Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00344
DEVELOPMENT SERVICES DATE ISSUED: 6/27/00
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 110AC -L0004
SITE ADDRESS: 11492 SW LAUREL GLEN CT •
SUBDIVISION: LAUREL GLEN ZONING: R -4.5
BLOCK: LOT : 004 JURISDICTION: TIG
Project Description: Install a 200 AMP service /feeder and seven (7) 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: 1 W /SERVICE OR FEEDER: 7 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
DON BUSS WEBER ELECTRIC INC
440 NW HILLTOP RD 14524 SW CHARDONNAY AVE
PORTLAND, OR 97210 TIGARD, OR 97224
Phone: 503 - 245 -9876 Phone: 579 -5168
Reg #: LIC 44087
SUP 4028S
ELE 34 -442c
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT GEO 6/19/00 $101.70 0003098 Elect'l Final
5PCT GEO 6/19/00 $8.14 0003098
ORIGINAL
Total $109.84
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 oft ules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE / v 7 ) ' SSUED Y:
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:
CONTRACTO' INSTA ATION ONLY
SIGNATURE OF SUP A. ELEC'N: ,UP - Y ff t DATE:
LICENSE NO: /vag 5
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIG4RD''O1 97223 Date Recd
__ Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit #£ - ao34 / y
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Lpv re./ 6/e r7 Number of Inspections per permit allowed
Name (or name of business) _4'e . . ! l y / &,. 1kmcs Service included: Items Cost Sum 4 '
Address ,ce 92 Lau re/ k C1 , 4a. Residential - per unit
City /State /Zip r � c� 1000 sq. ft. or less $ 117.75 y 4
n Each additional 500 sq. ft. or
T/GR O l� , ' �[ 7 Z al portion thereof $ 26.15 1
Commercial ❑ l Residential ' 11 Limited Energy $ 60.00
Each Manufd 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 rr her eC ri inc.- 200 amps or less / $ 64.25 4 q' 25 2
Address 14524 anwrio/Nwcut Ave- 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
City i r 5 co State e.,/e? Zip 972.24 601 amps to 1000 amps $ 192.50 2
Phone No. 5o 3 -- 6 Zs0 - 1'1061 Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
-- Elec. Cont. Lice. No. "wit- 442.e, Exp.Date /e - I -00 4c. Temporary Services or Feeders
OR State CCB Reg. No. 4 407 Exp.Date 6 -A-0. Installation, alteration, or relocation
COT Business Tax or Metro No. 5 c7 0 R Exp.Date 200 amps or less $ 53.50 2
1 201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n / /__,. �J, 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
License No. 40 2-88 Exp.Date /O -/'4./ see "b" above.
Phone No. 4d. Branch Circuits
New, alteration 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 7 $ 5.35 3 7, ys 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee. •
Phone No. First branch 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 $ 42.75
Signal circuit(s) or a limited energy .
• 3. Plan Review section (if required):* panel, alteration or extension $ 60.00
Minor Labels bels (10) $ - 481 1 4/9
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over nar)
4 or more residential units in one 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 $ 101 • 7O
f !
* Submit 2 sets of plans with application where any of the above apply. . /jjE„1f o, Surcharge (:65 X total fees) $ �j , I g
Not required for temporary construction services. Subtotal • . $ 104.1111
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS - BECOME- VOID - IF - WORK OR CONSTRUCTION AUTHORIZED - Subtotal $
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 $
is \fists \forms \electric.doc
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CITY OF TIGA!'> D 24 -Hour
BUILDING . - Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date�,•uested �� AM PM BUP
Location // `i / - Z • “iAL/ Suite d iao Zt 3-exit 7-7
Contact Person Ph ( ) 7 3 — 3 g # ‘4' • M 1 rres� 7 Z
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 2 (203 q t. /
Footing
Foundation E LC��
Access:
Ftg Drain ELR
Crawl Drain •
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear -
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling '
Roof
Other:
Final
PAS , T FAIL `
Beam
Unde -• '
• • gh -In
va - ervice `/(
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
-
- RT FAIL
Po -t & Beam
Gas
as ine
Smoke Dampers
Fi
(PAS PART FAIL
ELECTRICAL • • 3
Service
UG /Slab
Low Voltage
Fire Alarm
In* Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI + _ '; f >: El Please call for reinspection RE:
n Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date yi
/ Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL