Permit v CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00022
J. t •�4`� DEVELOPMENT SERVICES DATE ISSUED: 1/22/02
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135BC-00201
SITE ADDRESS: 10765 SW GREENBURG RD
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Job No.19533
Roof Outlet
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 ROSE CITY ELECTRIC CO INC ,
BY SOUTHLAND CORP 4012 NE CULLY BLVD
PO BOX 711 PORTLAND, OR 97213
DALLAS, TX 75221
Phone: Phone:
Reg #: 207)-61f47S
LIC 3567
ELE 26 -113C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 1/22/02 $46.85 2720020000( Elect'I Final
5PCT CTR 1/22/02 $3.75 2720020000(
Total $50.60
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
r
P ermit Signature: 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: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
L.. .
` ° Electrical Permit Application -
Date received: Permitn.. aOp GNU zZ
. ma y, ;. :/ I! City of Tigard Project/appl. no.: Expire date: . .
•
Address: 13125 SW Hall Blvd, • 0 : °' 10 923
City of Tigard Date issued: - - By: . Receipt no.:.•... .
Phone: (503) 639 -4171
Fax: (503) 598 -196 l of •
Land use approval, Case f i l e no.: _ . ... . Payment type: . `
I �� - --
.airlilf.. PERMIT -
❑ 1 & 2 family dwelling or accessory s kor i • mi. cial/industrial ❑ Multi - family 0 Tenant improvement •
❑ New construction &t . dition/alteration/replacement ❑ Other: 0 Partial
JOB SITE INFORMATION .
Job address: 1 Q '7(p 5 (,( (f-(\ U1�t 1 ldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name:.? - I -( ( I Description and location of work on premises: '(O� C) �,C 7
Estimated date of co pletion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: 1 4 J 3 Fee M
Business name: ROSE C T TY • ELECTRIC CO T N C Description . Qty. (ea.) Total no. insp
Address: New residentia - s or multi - family per
40 NE CULLY BLVD dwelling unit. Includes attached garage.
City: PORTLAND I State: OR I Z97213 Service included:
Ph51@3 287 616 4 I l to 3 282 1 46filail:' 1000 sq. ft. or less 4
CCB no.: 3567 Elec. bus. tic. no: 26 113.0 . Each additional 500 sq. ft, or portion thereof
U L y _ Limited energy residential 2
/ t
Clty a hc. . - Limited energy, non-residential 2
=l- ..Adiur4 ' A (// C /p 2--- Each manufactured home or modular dwelling
Signa 're o • supervr : e ec ? ian (requi ed) . . Date Service and/or feeder 2
Sup. elect. name (print): R L Go th am License no: 21 2 7 S Services or feeders – installation,
alteration or relocation:
PROPERTY OWNER • 200 amps or less 2
Name (print): 201 amps to 400 amps . . 2
Mailing address: =
401 amps to 600 amps 2
•
601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I 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:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
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 St ate: — 1 ZIP: B. Fee for branch circuits without purchase S.S
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: I 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc .(Service orfeedernotincluded):
0 Service over 225 amps - commercial' ' ❑ 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,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan O Other. Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other ,�{ 5
Not all jurisdictions Permit fee $ `Z
accept credit cards, please call jurisdiction for more information. N otice: This permit application
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ 3 7 C3
Credit card number. / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $ �• ( c)
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00/COM)
•
Electrical Permit Fees: Limited Energy Fees: 411 I
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 4, 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 Manuf'd 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 n Vacuum 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 n 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, n
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 $46.85 n
Each additional branch circuit $6.65 HVAC
Miscellaneous I I 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 n Landscape Irrigation Control
Minor Labels (10) $125.00
n Medical
Each additional inspection over
the allowable in any of the above Calls
Per inspection $62.50 El
Per hour $62.50
In Plant ;73.75 0 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 $
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 AM PM BUP
Location • Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) 7 SWR
BUILDING Tenan Owner 7 < < ELC °
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: C . � � 55DA. / 0 L SIT
Post & Beam
Shear Anchors -11`) r
Ext Sheath/Shear 1 ' , ✓v ��� -� 1` ` ����
Int Sheath/Shear
Framing
Insulation Pt�c
Drywall Nailing
Firewall %- VA
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
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fir arm
Flnfil' Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PISS PART FAIL
0 Please call for reinspection RE: Ei Unable to inspect - no access
Fire Supply Line /
ADA Approach /Sidewalk Date / f 2 -- Inspect I . ,_�.�. -i C�--� Ext
Other:
Final DO NOT REMOVE this inspection record from th = job site.
PASS PART FAIL