Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00021
,� DEVELOPMENT SERVICES DATE ISSUED: 01/13/2000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110CC 20500
SITE ADDRESS: 12384 SW KING GEORGE DR
SUBDIVISION: KING CITY NO. 5 ZONING:
BLOCK: LOT : 082 JURISDICTION: KIN
Project Description: Install 1 branch circuit in single family dwelling.
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:
CHRISTA LENZ BOONES FERRY-ELECTRICAL .
12384 SW KING GEORGE DR PO BOX 628
TIGARD, OR 97223 WILSONVILLE, OR 97070,
Phone: Phone:
682 -4936 P
Reg #: SUP 3170S
. LIC 00088482
• ELE 3 -223C
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT KJP 01/13/200C $37.50 00- 321120 Elect'l Final
5PCT KJP 01/13/200C $3.00 00- 321120
Total $40.50
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 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: 3 / 7 0 S
Call 639 -4175 by 7:00pm for an inspection the next business day
�G / YJ57 /e27
RECEIVED .: :,
CITY OF TIGARD Electrical Permit Application
P "cam`#
13125 SW HALL BLVD. Recd By
TIGARD OR 97223 JAN 13 2000 Date Recd
Phone (503) 639 -4171, x304 / Date to P.E.
COMMUNITY DEVELOPMENT JCS Date to DST
Inspection (503) 639 -4175 Print of Type Permit # C� - d - 1_1
Fax (503) 596 -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) () rls T9 z. c 4/Z. Service included: Items Cost Sum 4 .
Address /A 3W S 2 %' �j 6 ez �° Di -, 4a. Residential - per unit
City /State/Zip M9 �j O. j 7-- / Oi 9 �i�� ,/ 1000 sq_ ft. or less . $ 117.75 4
/ r Each additional 500 sq. ft. or
portion thereof 5 26.25 1
(�
Commercial ❑ Residential 9.., Limited Energy $ 60.00
• Each Maned 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 B O O N E S FERRY ELECTRIC 200 amps or less $ 64.25 2
Address P 0 Box 6 2 8 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
f
City Wi 1 sonvi 1 1State OR _ Zip 97070 601 amps to 1000 amps $ 192.50 2
Phone No. 503-682-4936 Over 1000 amps or volts 5 363.75 2
Job No. Reconnect only $ 53.50 _ 2
Elec. Cont. Lice_ No. 3 - 2 2 3 C Exp.Date 1 / 3 1 /00 . 4 C . Temporary Services or Feeders
OR State CCB Reg. No. 88482 Exp.Date 2/23/01 & Installation, alteration, or relocation • •
COT Business Tax or Me V. 0 2 8 51 Exp.Date 8/1 / 9 . 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec' • apt ��1 _, u�� 401 amps to 600 amps 5 107.00 2
Over 600 amps to 1000 volts.
License No. 317 0 see "b° above.
Exp.Date 0 /1 /01 '
Phone No. 6 8 2 -49 3. 4d. finch Circuits
New, aleration.or extension per panel
a) The fee 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 feeder fee. / �� ..5D Phone No Firstbra_nch 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 S 42.75
Signal circuit(s) or a limited energy
• 3. Plan Review section (if required): ` panel, alteration or extension $ _ 60.00
Minor Labels (10) $ 107.00
Please check appropriate Item and enter fee In section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in arty of the above
Service and feeder 225 amps or more Per inspection S 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 S -- _31 -.
' Submit 2 sets of plans with application where any of the above apply. $' % Surcharge (.05 X total fees) $ J
, 0 0
Not required for temporary construction services. Subtotal $ 1•l 01 50
Sb. Enter 25% of line 5a for
- NOTICE _ _ Plan Review if required.(Sec. 3)._ ___ -- - - $ - .. - - - -
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal 5
IS NOT COMMENCED WITHIN 180 DAYS. OR IF- CONSTRUCTION OR
. WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ ,2, S
i tdsttonnslerectric -doc •
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Date Requested ( l C 0)0 AM PM BLD
•
Location Ai 6' I ' Suite - / MEC
Contact Person ' 'it • /� Ph LP EZ_y9,�� PLM
C ontractor Ph SWR
'; Tenant/Owner 44) 2 oCO - D r
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 J v ✓ n 4 �' `Yj A ` /
�c? . 101
Roof
Misc:
Final -
PASS PART FAIL
PLUMBING i �` - S S
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
In
Gas Line
Smoke Dampers n
Final
PASS PART FAIL
CELEgTRIcA,
Ly
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date l l 9 -co Ins Ext
Other 6
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.