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Permit • CITY OF T I G A R D ELECTRICAL PERMIT PERMIT #: ELC2001 -00007 ,...,4 DEVELOPMENT SERVICES D ATE ISSUED: 1/8/01 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S115BC-05000 SITE ADDRESS: 16505 SW KING CHARLES AVE SUBDIVISION: ZONING: , BLOCK: LOT : JURISDICTION: KIN Project Description: Installation of one branch circuit. Job No. 66065. 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: MRS HARMON TUALATIN ELECTRIC 16505 SW KING CHARLES AVE PO BOX 655 KING CITY, OR 97224 WILSONVILLE, OR 97070 Phone: Phone: 682 -2955 Reg #: LIC 00065650 SUP 3483S ELE 3 -268C , FEES . Required Inspections Type By Date Amount Receipt Elect'I Service PRMT CTR 1/8/01 $46.85 2720010000( Elect'l Final 5PCT CTR . 1/8/01 $3.75 2720010000( • 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 rule -: e Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obta'- copies of these rules . direct questions to OUNC at (503) 246 -1987. !ftmv,, A ., f PERMITTEE'S SIGNATURE 0 I UED BY: 1 f a ' r 4 OWN =R 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 i SIGNATURE OF SUPR. `� ' J . (', _/.4�∎ DATE: U LICENSE NO: c_5( G3 `S • Call 639 -4175 by 7:00pm for an inspection the next business day • • Electrical Permit Application Date received: I - CC G/ Permit no.: i v6 _or,p 1 .,.11 City of Tigard Project/appl. no.: Expire date: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard r ess: / Date issued: By: Receipt no.: • Phone: (503) 639 -4171 1 � I 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 Job address: 1W? (.) yykl ( WV VS AV,P Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: I Subdi ision: Project name: I Description and location of work on premises: Estimated date of completion/inspection: CONTRACTOR APPLICATION FEE SCHEDULE Job no: V (p 0 G] Fee Max Business name: VA A i rV S J' [A ( q -f CI r i (f Description Qty. (ea.) Total no. insp New residential - single or multi - family per Address: 0 O dwelling tmit .Includes attached garage. City: V 1 ((')v v 1 I I .& I State: DPI ZIP: j) � T() Service included: Phone: Q ' iii6 Fax: I E -mail: ! 1000 sq. ft. or less • 4 7J ll CCB no.: IO/ G Elec. bus. lic. no: . f j 2 p Each additional 500 sq. ft. or portion thereof "J 0 v C .1 • Limited energy, residential 2 City /metro lic. no.: y u ez) Limited energy, non- residential • 2 cE�A' t7 - c.:� e 4 L.. /c4z -7 \ J !�. Each manufactured home or modular dwelling Signature of supervising electrician (required) Date • Service and/or feeder 2 • Sup. elect. name (print): d k vcr. A . License no: 4 Services orfeeders - installation, • alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): N‘{5 , kA V V O h . 201 amps to 400 amps 2 g 't 6 4IVV C ' Woe I M � . 401 amps to 600 amps 2 Mailing address: 1 p 6 V ! I � 11 V� 601 amps to 1000 amps 2 City: �,(V l (A `sate: ( / I ZIP: 0 1 -2.,2A -- 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 1 2t I . �O Phone: Fax: E-mail: of service or feeder fee, first branch circuit: �Y 2 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/lightingplan ❑ Other. Per inspection 1 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 $ .1-4 ❑ 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 %) .... $ 1). 1'5 Expires p complete. TOTAL $ G k9 . 10 0 accepted as Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00 /COM) Electrical Permit Fees: Limited Energy Fees: , • t 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 1, 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 • 0 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 [7 Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80.30 2 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 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. 