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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2001 -00494 'who it , DEVELOPMENT SERVICES (503) 639-4171 DATE ISSUED: 10/9/01 13125 SW Hall Blvd., PARCEL: 1S136DD-01400 SITE ADDRESS: 06855 SW BAYLOR ST SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT : 002 JURISDICTION: TIG Project Description: Installation of temporary power pole. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 1 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: 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: ESLINGER BUILDERS DAVID JEROME ELECTRIC 11575 SW PACIFIC HWY PO BOX 751 TIGARD, OR 97223 HILLSBORO, OR 97123 Phone: 503 - 620 -9515 Phone: Reg #: 614: SUP 2877S ELE 34 -119C FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT CTR 10/9/01 $66.85 2720010000( Elect'I Final 5PCT CTR 10/9/01 $5.34 2720010000( Total $72.19 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 -0080. You may obtain copies of these rules or direct questions to Permit Signatur L k � 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: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: 6i-1 (pa . DATE: LICENSE NO: • Call 639 -4175 by 7:00pm for an inspection the next business day Electrical Permit Ap l ,� /�� m Date received: F IGJL! /lam Permit no -i _•,, 9 , ,. Ike 4 r• ) II ! A City of Tigard 9 t =l Projeet/appl.no.: Expire date: r y. � City of Tigard Address: 13125 SW Hall Blvd, Tiga- OR Date issued: argil/, 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 ❑ CommerciaUindustrial ❑ Multi - family A ❑ Tenajt i provement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: latli ,:p iral at tr ` ' ` JOB SITE INFORMATION . Job address: , 855 " SL OPINIMIEM Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: Block: Subdivisi •. : Project name: Description and location of work on premises: j - 4 •, IIIMMIII Estimated date of completion/inspection: r`k r CONTRACTOR APPLICATION ':. FEE SCHEDULE Job no: l k---•\ Fee Max Business name: 2) A fie. -p P E t ec`ht-t Description Qty. (ea.) Total no. insp New residential - single or multi - family per Address: b C) gliiirMininillill dwelling unit. Includes attached garage. IIIIMMEMBIIMIIIII State 111 ZIP: I Service included: • 1000 sq. ft. or less Phone: ,, j 1 `l Fax. �`� �� Each additional 500 sq. ft. or portion thereof ___ CCB no.: 6 S ( Elec. bus. lic. no: ...3` (l. Limited energy, residential ___ 2 City /metro lic. no.: Ai A Limited energy, non- residential ___ 2 �'/ 10'13 —C-) ' Each manufactured home or modular dwelling Signature of supervising elect 1 required) Date Service and/or feeder ■■ 2 Sup elect name (print): V j t la . err License no:, E3 i iii... Services or feeders — installation, 1111■ alteration or relocation: z ; ,r ' ' 'PROPERTY OWNER ' ` 200 amps or less 2 r � • ( 201 amps to 400 amps ___ 2 — Name (print): s ��, p oil. t... k i O1 amps to 600 amps ___ 2 Mailing address: �� LII ''- 01 amps to 1000 amps ___ 2 � A ► i ZIP: ' 2dZ Over 1000.amps or volts ___ 2 Phone: , - di - `S - 1N LErigniainpril 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: NIL"' ORS 447, 455, 479, 670, 701. 200 amps or less A 201 amps to 400 amps __ 2 _ Owner's signature: /" Date: I 401 to 600 amps M_ 2 ' ENGINEER - 2 ` 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: State: • 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 .(Serviceorfeedernotincluded): MIN ❑ Service over 225 amps- commercial ' ❑ Health -care facility Each pump or irrigation circle 2 ❑ Service over 320 amps- rating of I &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 ___ Submit sets of plans with any of the above. Investigation fee 'The above are not applicable to temporary construction service. Other ,r Permit fee $ .• •` Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application %) $ (at ( _ review a ^�. ❑ Visa ❑MasterCard expires if a permit is not obtained Plan rev 3 . Credit card number: / / within 180 days after it has been State surcharge (8 %) $ - Expires accepted as complete. TOTAL $ � - Name of cardholder as shown on credit card $ Cardholder signature Amount 440-4615 (6/00 /COM) i • 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 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 I 1 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 I I 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, I see "b" above. Audio and Stereo Systems • Branch Circuits 0 Boiler Controls New, alteration or extension per panel a) The fee for branch circuits with purchase of service or r7 Clock Systems feeder fee. Each branch circuit $6.65 2 n Data Telecommunication Installation b) The fee for branch circuits without purchase of service rI Fire Alarm Installation or feeder fee. • First branch circuit $46.85 In HVAC Each additional branch circuit $6.65 Miscellaneous n Instrumentation (Service or feeder not included) • Each pump or irrigation circle $53:40 II Intercom and Paging Systems Each sign or outline lighting $53.40 Signal circuit(s) or a limited energy n Landscape Irrigation Control panel, alteration or extension $75.00 • Minor Labels (10) $125.00 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 ❑ Outdoor Landscape Lighting I. Fees: n 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 BUILDING INSPECTION DIVISION MsT 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 7 BUP • �`. Date Requested 7.0 —/ AM PM BLD / _ Location gL.S J Suite MEC Contact Person Ph PLM Contractor let I & ' Ph Co F S7 /7 SWR BUILDING TenanAwner • ELC 2"0 av 4g 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 `� /I . '� t W "Ma Bi _ Firewall Fire Sprinkler po r l y _ Fire Alarm !,1 `' Susp'd Ceiling Roof Misc: r.1 .�_/ i;r■ • Aol _ Final PASS PART FAIL PLUMBING, Post & Beam Under Slab Top Out 1 Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICA • Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service !EgT7 .. 7 Fire Alarm Final PART FAIL 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 Approach /Sidewalk • Other Date fl 4i Inspector Ext Final V P PASS PART FAIL DO NOT REMOVE this inspection record from the job site.