Permit CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00551
u
DEVELOPMENT H PMENT Tigard, ) 639 -4171 DATE ISSUED: 11/7/01
PARCEL: 2S101 AC -01800
SITE ADDRESS: 07585 SW HUNZIKER ST
SUBDIVISION: ZONING: I -L
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (4) 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: 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: 3 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:
MOSTUL, TERRY A + DEBBI C ROBERTS ELECTRIC INC
7585 SW HUNZIKER ST 5759 SW 48TH
TIGARD, OR 97223 PORTLAND, OR 97213
Phone: Phone: V- 244 -7754
Reg #: SUP 3886S
LIC 9388
ELE 34 -23C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 11/7/01 $66.80 2720010000( Wall Cover
Elect! Final
5PCT CTR 11/7/01 $5.34 2720010000(
Total $72.14
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 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
r Electrical Permit Application •
Datereceived: Permit no.: / - ��ls
4, tf?tJ1'' °
�, j j, ;,.I I City of Tigard Project/appl. no.: Expire date:
CityofTigard 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:
.:
:; ,' , .;• -7 • .. ', - = 'TYPE OF PERMIT' °.:- ,.. . f t
0 I & 2 family dwelling or accessory Commercial /industrial ❑ Multi - family 0 Tenant improvement
❑ New construction 0 Addition/alteration /replacement 0 Other: ❑ Partial
' .' JOB SITE, INFORMATION . ' °,c' a .
Job address: 751 5 S' w - , u N 2i (ee,Z, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: Description and location o work on premis -s.
Estimated date of completion/inspection: ' `. E� • f
' CONTRACTOR APPLICATION. :, - ' •: FEE SCHEDULE ;
Job no: Fee Max
Business name: ' • 8 L -72:1 - 5 t— r s-r----`a uz_ &.) c Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Address: 3 S 9 S w L-1 ce .dwelling unit. Includes attached garage.
City: P ZIP: g 72Z 1 Service included:
Fax: ,2414--6,51, -�/ E-mail: o 4, -ma: 1000 sq. ft. or less 4
Phone: �( �{ — � SuF o� Each additional 500 sq. ft. or portion thereof __
CCB no.: i g k Elec. bus. lic. no: S 4 Z 3 C
Limited energy, residential ___ 2
City /metro lic. no.: e - ( Limited energy, non- residential ___ 2
Each manufactured home or modular dwelling
Signature electrician (required) Date f,"�'o Service and/or feeder ..1 2
' r j4 C ,( U A Li cense no: (o Services or feeders - installation,
Sup. elect m
nae (print): i alteration or relocation:
', -•;l PROPERTY OWNER- ' ... 200 amps or less ll 2
Name (print): 201 amps to 400 amps ___ 2
401 amps to 600 amps ___ 2
Mailing address: 601 amps to 1000 amps ___ 2
City: j State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: E - mail: Reconnect only ME_ 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,orrelo ill
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: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: IIIIIII 2
Phone: Fax: E I �_ _ -
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
U. Service over 225 amps- commercial 0 Health - carefacility Each pump or irrigation circle ■
0 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* 1111111 2
0 Building over three stories 0 Feeders, 400 amps or more *Descti . tion:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
Cl Egress/lightingplan 0 Other: Per inspection __
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 $
O 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 %) .... $
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 PERMIT 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 1, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ! I 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
Dwelling Service or Feeder $90.90 2 n Garage Door Opener
Services, or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 n Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 pi 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. n Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n Boiler Controls
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
or feeder fee. i G n Fire Alarm Installation
// /�,//-
First branch circuit / $46. ilk, 0
Each additional branch circuit $6.65 ) �j . G/ 5 n HVAC
Miscellaneous Ti Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125,00
Each additional inspection over n Medical
the allowable in any of the above -
Per inspection $62.50 n Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
•
Fees: (�) n Protective Signaling
Enter total of above fees $ 6- n Other
7
8% State Surcharge $ 3 3"I /,/ 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 $ - 7a,/
•
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
is \dsts \forms \elc- fees.doc 06/07/01
(flY OF TIGARD BUILDING INSPECTION DIVISION • .
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP •
, Date Requested / Z — 1? AM PM BLD
Location 7 S as )44-64-2-1 Suite MEC
Contact Person Ph : ( i PLM
Contractor /�o6Frfs �P/ i a , � 5 e7 5"9 Ph S7:9-- 3 2-3Z SWR
BU1BUILDING Tenant/Owner -;v Ps :c�:. :�;�f,� _ ELC
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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL & � c7 4 7l G
PLUMBING 4iir - -
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
ELECTRICAL ✓
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
mad
y9S 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 — ! — 0/ Inspector co/ ( / Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.