Date Requested - 30 _ 4 AM PM BLD
-1
Location I ( 3 2. RAJ 1fri � � l Suite MEC
Contact Person ��,X Ph PLM
,
Contractor Ph SWR
BUILDING Tenant/Owner ELC 7,
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear ' i�,, 7 n ,.` f 1
�Q ( /�,�— y( �s�1
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall I ' L Fire Sprinkler 46) ,4 e_ A. Q 141 ,� / . V 3 nil
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
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
T FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
F' - Alarm
PASS PART F AIL
SITE
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 7 ns Approach /Sidewalk Date I ector Ext/ Other Inspector
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
6/19/00 Activities for Case #: ELC98 -00431
2:03:16 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 7/29/98 DLH RECD DLH 7/29/98
ELCA003 Permit created 7/29/98 DLH DONE DLH 7/29/98
ELCA799 Elect'l Final 7/30/98 BRP FAIL B *P 7/30/98 No one home.
ELCA500 (F) Issue permit 7/29/98 DLH DONE DLH 7/29/98
ELCA799 Elect'l Final 8/18/98 CD PASS CD 8/18/98 wiring of hot tub
ELCA800 Case finaled 8/18/98 CD PASS J *H 8/18/98
ELCA799 Elect'l Final 8/14/98 CD FAIL CD 8/20/98 no one home, shawn will res.
for inspection.
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