Permit L .r CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00392
01 DEVE L ICES 639 -4171 DATE ISSUED: 8/2/01
- 13125 S. PARCEL: 1S136CD-01601
SITE ADDRESS: 11670 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install of sub -panel and (5) 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: 5 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:
DOUGHTY, J PAUL AND LILLI DICKINSONS ELECTRIC
10150 SW CANYON RD • 8449 SW BARBUR BLVD
BEAVERTON, OR 97005 PORTLAND, OR 97217
Phone: Phone: 246 -3550
Reg #: LIC 65534
SUP 3100S
ELE 26 -140C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 8/2/01 $113.55 2720010000( Wall Cover
Elect'I Service
5PCT CTR 8/2/01 $9.08 2720010000( Elect'I Final
Total $122.63
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty 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- , 01 -00; e. You may obtain copies of these rules or direct questions to OUNC at (503)
2466699 or 1 -800- 332 -2344.
Permit 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: 001 afpi6,ea i l — DATE:
LICENSE NO: 3100
Call 639 -4175 by 7:00pm for an inspection the next business day
•
Electrical Permit Applican
_ I D atereceivedgy a 7 Permit no.: t / . - pv35�
rt, I I I Project/appl. no.: Expire date:
.i I' City of Tigard
City of Tigard Address: 13125 SW Hall Blvd, Ti d OR 97 Date issued: By: 8p I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PEICHIT
❑ 1 & 2 family dwelling or accessory Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction Q- Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: C, 70 W A WARE : a g. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: ,`- (, opc,_e_ j Description and location of work on premises: -fig Xige-e-e /1/1 -e-
Estimated date of co pletion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: 4)1`r� (c 1 /t_ca t. t Description Qty. (ea) Total no. insp
Address: name /� � dwelling
7 New egunt.Incln Includes ied per
''/ / / v5 tmit. Includes attached garage.
City: k( ...,./ State e' it I ZI1* 7 2 /c Serviceincluded:
Phone: f 6 -,,1 5' S' Fax,;?/_3-699 -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: �j �jr S (( I Elec. bus. lie. no: 6/ yU- Limited energy, residential 2
City /metro lie. no.: Lt.-1 f -o?j Limited energy, non- residential 2
� : , l Each manufactured home or modular dwelling
Signature of !•f � -- " %�P� Da t� �I Service and/or feeder 2
/ Services or feeders — installation,
Sup. elect. name (print): _ A _ ` i License no:
alteration or relocation:
PROPERTY OWNER 200 amps or less / 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: !ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only
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 hnsfallation , alteration, orrelocation:
200 amps or tens 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of 5
Address: service or feeder fee, each branch circuit 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial ' O Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1 &2 O Hazardous location Each sign or outline lighting . 2
family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O 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:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
❑ Egress/lighting plan O Other. Per inspection I I
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 $ -. / /3 • -S S
0 Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number / / within 180 days after it has been State surcharge (8 %) .... $ 9—PI(
Expires accepted as complete. TOTAL $ lo1A • t3
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00/COM)
•
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ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT 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 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd 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 �^
OU ,30 2 ,
201 amps to 400 amps $106.85 2 ❑ Vacuum Systems
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 ❑
_ New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ 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
Each additional branch circuit $6.65 ❑ HVAC •
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ 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
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
•
Fees: ❑ Protective Signaling
Enter total of above fees $ � 1 Other
8% State Surcharge $ Ct'° 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. •
- Fees:
Total Balance Due $ OA (3
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
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;:',dsts\forms\elc- fees.doc 06/07/01
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24. is r Inspection Line: 639 -4175 Business Line: 639 -4171 1 .
BUP
Date Requested g AM PM BLD
Location f / (, c 26 Suite MEC
Contact Person Ph 3 9 ( PLM
Contractor 4 �J Ph SWR
BUILDING TatM Owner �j ELC D-06/ 392.
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam _
Ext Sheath /Shear S� �G e / r' Ci r'
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall ) n
Fire Sprinkler / 7 ,T U t" / 9 ( 9' /1 y1n 7 —
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final /
PASS PART FAIL . 1/C-L Ci -
PLUMBING
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
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
F
-1
S 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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk 7—D /
Other Date ! Inspector I'■ _ Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.