Permit 1 . .00 A CITY F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00164
iii-apve � ��; � DEVELOPMENT SERVICES DATE ISSUED: 4/11/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135DD -05000
SITE ADDRESS: 11981 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Replace (1) 20Q amp service panel and (2) 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: 2 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:
DREW HOFFMAN DAVID CHANDLER ELECTRIC
11981 SW PACIFIC HWY PO BOX 80696
TIGARD, OR 97223 PORTLAND, OR 97280
Phone: Phone: 503 - 245 -7774
Reg #: LIC 94908
ELE 26-1081C
SUP 688S
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT CTR 4/11/02 $93.60 2720020000( Rough -in
Elect'I Final
5PCT CTR 4/11/02 $7.49 2720020000(
Total $101.09
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 • . = in - _• rdance with - • 'roved plans. This permit will expire if work is not started within 180 days of issuance, or if
work is suspended •r more than 18 •.y NTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification
Center. Those r - es are set forth in es 95211 -0010 through OAR 952 - 001 -0080. You m. • stain copies of these rules or direct questions to
Permit Sign
1111L /1i..A., Issu :d By:
U./ 64%
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: � G�� �` l �`' DATE:
LICENSE NO: ZOCS8
Call 639 -4175 by 7:00pm for an inspection the next business day
c
f {Electrical Permit Application
Date received: /` OA Permit no.: — j/6
ll :.� I C llty of Tigard Projecdappl. no.: Expire date:
Address: �Iyd Tigard, OR 97223 Date issued: B Receipt CiryofTigard Add 1312 -r. �VED Y� � tno.:
P
Phone: (503) Fax: (503) 598 19 , 1 Case file no.: Payment type:
Land use approve
TYPE OF PERMIT
❑ I & 2 family dwelling or ac • '� 9112Wraepgindustrial ❑ Multi= family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
JOB SITE INTORMA7•ION
Job address: I l lr r A 'r, ‘ Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: Subdivision:
Project name: ,, „ ` Description and location of work on premises:. ) I . /f
Estimated date of completion/inspection: , __MWW,W411111
CONTRACTOR 'APPLICATION FEE SCHEDULE.
Job no: . Fee Max
Business name: ) t d Ch df fi Si & � C . Description Qty. (ea.) Total no. insp
/ New residential - single or multi- family per
Address: 0. Sax 2D(o9 dwellingunM . Includes attached garage.
City: RD f'�(i vtt� State:0 -a I ZIP: Cf 7 go Servicemciuded:
Phone:
Z less 7 7 7 t( I Fax:Zy - 'yip E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: • w g0 g Elec. bus. ),ic. no: / r 61 Limited energy, residential 2
City /metro li no.: $ \ • Limited energy, non- residential 2
J.1 / Ai — /- O Z Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): \ Q, ` ,, i .. • •'7 License no: , : f S Se or feeders— installation,
alteration or relocation:
-,- u ! -.. PROPERTY OWNER .11 200 amps or less 4 2
Name (pri t : ', t i ” 201 amps to 400 amps 2
� :
401 amps to 600 amps 2
Mailing addressy2 ( • 601 amps to 1000 amps 2
City: J State: I ZIP: Over 1000 amps or volts 2
Phone: [Fax: (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 installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 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 2„ 2
City: I State: • 1 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:
J
PLAN REVIE11' (Please check all that h apply) Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial ' O Health-care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of I &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings 0 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 0 Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O Egress/lightingplan ❑ Other Per inspection I 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 $ -9 , ' - - a
❑ 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 %) .... $ 7 4'7
Expires accepted as complete. TOTAL $ 101 '0
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00/COM)
,_a ®$.
' Electrical Permit Fees: Iry. Limited Energy Fees: zs S
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 y 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 Manuf'd Home or Modular Garage Door Opener
Dwelling Service or Feeder $90.90 2 El
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 ❑ • Boiler Controls ,
New, alteration or extension per panel •
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 $46.85
Each additional branch circuit $6.65 ❑ HVAC
•
•
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle • $53.40 ,
53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control .
Minor Labels (10) $125.00
Medical
Each additional inspection over •
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 $ ❑ Other '
8% State Surcharge $
l 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 \e1c- fees.doc 10/09/00 •
CITY OF 24 -Hour
BUILDI Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
• BUP
Received / Date Requested S / 3 AM PM BUP
f
Location Si D Suite MEC
Contact Person y "� Ph ( ) c 77 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC e71 (°) 6 ° /6 T
Footing
Foundation ELC
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 \I+ AF15
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: <``. • �
Final 0, � `��� `4'y ��i1. — . r. t�∎����\ : • ,=1` . .\ \
PASS PART FAIL
PLUMBING
Post & Beam " j - "� . �ic=��:�
Under Slab ��+'_ �.�ir c�.�R►s
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
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
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Dais, l ` � Inspe i Ext
Other:
Final DO NOT REMOVE this inspection record fro e Job site.
PASS PART FAIL