Permit A ,, Y CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00421
�F . �i 6 DEVELOPMENT SERVICES DATE ISSUED: 8/16/01
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S114A0 -01500
SITE ADDRESS: 17005 SW 92ND AVENUE
SUBDIVISION: ZONING: R -12
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (1) 200 amp or less service and (2) 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: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 2 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:
TIGARD, CITY OF WILSONVILLE ELECTRIC INC
13125 SW HALL PO BOX 845
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: Phone: 503 - 638 -5353
Reg #: SUP 3854S
LIC 75752
ELE 3 -307C
FEES Required Inspections
Type By Date Amount Receipt Underground Cover
PRMT CTR 8/16/01 $93.60 2720010000( Elect'I Service
Elect'I Final
5PCT CTR 8/16/01 $7.49 2720010000(
Total $101.09
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 approv is. Thi •ermr ill expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATT ION: Oregon -w requi -, you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 -001 -4 through 0 95, 001 - 0080. You may obtain / copies of these -rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Permit Signatur= Issued By: �� , . / , I i
OWNER INSTALLATION ONLY .
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: __ 7 .---h ∎ d DATE:
ON TRACTO, STALLATIQN ONLY
SIGNATURE OF SUPR. ELEC' / DATE:
LICENSE NO: 3s"5 5 Call 639 -4175 by 7:00pm for an inspection the next business day
•
4 P
Electrical Permit Application
Date received: ff /G d/ Permit no.: g/�app/i DD y 4
.."+rt,'I„ j City of Tigard Projectlappl.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 . 1Commercial /industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/rep)acement ❑ Other: ❑ Partial
. JOB SITE INFORMATION`
Job address: 9 . O 2 p' fAci Bldg. no.: Suite no.: • Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: [Description and location of work on premises: ^1,41 ..r, ei ft ee„i
Estimated date of completion/inspection:
\.:..' • , ' CONTRACTOR. APPLICATION FEE SCHEDULE •
Job no: Fee Max
Business name: _e'.-- _ Description Qty. (ea.) Total no. insp
- -S._ ' _ __. • New reisidental - single or multi-family per
Address: / 1 t7 V A.� r dwelling unit. Includes attached garage.
City: L n State: # , ZIP: 4•�1, i ") o Service included:
Phone: to ;y .,,, . E -mail: Fes' 1000 sq. ft. or less 4
CCB n0 . �� Free. b us. I1C. no: Each additional 500 sq. ft. or portion thereof
�� 0 C... Limited energy, residential 2
City /m :4rlic. no • i ' Limited energy, non residential 2
` _ .. Ai —ti , s Each manufactured home or modular dwelling
F
/ gnature of supervis �_• electr S ian ' egw ; �' � d) Date Service and/or feeder 2
Sup. elect name (punt) , R 1 7 o License no: I
Services or feeders — installation,
alteration or relocation:
-- , -• ' , `--; *- PROPE OWNER -H— - - 2 00 amps or less 1. 2
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: 1 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:
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 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/lighting plan ❑ Other: Per inspeciion I 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 $
❑ 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 %) .... $ -C
Expires accepted as complete. TOTAL $
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
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total sl, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ri Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 n Burglar Alarm
Limited Energy $75.00
Each Manuf'd Home or Modular I I Garage Door Opener
Dwelling Service or Feeder $90.90 2
•
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation �v
200 amps or less / $80.30 (� 0 • g0 2
201 amps to 400 amps $106.85 2 I I Vacuum Systems* ,
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 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
200 amps or less $66.85 2 Fee for each system $75.00
201 amps to 400 amps $100.30 2 (SEE OAR 918 - 260 -260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above.
Branch Circuits n Audio and 'Stereo-Systems
New, alteration or extension per panel ":,
I
a) The fee for branch circuits Boiler Controls
with purchase of service or
feeder fee. •q 3 I I Clock Systems
Each branch circuit (d--� $6.6 2
b) The fee for branch circuits I I Data Telecommunication Installation
without purchase of service
or feeder fee. r7 Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65
HVAC
Miscellaneous
(Service or feeder not included) ri Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 I I Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00
Minor Labels (10) $125.00 I I Landscape Irrigation Control
Each additional inspection over Ti Medical
the allowable in any of the above
Per inspection $62.50
Per hour $62.50 Ii Nurse Calls
In Plant $73.75
ri Outdoor Landscape Lighting
Fees:
�v® / r7 Protective Signaling
Enter total of above fees $ 93
8% State Surcharge $
I I Other
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ /p, G (71 Fees: ,
El Trust Account # Enter total of above fees $
8% State Surcharge $
Total Balance Due $
is \dsts \forms \elc- fees.doc 10/09/00
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
/Z/3 a BUP
Received Date Requested AM PM BUP
Location 7 t ' e 2 Suite MEC
Contact Person j. f r Ph ( ) X } �' PLM
Contractor l!1/! c Ph .>% C1 1 " ° 5 353 SWR
BUILDING Tenant/Owner ELC (WD /-ge9°'�
Footing
•
Foundation ELC
Access: _
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 1e�i12iov / tze�l SIT
Post & Beam
Shear Anchors a , '�'J.) �� - / yr
Ext Sheath/Shear "c ` Yl
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
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
PASS PART FAIL
ICAL
-rvice
V •.•` -In
. •
Low Voltage
Fire larm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date C ® � �o Z Inspector •
' �.� Ext
Other:
Final DO NOT REMOVE this job site. inspection record from the
p 1
PASS PART FAIL