Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00212
Airu*V I DEVELOPMENT SERVICES DATE ISSUED: 4/25/01
II 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136AA-09300
SITE ADDRESS: 06955 SW LOCUST ST MODEL HOME'
SUBDIVISION: VII NCIOJRA ESTATES ZONING: R-4.5
BLOCK: LOT : 015 JURISDICTION: TIG
Project Description: Hot Tub
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: 1 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:
WINGATE CORPORATION DEXHEIMER ELECTRIC INC
15840 S POPE LANE 10639 SE FULLER ROAD
OREGON CITY, OR 97045 MILWAUKIE, OR 97222
Phone: 503 -657 -3300 Phone: 786 -0886
Reg #: SUP 2514 -S
LIC 00043975
ELE 26-321C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 4/25/01 $46.85 2720010000( Elect'I Final
5PCT CTR 4/25/01 $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 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 -6699 or 1 -800- 332 -2344.
Permit Signature: Issued By: n f
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:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
D ate received: 1.4-a.,j,01 P ermit no a ...1.a. i,L� .,�1'� i City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ I & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family O Tenant improvement
❑ New construction gAddi tion/alteration/replacement ❑ Other: ❑ Partial
JOB SITE 1NFORMMATION
Job address: toCT 55 S L_oc--0 S T Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 1 I Block: 'Subdivision: VE„ .7--jp-A is r-il i e f
Project name: I Description and location of work on premises: tie, ew:49411
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCNEDILE
Job no: Fee Max
Business name: ..9‘.‘ _ Description Qty. (ea.) Total no. insp
B
f' P r l �� New residential - single or multi - family per
10 c, 2 5 6 < u 1\ P.c R, • dwelling unit. Includes attached garage.
City: 9t i s \ I State:0iL I ZIP: C j 7 a Service Included: or s 4
Phone: 5 02 764044 I F 76b a ols I E -mail: iepp Each additional 500 sq. ft. or portion thereof
CCB no.:. 3 q 2 - I Elec. bus. tic. no: '
r� Limited energy, residential 2
pl
icy /metro tic. no.: 63 a, I Limited energy, non- residential - 2
N -) 1//ZS l 0 Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date ! Service and/or feeder 2
Sup. elect name (print): ,_, - - a ,, License no: '• s 1, S r ices or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: 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 inset )latlon, alteration, orrelocation:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owners signature: Date: 401 to 600am.s 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 ' 0 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 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 0 Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection 1 1 I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other /- Q
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ �V '
❑ 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%) .... $ 5-IC
Expires accepted as complete. TOTAL $ 5a 4 O
Name of cardholder as shown on credit card '
$
Cardholder signature Amount 440 -4615 (6100/COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each. additional 500 sq. ft. or
portion thereof $33.40 1 D Burglar Alarm
Limited Energy $75.00 r
Each Manuf'd Home or Modular ❑ Garage Door Opener'
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ 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 El
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 ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits •
with purchase of service or 0. Clock Systems
•
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 HVAC
Each additional branch circuit .$6.65 ❑
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy Landscape Irrigation Control'
panel, alteration or extension $75.00
Minor Labels (10) $125.00' ❑
Medical
Each additional inspection over
the allowable in any of the above Calls
Per inspection $62.50
Per hour $62.50 El In Plant $73.75 Outdoor Landscape Lighting
Fees: J ❑ r
Protective Signaling
Enter total of above fees $ I f 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
ii. 3C,
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
• BUP
Date Requested L/- 1-9 AM PM BLD
Location C fJ 5 w GG C 7 J Suite MEC
Contact Person Ph 7ff 60 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC 2' o / -09 Z/ Z-
Retaining Wall ELR
Footing Access: n � � � / /
Foundation � � /� G e :-g FPS
Ftg Drain f4f > SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler A
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam ' 4' G/ C / / �
Under Slab �, cc �
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
r A RT FAIL
E TRI
Service H
Rough In �
UG /Slab .
. / u 6 •
Low Voltage
Fire A m
al
P S P RT FAIL
SITE
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
Other oach /Sidewalk Date Z 7 0/ Inspector � 'i _ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.