Permit CITY OF T I G A R D - ELECTRICAL PERMIT
PERMIT #: ELC2001 -00274
2 p DEVELOPMENT SERVICES DATE ISSUED: 5/29/01
r�' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136CD-00102
SITE ADDRESS: 11681 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Reconnect of electrical service due to fire damage.
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
MILLAR, TED L TRUSTEE
BY WILLIAM C FLOBERG
834 SW ST CLAIR
PORTLAND, OR 97205
Phone: Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT CTR 5/29/01 $66.85 2720010000( Elea! Final
5PCT CTR 5/29/01 $5.35 2720010000(
Total $72.20
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 rule - • • • -• by-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 rule or direct questions to OUNC at (503)
246-6699 or 1-800- 332 -2344.
Permit Signature: - Iss , ed By:
t .0 Te-
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
;75 0e,S2
Electrical Permit Application
Datereceived: 5 Alio/ Permit no.: &Very ,.00 A7
X 11 : City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory O Commercial/industrial O Multi - family O Tenant improvement
O New construction O Addition/alteration /replacement O Other: O Partial
JOB SITE INFORMATION
Job address: //f8 j S'tJ pac,:-F,C jtt.3 y Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: (Subdivision:
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CON7'RACTOR APPLICATION — -, ^;, FEE SCHEDULE
Job no: Fee Max
Business name: Description Qty. (ea.) Total no. Insp
New residential - single or n u ii- family per
Address: • dwelling unit. Includes attached garage. •
City: - I State: I ZIP: Service included:
Phone: I Fax: I E -mail: 1000 sq. ft. or less 4
CCB no.: I Elec. bus. lic. no: Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic. no.: Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
•
Sup. elect. name (print): License no: Services or feeders — installation,
alteration or relocation:
PROPERTY' OWNER 200 amps or less 2
. A r . Name (print): SV N67- /3A._ y 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
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 / (441S- 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
losta
which is not intended for sale, lease, rent, or exchange according to llad°°+aiterad° °,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signatu • Date: — d — °) 401 to 600 amps 2
. Branch circuits - new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 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):
O. Service over 225 amps- commercial ❑ Health- carefacility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1 &2 0 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
O Building over three stories O Feeders, 400 amps or more *Description:
O Occupant load over 99 persons O Manufactured structures or 1W park Each additional Inspection over the allowable in any of the above:
O Egress/lightingplan O 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 $ l O�p , g�
O 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 %) .... $ S 35
Expires accepted as complete. TOTAL $ 7L
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6i00/COM)
•
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Number of Inspections per permit allowed Restricted Energy E $75.00
(FOR ALL SYSTEMS)
Service included: Items Cost Total I 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
Limited Energy $75.00 ❑ Burglar Alarm
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener
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
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 ❑
(Service or feeder not included) Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging S y stems
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 $ I I Other
8% State Surcharge $
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 $
. Enter total of above fees $
❑ Trust Account #
8% State Surcharge $
Total Balance Due $
i:\dsts\forms\elc- fees.doc 10/09/00
rTITY OF TIGARD BUILDING INSPECTION DIVISION
•• • MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 53 0 - D / AM PM BLD
Location /1 / 5(i) A i fl,r /4 Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner r7 ,Q ELC 00,17 �f
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 Ac) n p al n
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
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)
Rough In ��
UG /Slab
Low Voltage
Fire Alarm
Final
ASS 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 Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk I
Date ' r
Other v ^� � �� Inspector a p Ext
d►
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.