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 HVAC Each additional branch circuit $6.65 • Miscellaneous • n 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 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 Per hour $62.50 ❑ In Plant $73.75 Outdoor Landscape Lighting Fees: ❑ Protective Signaling Enter total of above fees $ n Other 8% State Surcharge $ 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 $ • 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 Permit Application Plan Check# Electrical Rec'd By 13125 SW HALL BLVD. Date Rec'd TIGARD OR 97223 Date to P.E. Phone (503) 639 -4171, x304 Print of Type Date to DST Inspection (503) 639 - 4175 Incomplete or illegible will not be accepted Permit # Fax (503) 598 = 1960 Called 1. Job Address: 4. Complete Fee Schedule Below: `1 Number of Inspections per permit allowed Name of Development V\rS TA0,,r.0Y. -) Service included: Items Cost Total Name (or name of business) Address , io `F SVu) }{ c \- 4a. Residential - per unit �� ^`� °'`'��S �� 1000 sq. ft. or less $147.15 4 City/State /Zip F4, , rn C., C3-4 `l y Each additional 500 sq. ft. or ...JJJ portion thereof $33.40 1 Commercial ❑ Residential'1 Limited Energy $75.00 Each Manufd Home or Modular Dwelling Service or Feeder $90.90 2 2a. Contractor installation only: 4b. Services or Feeders (Prior to permit issuance, applicants must provide contractor license Installation, alteration, or relocation information for COT data base). 200 amps or less $80.30 2 Electrical Contractor .- 7,,,,,.1.....4--; EAC, (11. L 201 amps to 400 amps $106.85 2 Address 00 f :::)(3»C ■05' 401 amps to 600 amps $160.60 2 City 1,.)',1ScvrwAk - State c Zip 9 a' p 601 amps to 1000 amps $240.60 2 Phone No. l .9 - bZ O 5 Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 Job No. ‘czb065 Elec. Cont. Lice. No. Sal c... Exp.Da - \C. - (31 4c. Temporary Services or Feeders • Installation, alteration, or relocation OR State CCB Reg. No. t..5 bs v E ,.!Date o -k.- oa . 200 amps or less $66.85 . 2 COT Business Tax or Metro No. / Exp.Date 201 amps to 400 amps $100.30 2 l', 401 amps to 600 amps $133.75 2 Signature of Supr. Elec' ; . ola ill', Over 600 amps to 1000 volts, j see "b" above. License No. ` 83S • Exp.Date i p - 0 1 4d. Branch Circuits Phone No. C. -;,► - so., - , New, alteration or extension per panel a) The fee for branch circuits with purchase of service or 2b. For owner installations: feeder fee. Each branch circuit $6.65 2 Print Owner's Name b) The fee for branch circuits Address without purchase of service _. City State Zip or feeder fee. First branch circuit 1 $46.85 4 (. . T Phone No. Each additional branch circuit $6.65 • The installation is being made on property I own which is not 4e. Miscellaneous (Service or feeder not included) intended for sale, lease or rent. Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 Owner's Signature Signal circuit(s) or a limited energy panel, alteration or extension $75.00 3.. Plan Review section (if required):* Minor Labels (10) $125.00 4f. Each additional inspection over Please check appropriate item and enter fee in section 58. the allowable in any of the above 4 or more residential units in one structure Per inspection $62.50 Service and feeder 225 amps or more Per hour $62.50 System over 600 volts nominal In Plant $73.75 Classified area or structure containing special occupancy as 5. Fees: described in N.E.C. Chapter 5 5a. Enter total of above fees $ LA 8% Surcharge (.08 X total fees) $ S. 1 5 * Submit 2 sets of plans with application where any of the above apply. Subtotal $ Not required for temporary construction services. . 5b. Enter 25% of line 5a for NOTICE Plan Review if required (Sec. 3) $ Subtotal $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR ❑ Trust Account # WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS Total balance Due $ ` , AT ANY TIME AFTER WORK IS COMMENCED. • is \dsts \forms \electric_rev.doc - 8 /00 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested /—/ ' AM PM BLD Location /65 51-4-i /6 C'4vl'tD Suite MEC Contact Person / Ph 61z_- Z f S J PLM Contractor /( % a --7 -7� ,-( / - ) j--e-e- - Ph x • —/ SWR BUILDING Tenant/Owner ELC 0i4/- oe)0 7 Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN ' • Crawl Drain Inspection Notes: / Slab ` — C i /L, SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler 114 111 . -0 2 6 Fire Alarm Susp'd.Ceiling Roof Final Final PASS PART FAIL � `SS PLUMBING Post & Beam Under Slab 0 -------7. ; ---- D v / Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL - Post & Beam Rough In Gas Line Smoke Dampers Final J1SS�PART FAIL ,L, ELECTRIC Service Rough In UG /Slab. _ Low Voltage Fire Alarm a C4. Th C rC ��f S 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk Date 01 -` I / 4 - t ( Inspector Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.