Permit CITY OF TIGARD ELECTRICAL PERMIT
z i DEVELOPMENT SERVICES PERMIT #: ELC99 -0167
pj�� 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 03/23/99
PARCEL: 2S109AD -03300
SITE ADDRESS °. °:14569 SW 130TH AVE
SUBDIVISION •WOODFORD ESTATES Y ZONING:R -7
BLOCK ° LOT °025 '£ JURISDICTION: TIG
Project Description : Electrical alteration
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR •LESS ° 0 0 — 200 amp.......: 0 PUMP /IRRIGATION • 0
EACH ADD'L 500SF ° ° °: 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 SRVG OR FDR.: 1 , PER HOUR ° 0
401 — 600 amp : 0 EA ADD'L BRNCH CIRC: 0 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
DURGIN, ED & JILL type amount by date recpt
14569 SW 130TH AVE PRMT $ 35.00 B 03/23/99 99- 313932
TIGARD OR 97223 SPCT $ 1.75 B 03/23/99 99- 313932
Phone #:
Contractor:.
CURRENT ELECTRIC $ 36.75 TOTAL
PO BOX 19652
REQUIRED INSPECTIONS
PORTLAND OR 97280 Rough —in Elect' 1 Final
Phone #: 245 -5997 Elect'1 Service
Reg #• • : 000469
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 for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those 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 OUNC by calling (5'. i 1987.
Permittee Signature: ✓ , „ ,,1 Issued By: �'
9 .r /
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 INSTALL \ TION ONLY •- - - --
SIGNATURE OF SUPR. ELEC' N : aYk I ( DATE:
LICENSE NO: `! l
+++++++++++++++++++++++++++++++++++++;+++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m° for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITYOF TIGARD Electrical Permit Application Plan Chec
13125 SW HALL BLVD. Rec'd By G at
Date Rec'd ""2-11M
TIGARD OR 97223
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639-4175 Incomplete or illegible will not be accepted Permit # EL-C--/q 7
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 ( (NJ ) N y L iA l (o i-f T Service included: Items Cost Sum
I
Address / 47 / /B :c 6 7 c$ ()J / 3 0 t11 4a. Residential - per unit
City /State /Zip '7' -7 r1 1000 sq. ft. or less q $110.00 4
/ PA 1r d De .. q < aai y Each additional 500 s ft. or
F1
portion thereof $25.00
Commercial ❑ Residential F14 Limited Energy $25.00 1
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all rent licenses) 9 4b. Services or Feeders
Electrical Co,pAraRtor (. l J-ir Y` Yo / r ) PQ • Installation, alteration, or relocation
l! 200 amps or less $60.00 2
Address r clx 41 501 � 201 amps to 400 amps $80.00 2
City t� ?�i2..* . State f? Zip p 7- 2.I q 401 amps to 600 amps $120.00 2
Phone No. 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. I�Yrlgati Ex. Date AIWA Reconnect onl $50.00 2
OR State CCB Reg. No. ' xp.Date # 9 4c. Temporary Services or Feeders
COT Business Tax or Metro Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Su r. Elec'n Cti� C 201 amps to 400 amps $75.00 2
g p 401 amps to 600 amps $100.00 2 3 ( p U 7 S Exp.Date / �/� / 0 Over 600 amps to 1000 volts,
License No. see "b" above.
Phone No. .,2 £/$'- ,'`gq 7
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
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee. S . 0 t)
First branch circuit / $35.00 � 2
The installation is being made on property I own which is not Each additional branch circuit $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 $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 5
Not required for temporary construction services. 5a. Enter total of above fees $
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 # $ '-(4)'-15".•
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 71
BUP
Date Requested AM PM BLD
Location / ( 13 6 f Sca) / 3c 6( 44. < Suite MEC
Contact Person Ph a59 -O « 6 5 --" PLM
Contractor e.,ST E-1-e-e-WT7 L Ph SWR
BUILDING Tenant/Owner ELC • f 9 -av 7
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab - SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall 3 D `, C
Fire Sprinkler [7`
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
PASS PART FAIL
ELECTRICAL
Service
Rough In i
UG /Slab
Low Voltage
Fi e Alarm
RT -1:
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 Lt,
Other Dat c---0 Inspector Ext
Final v
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
6/19/00 Activities for Case #: ELC99 -00167
2:23:33 PM 4:10
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 3/23/99 B RECD DST 3/23/99
ELCA003 Permit created 3/23/99 B DONE DST 3/23/99
ELCA700 Rough -in DST 3/23/99
ELCA730 Elect'I Service - DST 3/23/99
ELCA799 Elect'I Final DST 3/23/99
ELCA500 (F) Issue permit 3/23/99 B PASS DST 3/23/99
ELCA845 Request inspection research 6/8/00 JMT DONE No Hold JMT 6/8/00
ELCA580 Expired by limitation 6/11/00 HAP DONE No Hold AKJ 6/11/00
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