Permit . CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00670
V DEVELOPMENT SERVICES DATE ISSUED: 12/5/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1 S126DC -04900
SITE ADDRESS: 09445' SW LOCUST ST
SUBDIVISION: L EHMANN ACRE TRACT ZONING: C -P
BLOCK: • LOT : 003 JURISDICTION: TIG
Project Description: Installation of two 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: 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: 1 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:
BBH INVESTMENTS THREE DOG ELECTRIC
9445 SW LOCUST 5250 SW CAMERON RD
TIGARD, OR 97223 PORTLAND, OR 97221
Phone: Phone:
Reg #: SUP 4613S
LIC 138509
ELE 26 -1046C •
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 12/5/00 $53.50 2720000000( Elect'I Final
5PCT CTR 12/5/00 $4.28 2720000000(
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 rulesad. opted the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0080. You may obtain pies of these ru - or direct questions to OUNC at (503) •
246 -1987.
PERMITTEE'S SIGNATURE � ISS D BY: \ , �j, ,C / /"
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: /� c-f1,7 DATE: -S _ ZC�6 •
LICENSE NO: /&6
Call 639 -4175 by 7:00pm for an inspection the next business day
gt
Electrical Permit Appl
Date received: li ' Permit no.: giz - pa 6 O
,.SIl City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type: •
Land use approv .
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: 6 (ygs 5 W 1 -- 0' ( t Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: I Description and location of work on premises C67RC'uiiS \tSiJw1A9t 2./1INS 414
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: 1 Qty. (ea.) Total no. insp
TI IQrriC .- t oc, F a it .. ' . L New residential
Address: (a la tM 003 dwelling unit. Includes attached garage.
City PO C L flivid I State ZIP:q ZZ 1 Service included:
Phone j 3 -Zq ,_y7zio I Fax: �- I E -mail: 111 sq. ft. or less 4
Each CCB no.: t 3 a $Q q I Elec. bus. lic. no: " 11 . . '. • . __ _—
Limited energy, residential 2
City /metro lic. no.: Limited energy, non-residential 2 .
∎•- . C>
1Z rj- 2 .000 -� -. .. dwelling
Signature of-supervising electrician (required) Date Service and/or feede
• Services or feeders installation,
Sup. elect. name (print): r (V License no:4 ( 3 5
alteration or relocation:
PROPERTY OWNER 11 amps or
401 amps o 600 amps MIMI _ 2
Mailing .•• w
.1 . 100
. 111. . __ 2
•'1 ► Y e ° P Over 111 amps or . ___ 2
Phone: Fax: • E-mail: ' Reconnect only 1
• Owner installation: The installation is being made on property I own Temporary services or feeders -
installation, alteration, or relocation:
which is not intended for sale, lease, rent,.or exchange according to
200 amps or less 2
201 amps to • 11 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
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail: of service or feeder fee, first branch circuit:
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
U. 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
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 $ • . 110
❑ Visa ❑ MasterCard expires if a permit is not obtained' Plan review (at _ %) $ at-'
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $ •
Name-of cardholder as shown on credit card
$
Cardholder signature Amount
440-4615 (6 /00 /COM)
. it
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 IT Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 . 1 n Burglar Alarm •
Limited Energy $75.00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 U Garage Door Opener
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106:85 2 I I Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n 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 •
New, alteration or extension per panel n Boiler Controls
• 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 ❑
or feeder fee. Fire Alarm In
First branch circuit {i $46.85 4( $
Each additional branch circuit $6.65 C C,S ❑ HVAC
Miscellaneous n Instrumentation
(Service or feeder not included)'
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above I � 1
Per inspection $62.50 l l Nurse Calls
Per hour $62.50
In Plant - $73.75 n Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ 5� n Other
8% State Surcharge $ 'V•
Number of Systems
•
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
7 e Fees: -
Total Balance Due $,j
• Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts \forms \etc- fees.doc 10/09/00 •
- —
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour 10peetion Line: 639-4175 Business Line: 639-4171 MST
BUP
Date. Requested / Z—( 4 AM PM BLD
Location got( Coce, 5 Suite MEC
Contact Person Ph "Z.,- -4 6P 7/ PLM
Contractor o 6— Ph SWR
BIM-PKO :„ Tenant/Owner ELC -006 7 0
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab — SIT
Post & Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm ,-----
Susp'd Ceiling
Roof
Misc:
Final
PASS - PART FAIL
PtunABING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL Post & Beam
Rough In
Gas Line •
Smoke Dampers
Final
PASS PART FAIL
„LEPT,
Service
Rough In
UG/Slab
Low Voltage
Fire Alarm
- 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
Fire Supply Line
[ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Ay --
ADA
Approach/Sidewalk
Date 7 2 - 6°17 Inspector d ir
Ext
Other —
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.