Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00672
4IIi4 b SW DEVEL 97223 (503) 639-4171
DATE ISSUED: 12/6/00
PARCEL: 1S126C0-00100
SITE ADDRESS: 09225 SW HALL BLVD E
SUBDIVISION: ZONING:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of 15 branch circuits for new dental office.
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: 14 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:
MENASHE, R BARRY GARNER ELECTRIC
621 SW ALDER, STE 605 21785 SW TUALATIN VALLEY HWY S
PORTLAND, OR 97205 ALOHA, OR 97006 -1248
Phone: Phone:
591 -1320
Reg #: LIC 121159
SUP 3707S
ELE 34 -305C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 12/6/00 $139.95 2720000000( Elect'I Service
5PCT CTR 12/6/00 $11.20 2720000000(
Total $151.15
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 cop of these r es or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE ISS ED BY: z ' L L
•
OWNE I STALLATION ON
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 N'O: 7075
•
Call 639 -4175 by 7:00pm for an inspection the next business day
FROM : GARNER ELECTRIC FAX NO. : Dec. 05 2000 02:29PM P1
a
,.1: A
CITY OF TIGARD . Electrical Permit Application Plan Check
13125 SW HALL BLVD. Recd By 4-,e
TIGARD OR 97223 Date Recd /a -5 ao
Phone (503) 639 -4171, x304 Date to P.E.
Date to DST
Inspection (503) 639 -4175 'Print of Type Permit# a- do } - erg!) 74.
Fax (503) 598-1960 Incomplete or illegible will not be accepted Calle ..
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business)' M. 'S \r-.„O.‘t‘:h c p `i:,�;' Service included: Items Cost Sum 4, Address 9 ate. % . k.1 _. \--VIA-IL e�i,,, n k 4a. Residential - per unit
City /State /Zip S S. � 0.Cf --X- s�„',Z 1000 sq. ft, or less $ 117.75 4
acn additional eoo sq. ft. or
portion thereof $ 26.25 1
Commercial Residential ❑ Limited Energy $ 60.00
Each Manned Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders •
information for COT data base). Installation, alteration, or relocation
Electrical Contractor G t IV,..r _ € . c. s: T e... Cr- 200 amps or less $ 64.25 2
Address ".V1 .U.. -. G1y G 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
�c
City {a1,�.t�. State CZ CZ Zip 9`l d 3c, 601 amps to 1000 amps $ 192.50 2
Phone No. C, 4`? - `-F 0-___ . Over 1000 amps or voile $ 353.75 2
Job No. Reconnect'only $ 53.50 2
Elec, Cont. Lice. No. 4- ."10 . Exp_Date ' .ac. Temporary Services or Feeders
OR State CCB Reg. No. - 1 ./ Exp.Date - Installation, alteration, or relocation
COT Business Tax or Metro No,
� � c) E , ► 200 amps or less $ 53.50 2
, r / ,.. - te 201 amps to 400 amps
5 80.25 2
Signature of Supr. Elec'n �' , 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
License No. '`I O`i S Exp.Date see "b" above.
Phone No, CL{ - - 4t . , 4d. Branch Circuits
New, alteration or extension per panel
a) The foe for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
b) The fee for branch circuits
Address without purchase of service
City State Zip or !ceder fee,
Phone No. First branch circuit I $ 37.50 "? Q
Each additional branch circuit i 4- $ 5,35 '1 lk y,q 4
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 circalt(s) or a limited energy
• (if required):* panL alteration or extension $ 60.00
3. Plan Review section
(' Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 58. 4f. Each additional inspection over
4 or more residential units in ono 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. Enter total of above fees $ _ _
W Submit 2 sets of plans with application where any of the above apply. 5 °h Surcharge (.05 X total fees) $
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED SubroG4l S
IS NOT COMMENCED WITHIN 180 DAYS. OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS Trust Account # /39,
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due // atO S ; VA _ ___
• is \dsts\forms \elcctric.doc A/57, / 5-- 1_53i-----
CITY OF TIGARD BUILDING INSPECTION DIVISION {> S
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
MST
BUP
Date Requested 3' ' AM PM BLD
Location � 1 ' 5 h R/, d Suite MEC
Contact Person Ph . ') - C-4k I/54 PLM
Contractor L./-q Q�la%�2 � .� �cl'iC� Ph SWR
Tenant/Owner
ELC 6 ' 2 �'
-
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
C
•
rawl 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
PLUMBING ,.
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
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Final
PASS ART FAIL
Service
Rough In
UG /Slab
Low Voltage
Fire larm
- ASS - ART FAIL
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 Date Inspector Ext
3 _ . - / Inpo �,� x t _
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.