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Permit
CITY OF T I GA R D ELECTRICAL PERMIT PERMIT #: ELC2000 -00647 , c �� DEVELOPMENT I Tigard, SERVICES 639 -4171 DATE ISSUED: 11/28/00 — 13125 PARCEL: 25101 AB -01300 SITE ADDRESS: 07315 SW HERMOSO WAY SUBDIVISION: HERMOSO PARK ZONING: MUE BLOCK: LOT : 003 JURISDICTION: TIG Project Description: Reconnect only. 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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: LAURENS, MICHAEL F EVANS ELECTRIC INC PO BOX 3770 10150 SW NIMBUS AVE SUNRIVER, OR 97707 E -6 TIGARD, OR 97223 Phone: Phone: 639 -5572 Reg #: LIC 001048 SUP 4225S ELE 34 -405C FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT CTR 11/28/00 $66.85 2720000000( Elect'I Final 5PCT CTR 11/28/00 $5.35 2720000000( • Total $72.20 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable lam. 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 OUNC at (503) 246 -1987. PERMITTEE'S 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 1 I I 1....,, ' , °" , Electrical Permit Application _ �ti . C4 Date received: Permit no.: � C, pZUl1 b — -- : ��I11� City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receiptno.: 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 ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION 2 { Job address: 43 j ..5 Sut) - ({e11,r10 SO t,,7gt Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: I Subdivision( Project name: I Description and location of work on premises: Estimated date of completion/inspection: CONTRACTOR APPLICATION FEE SCHEDULE - Job no: Fee Max Business name: tog u i t_: L • Description Qty. (ea.) Total no. insp New residential - single or multi- family per Address: (o ( 't 5(A) tV : A-v/};,g 4 J.,- dwellingunit .Includesattachedgarage. City: ° t tsso I Statev_ I ZIP: p-22.3 Service included: Phone: (, 3 ?- S 5 I Fax: I E -mail: 1000 sq. ft. or less 4 �{ (cl (o I Each additional 500 sq. ft. or portion thereof CCB no.: j 0 Elec. bus. lic. no: `I `-10S� Limited energy, residential 2 City /metro lie. no.: Si 4'3 Limited energy, non- residential 2 S € '9 9ejf -fj Arie S76>V41--iect Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2 Sup. elect. name (print): License no: Services or feeders — installation, alteration or relocation: PROPERTY OWNER 200 amps or less 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: 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, or relocation: 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 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 inspection 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 $ k5 ❑ 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 %) .... $ S, 3 .5 Expires accepted as complete. TOTAL $ 7a . a20 Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00 /COM) 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 y 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 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 n Vacuum Systems • 201 amps to 400 amps $106.85 2 401 amps to 600 amps $160.60 2 f�I Other 601 amps to 1000 amps $240.60 2 I I Over 1000 amps or volts $454.65 2 Reconnect only / $66.85 6, 4, , ,e3" 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 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 Each additional branch circuit $6.65 pi Miscellaneous n Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 Ti 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" n 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 w Fees: Ti Protective Signaling Enter total of above fees $ 4 G' , es n Other . 8% State Surcharge $ -5' 3_5 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 $ 2 . AO 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 Plan Check # 13125 HALL BLVD. Electrical Permit Application Rec'd By ` TIGARD OR 97223 Date Rec'd Date to P.E. Phone (503) 639 -4171, x304 Date to DST Inspection (503) 639 -4175 Print of Type Permit # Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections per permit allowed Name (or name of business) Service included: Items Cost Sum Address 1 3 / S s ln/ 12. PIA-0 S d (A J 1 4a. Residential - per unit T 1000 i 0 1 Each additional it or less $ 117.75 4 City/State /Zip t --" � Each additional 500 sq. ft. or portion thereof $ 26/5 1 Commercial Residential ❑ Limited Energy $ 60.00 Each Manufd Home or Modular 2a. ntractor installation only: Dwelling Service or Feeder $ 72.75 2 (Prioyy o permit issuance, applicants must provide contractor lic se 4b. Services or Feeders inf fmation for COT data base). � stallation, alteration, or relocation ectrical Contractor E',4.,vS , ..7e ,/ ivr r� 200 amps or less $ 64.25 2 Address kw 50 .1`tt/ /1. ,,- .6,,,s AT/v._ 12 201 amps to 400 amps $ 85.50 2 � 401 amps to 600 amps $ 128.50 2 City , �/ State IO Zi � 5 7'`f'' p 601 amps to 1000 amps $ 192.50 2 Phone No. C;�_ - .5572. ver 1000 amps or volts $ 363.75 2 Job No. connect only / $ 53.50 53 . S 2 Elec. Cont. Lice. No. 3Ly-- O < . Exp.Date 4_) /o 4c. emporary Services or Feeders OR State CCB Reg. No, /t1 '15,C Exp.Date .J/ © / Ins Ilation, alteration, or relocation COT Business Tax or Metro No. c -/ ' ''i Exp.Date 12 /0i) 00 amps or less $ 53.50 2 201 amps to 400 amps $ 80.25 2 401 amps to 600 amps $ 107.00 2 Signature of Supr. Elec'n"---- .t/ / Over 600 amps to 1000 volts, i / see "b" above. icense No. L/(a?- S Exp.Date /Cya/ one No. (;U S, 5`5'7,_ 4d. Branch Circuits New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or feeder fee. Print Owner's a Each branch circuit $ 5.35 2 Address b) The fee for branch circuits without purchase of service City State Zip or feeder fee. Phone No. First branch circuit $ 37.50 Each additional branch circuit $ 5.35 The installation is being made on property I own which is not 4e. Miscellaneous intended for sale, lease or rent. (Service or feeder not included) Each pump or irrigation circle $ 42.75 Owner's Signature Each sign or outline lighting $ 42.75 Signal circuit(s) or a limited energy 3. Plan Review section (if required):* panel, alteration or extension $ 60.00 Minor Labels bels (10) $ 497786• Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over OD •DD 4 or more residential units in one structure the allowable in any of the above Service and feeder 225 amps or more Per inspection $ 50.00 Per hour $ 50.00 System over 600 volts nominal In Plant $ 59.00 Classified area or structure containing special occupancy as described in N.E.C. Chapter 5 5. Fees: 5a. ter total of above fees $ c.% . 50 * Submit 2 sets of plans with application where any of the above apply. 8;4 /o Surcharge (.85 total fees) $ y .. S" Not required for temporary construction services. Subtotal •e8 $ 5b. Enter 25% of line 5a for NOTICE Plan Review if required (Sec. 3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # 7, ' °2 0 AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 57 .. 7 5( is \fists \forms \electric.doc / , X02_, CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 6394175 Business Line: 639 -4171 Date Requested // 3 U AM PM BLD Location 1/3) S f /°Y /L( 650 (A Suite MEC . Contact Person , / Ph �j 3 `. s } Z PLM v Contractor � Ph SWR r ELC ? ov -cam ' c/ 7 BUILDING ' Tenant/O ner P I n c S - r` i � � Sf Retaining Wall {Irf / 1�`.,9 /.e pi 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 ( -/e Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling - Roof Misc Misc: Final PASS PART FAIL 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 Service co? 4e ,/ , Rough In UG /Slab .., Low Voltage Fire Alarm F' A PART FAIL SITES _ 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 V i Inspector • xt Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.