Permit • CITY O,F T ELECTRICAL PERMIT
A.A0 & DEVELOPMENT SERVICES PERMIT #: ELC99 -0119
_ 1, -� I � _13125 SW_HaII.BIvd., Tigard,_OR_97223 (503)_639- 4.17.1 _ _ _ __ DATE ISSUED: 3/01/99
PARCEL: 2S103CB -02000
SITE ADDRESS...:12220 SW JAMES ST
SUBDIVISION °WTLLAMETTE ZONING:R -4.5
BLOCK LOT . ° JURISDICTION: URB
Project Descri pt i on a Electrical addition
- --- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 - 200 amp : 0 PUMP /IRRIGATION • 0
EACH ADD' L 500SF...: 0 201 - 400 amp........: 0 SIGN /OUT LINE LTG,.:' 0
. LIMITED ENERGY 0 401 - 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 - 200 amp ° 1 W /SERVICE OR FEEDER: 0 PER INSPECTION : 0
201 - 400 amp : 0 ist W/O SRVC OR FDR.: 0 ' PER HOUR...........: 0
401 - 600 amp ° 0 EA ADD'L BRNCH CIRC: 0 IN PLANT ° 0
601 - 1000 amp......: 0 PLAN REVIEW SECTION --
1000+ amp /volt 0 > =4 RES UNITS ) 600 VOLT NOMINAL..:
Reconnect only 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
CROUCH, FRED & KAREN type amount by date recpt
12220 SW JAMES ST PRMT $ 60.00 B 03/01/99 99- 313345
TIGARD OR 9722,.?, SPCT $ 3.00 B 03/01/99 99- 313345
Phone #:
Contractor:
FRED CROUCH .$. 63.00 TOTAL
12220 SW JAMES ST
REQUIRED INSPECTIONS
TIGARD OR.97223 Rough -in Elect'l Final
Phone #: Elect'l Service
Reg #...
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952-m1-1987. You may obtain a copy
of these rules or direct questions to by calli 503)246 -1987.
Permittee Signature: Issued By: . i,-"C:/
OWNER INSTALLATION. ONLY
The installation is being made on prop- ty I own which is not intended for
sale, lease., or rent.
OWNER'S SIGNATURE: DATE :,> 3—/ 7
CONTRACTOR INSTALLATION ONLY
•
SIGNATURE OF SUPR. ELEC' N : DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++'++++++++++++ + + + + + + + + + + + + + + + + + + ++ + + + + ++ + + + ++
•
-CITY TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By d..roliJ
TIGARD -OR -97223 Date Rec'd 3 -I -° I`I
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # EX :11 I`1'
Fax (503) 684 7297 Incomplete or illegible will not be accepted Called
1. Job Address: / 4. Complete Fee Schedule Below:
//
Name of Development LN'' / !.. / G /k e_ fle-- Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum
Address J' a 0 $ tv �J T !1 n e-r S? p • 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip T 6 -6-4,d___ � � l U 4. 970a 3 Each additional 500 sq. ft. or
l portion thereof $25.00 1
Commercial ❑ Residentia
�� >, Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor Installation, alteration, or relocation
Address 200 amps or less / $60.00 (QD , 2
201 amps to 400 amps $80.00 2
City State Zip 401 amps to 600 amps $120.00 2
Phone No. 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. Exp.Date Reconnect only $50.00. 2
OR State CCB Reg. No. Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
201 amps to 400 amps Signature of Supr. Elec'n 401 amps to 600 amps $1 2
Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No.
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
a , v i purchase of service or
Print Owner's Name /' „di- feeder fee.
Address / o 5 - W - /j A-1 . J' J Each branch circuit $5.00 2
b) The fee for branch circuits
City T g .of r. State O 2- Zip 97 - c 3 without purchase of
Phone No. ' 9 - 7 4. } service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature ..__.ef- Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: p°
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ S`
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # (a3.0
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION Msr /
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
y t� BUP
Date Requested ( 2A / AM PM BLD
Location ( -L'C l' S s'}° Suite MEC
Contact Person Ph ,5 - r2 (03 PLM
Contractor Ph SWR l
BUILDING:;f�,°.-: .`- Tenant/Owner ELC qq -on •
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 l "' /f7L 91 ° �35�
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL &L2 `" - ® /9 - - A,
PLUMBING` Fey
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL , a "_, ,
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
-
PASS PART FAIL
•
is
Roug In •
UG /Slab
Low Voltage
Fire Alarm •
4 PART 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
Other - 9? Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.