Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00282
111 DEVELOPMENT SERVICES DATE ISSUED: 5/16/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S104DA 04100
SITE ADDRESS: 13411 . SW 129TH AVE
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R-4.5
BLOCK: LOT : 027 JURISDICTION: TIG
Project Description: Install (4) branch circuits, hot tub, 2 pond and 1 outdoor plug.
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 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:
MAYNARD TYE HIGHLAND ELECTRIC COMPANY INC
13411 SW 129TH PO BOX 655
TIGARD, OR 97224 TROUTDALE, OR 97060
Phone: Phone: 220 - 1935
Reg #: LIC 109850 N.
SUP 2431S
FEES ELE 26-962C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/16/03 $66.80
[TAX] 8% State Tax 5/16/03 $5.34 Rough -in
Elect'I Final
Total $72.14
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 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1- 800 - 332 -2344. /
Issued By: (' / / �[ `i�z 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: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
- 0)0.2. '
6 7 ? Electrical Permit Application - .
Date received: - b -/ i 5 Permit no.: D 3 _
_ ti``.� City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: a Receiptno.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
'Land use approval: / 6
TYPE OF PERMIT
sa 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction . ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 34 l/ S 1 2 • Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 'Block: Subdivision:
name: 'Description and location of work on premis Het 6 a PON a ( ( cl2 1 1 ti.
Estimated date of completion/inspection: 6 - / - 0 _ k - ' ..
CONTRACTOR APPLICATION • FEE SCHEDLLE , :'
Job no: // • Fee Max
Business name: /` N ZfAt !G 1�2dit C Co 'T N C Description
New residential - single or multi - family per
Address: po c G S dwelling unit Includes attached garage. Qty. (ea.) Total no. insp
I /L
City: () (4 Gt // 7 I Star k / I ZIP: 2(�6 t2 Service included:
Phone: a,p.0 -1ei 1 s- I Fax: 7L{ 671'7 E -mail: 1000 sq. ft. or less 4
CCB no.: 10 9 g TO I Elec. bus. lic. no: ?,i ^ f 2 c Each additional 500 sq. ft. or portion thereof
� Limited energy, residential 2
City /metro lic. no.: 7 O .� • Limited energy, non residential 2
/��`'���,,tp � Each manufactured home or modular dwelling
Signature of electrician (required) Date t. /6 07 Service and/or feeder 2
Sup. elect. name (print): ) 1/:"(-. -t / 1(.... License no: ay /s Services orfeeders — installation,
{ ' PROPERTY :OWNER alteration or relocation:
200 amps or less 2
Name (print): A.� �� 1- i 201 amps to 400 amps 2
401 amps to 600 amps . • 2
Mailing address: _ 1 ) 601 amps to 1000 amps 2
City: : Fax: State: 'ZIP: Over 1000 amps or volts 2
�
Phone: E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - . .
which is intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
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 I lf6 g'S 2
City: I State: • 'ZIP: B. Fee for branch circuits without purchase ` /O qs 2
of service or feeder fee, first branch circuit: ( 7
Phone: Fax: E -mail:
Each additional branch circuit:
I LAN`' ill (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: Y
-
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other: Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ �G
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ Visa ', MasterCard 111904 I expires if a permit is not obtained Plan review (at _ %) $
' Credit card nu .5 L i • b 0 0 . T-1 c / 3 /- " D� .-- 3 q 180 days after it has been State surcharge (8 %) $ / d a
Expires accepted as complete. TOTAL $; 7 + .
. � , Name of car ho r as s own on credit card I�
Cardholder ipature Amount 440 -4615 (6/00 /COM)
Electrical Permit Fees: Limited Energy Pees: ..
•
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 1, 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 n 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 F 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 Other
601 amps to 1000 amps $240.60 2 I
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 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.
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 I $46.85 n HVAC
Each additional branch circuit 3 $6.65
Miscellaneous Li 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 n
Medical
Each additional inspection over
the allowable in any of the above n Nurse Calls
Per inspection $62.50 _
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: n Protective Signaling
Enter total of above fees $ _ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee licenses are required. Licenses are required for all other installations
See `Plan Review r" section on $
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
is \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
�f BUP
Received - A 1 O O Date Requested s AM PM BUP
Location / -31/ It /20 47/ Suite MEC
Contact Person 6-P4.2 Ph ( ) 5-15-- / /b PLM
Contractor 91 ph ( ) SWR
BUILDING Tenant/Owner ELC "3 g �
Footing
•
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: % � a SIT
Post & Beam o ry p
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation 41► NT*
Drywall Nailing �� �pr — ��� ' ', , � � '�► j �' ��� j t � ` �-,
L"'��_���r■�`
Firewall
Fire Sprinkler
Fire Alarm ���� ,•�
Susp'd Ceiling �'v�'1 to ea.
Roof
Other: - _\
Final 1 � i LI 6.4
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
•
Rain Drains
Catch Basin / Manhole
Storm Drain _
Shower Pan � • � -� '. w'
Other: - - - T
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PAS PART FAIL
CTRIC L
Service
Rough -In
UG /Slab
Low Voltage /'I"
Fire Alarm
Reinspection fee of $ required before next inspection. ' -∎ ity Hall, 13125 SW Hall Blvd.
•41110 PAR i,W11t►
SITE Please call for reinspection RE: t. "enable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date, $ . 3 ' 0 _5 Inspe r 6 r -.� Ext
Other:
Final J On NOT REMOVE this inspection record f om th ob site.
PASS PART FAIL J J Y ,