Permit CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00337
d 111 DEVELOPMENT r
O (503) 639-4171
DATE ISSUED: 06/27/2001
PARCEL: 1S135BC-00201
SITE ADDRESS: 10765 SW GREENBURG RD
SUBDIVISION: ZONING: C -
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (1) branch circuit. Job 29460
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: 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:
BELANICH, ROGER M BECK ELECTRIC INC
BY SOUTHLAND CORP 9318 SE CHURCH ST
PO BOX 711 CLACKAMAS, OR 97015
DALLAS, TX 75221
Phone: Phone: 656 - 7396
Reg #: SUP 1326S
LIC 00002629
ELE 3 -5C
FEES Required Inspections
Type By Date Amount Receipt Elect'l Final
PRMT CTR 06/27/2001 $46.85 2720010000(
5PCT% CTR 06/27/2001 $3.74 2720010000(
Total $50.59
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 d irect questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Permit Signature: � Issued By: j atr4......,
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: ! } _- gir 's I / DATE:
LICENSENO: ./ - `S
Call 639 -4175 by 7:00pm for an inspection the next business day
•
N.,
r
Electrical Permit Ap i lication •' n i ,:
�1
� . Date received: r� 0 7 Permit no.: CZL2, /-
A L..: :•1 II. , City of Tigard t 6 Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigar• , ; ' ' 7223 Date issued: B ' Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval:
. � ` � � -, _,'s � 7 ,� > . TYPE OF PEIt1VI1 ; � .> , ., . ... , -. , - • - ,
Ci 1 & 2 family dwelling or accessory )(Commercial/industrial ❑ Multi - family ❑ Tenant improvement
0 New construction Cl Addition/alteration/replacement ❑ Other: ❑ Partial
.`., c4. • '. �:? :'- JOB: SITE:INFORMATION t ', ^•, .-;:•,,,,,.•,
Job address: f 0 51,4) ( free, li•c,tr, ,2d Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: Description and location of work on premises: / Y
Estimated date of completion/inspection: .
' . :, CONTRACTOR •-k x - ' ", '. F ' :FEE SCHEDL><E:` ? _
Job no: a9 tf 4On Fee Max
Business name: Bec..f c, Description Qty. (ea.) Total no. insp
, / / New residential - single or multi- family per
Address:
q3/' J CJt•¢ -L rG dwelling unit. Includes attached garage.
city: 'c.... J a G K R vi/I S I State: o ZIP: 970 is Service included: 1000 sq. ft. or less 4
Phone: (0510 -72,9 Fax: (� Y. 7 I E -mail:
Each additional 500 sq. ft. or portion thereof
CCB no.: „? I Elec. bus. lic. no: 3 5 .. c
_ Limited energy, residential • 2
City/metro lic. O.: ;., - Limited energy, non- residential 2
�i 'V Each manufactured home or modular dwelling
Sign turre sup/ sing electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): W pCj • i . T. i v l License no: 1 7j�(p - 5 Services orfeeders— installation, •"• t:;, :PROPERTY O ; '': ' • 00 amps or less ocahon. 2
alt
2
Name (print): '7 — 11 S-1--cNre_ 201 amps to 400 amps 2
Mailing address: /) 7 / Su} (� ,-g /o.(. r-q 1
401 amps to 600 amps 2
. J 601 amps to 1000 amps 2
City: 7' e,c, rd I State: 0/2-I ZIP: r1 712 ‹ � Over 1000 amps or volts • 2
Phone: ` I Fax: I E -mail: Reconnect only t
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:
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
— y . ENGINEER''% !'y= j'' axf, ~ 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: of 1 2
Phone: Fax: E -mail: Each additional branch circuit:
-
'` Misc. Serviceorfee
PLAN': REVIEW (PIease_ clieck�:alltttliat apPl3`)' Y. �• ( ):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 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 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other. Per inspection + + - 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 $
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 3 . 7
Expires accepted as complete. TOTAL $ `�()• •
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00 /COM)
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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 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 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 n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 Systems*
201 amps to 400 amps $106.85 2
•
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 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. ri 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 FT Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
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without purchase of service / n Fire Alarm Installation
or feeder fee. / $46. Y [O �5
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First branch circuit HVAC
Each additional branch circuit $6.65
Miscellaneous n 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'
Each additional inspection over
❑ Medical,
the allowable in any of the abc.e Nurse Calls
Per inspection $62.50
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Per hour $ 62 . 50 ❑
In Plant $73.75 Outdoor Landscape Lighting
•
Fees: n Protective Signaling
Enter total of above fees $ n Other ' . '
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $ ..
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i:\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
BUP
Received Date Requested /6 /2- AM PM BUP
Location / D 7 (o bv4 Suite MEC
Contact Pers• • Ph ( ) PLM
Contractor ` _ s
_ ._ - ..• 3 5 Ph ( ) & _" 7 �3 � � SWR
BUILDING Tenant/Owner — 2
•
ELC c ) /'"ov J 7
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler o Y14 e
Fire Alarm fc) t J(
Susp'd Ceiling
e
Roof r . . •
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
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
, ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date /t Inspector . _ �� Ext
Other: V
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL