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Permit
/` CITY OF T I GA R D ELECTRICAL PERMIT PERMIT #: ELC2002 -00380 1 �� ;� DEVELOPMENT SERVICES DATE ISSUED: 8/8/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102CB -03101 SITE ADDRESS: 12950 SW PACIFIC HWY 115 SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G BLOCK: LOT : 021 JURISDICTION: TIG Project Description: 3 branch circuit for ADA restroom. 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: 2 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: HENDERSON, MARILYN DOROTHEA WILLAMETTE ELECTRIC INC JENSEN HUDSON TRUSTEE PO BOX 230547 11795 SW KATHERINE ST TIGARD, OR 97281 TIGARD, OR 97224 Phone: Phone: 624 -3631 Reg #: LIC 75059 SUP 1965S ELE 34 -283C FEES Required Inspections Type By Date Amount Receipt Rough -in PRMT CTR 8/8/02 $60.15 2720020000( Elect! Final 5PCT CTR 8/8/02 $4.81 2720020000( Total $64.96 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 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 Permit Signature: rk ` p Issued By: idt/1.-Z cz-f_e.t_, A _ 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: �'i DATE: 9 LICENSE NO: / / (5- S Call 639 -4175 by 7:00pm for an inspection the next business day • 4 - --Electrical Permit Application Datereceived�©, Q'Jj Pennit no. �, . i,- —00�'� 4 . 14 1 ..‘41; City of Tigard r ., k Projectiappl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Ew Date issued: By t 7 Receipt no.: Phone: (503) 639 -4171 G Fax: (503) 598 - 1960 Case file no.: Payment type: 7 rr1 ; ; ,.. Land use approval: L 1 0 I & 2 family dwelling or accessory 0 Co In ustrial 0 Multi - family Tenant itnprovetnent O New construction O Addition/alteration/replacement 0 Other: O Partial JOB SITE INFORMATION . Job address: ' -♦ s Pace c (/.t) Bldg. no.: Suite no.: 0 fax map /tax lot/account no.: Lot: Block: Subdivision' Project name: 14 u kt t.... (1 ( c� e< Description and location of work on premises: 4 0 A1 �4 f n n >•t. Estimated date of completion/inspection: CONTRACTOR APPLICATION FEE SCI ILDULE Fee Max Job no: 2'56 7 Description Qty. (ea.) Total no. Map Business name: IA) , I I R A.+ n f 4 e c) it 1 r: Ai, L New residential -singk or multi- family per Address: P D , 6 , .. 2 o S4 - dwelling emit Includes attached garage. City: 1 r S A a 0 I Slate:at I ZIP:, 97 a- / Service included: Phone: 6 Z 4 -14 t I Faz: f 2y- Zq ?id E 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof CCB no.: 7 1 - 0 t-'i [ Elec. bus. lic. n 3 y - ZJ' 3 t- Limited energy, residential 2 City/metro lic. no.: �' ^- / S - y f. Limited energy, non- residential 2 A g /� R—/-6't Each manufactured home or modular dwelling Signature of supervising wars (required) Date Service and/or feeder 2 Lice nse no: / f -S Services or feeders - Installation, Sup. elect. name (print): f) . ... F. alteration or relocation: PROPERTY O11'NI•:It 200 amps or less 2 Name /� 201 amps to 400 amps 2 (p rinl ) : �0 0 , y c' I�O Cc , 401 amps to 600 amps 2 Mailing address: , ► 7 q c 91 kctko.cr w-e S 7"� 601 amps to 1000 amps 2 City: 1', Nzh I State: 0 ZIP: 0 Z3 Over 1000 amps or volts Phone: (, 3g _ s 5?? I Fax: 1E-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 Installation, alteration, 200 amps or less 2 ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 am .5 2 • ENGINEER Branch circuits - nen, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 . City: State: ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: / 9CF 4 2 Phone: Fax: E -mail: Each additional branch circuit: Z OF i y7`' PLAN REVIEW (Please check all that apply) Misc. (Senice or feeder not included): O Service over 225 amps - commercial • 0 Health -care facility Each pump or irrigation circle 2 O Service over 320 amps - rating of I&2 O Hazardous location Each sign or outline lighting 2 family dwellings U Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel. CI System over 600 volts nominal more residential units in one structure alteration, or extension' _ 2 , O Building over three stories U Feeders, 400 amps or more *Description: O Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable in any of the above: O Egress lighningplan O Otter: Per inspection I I I I Submit _ sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other _ Pernlit fee $ G C, Not dl Jurisdictions Keeps credit cants, please call jurisdiction for more Inhumation Notice: This permit application Plan review (at _ %) $ State v ew a 8% O Visa O v MasterCard expires if a permit is not obtained $ 4,E / Credit card number: / / within 180 days after it has been g ( ) •••' Expires TOTAL as comp TOTAL $ 6 y 4 ('% Name of cardholder as shown on credit card S • Cardholder signature Amount 410-4615 (600R:OM) Electrical Permit Fees: Limited Energy Fees: . Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY p Restricted Energy Fee $75.00 Number of Inspections per permit allowed (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 ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular El Garage Door Opener' Dwetting Service or Feeder $90.90 2 Services or Feeders ❑ Healing, Ventilation and Air Conditioning Syslk:nr' Installation, alteration, or relocation 200 amps or less $80.30 • 2 El 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, atteratkxh, or relocation 200 amps or less $66.85 2 Fee for each system $75.00 201 amps to 400 amps $100.30 2 (SEE OAR 918- 260 -260) 401 amps to 600 amps $133.75 2 Over 600 amps to 1000 volts, - Check Type of Work Involved: see "b" above. ❑ Branch Circuits Audio and Stereo Systems New, alteration or extension per panel ❑ a) The fee for branch circuits Boller Controls with purchase of service or feeder fee. ❑ Clock Systems . Each branch circuit $6.65 2 b) The fee for branch circuits ❑ Data Telecommunication installation without purchase of service or feeder fee. . ED Fire Alarm Installation Each circuit $46.85 Each additional branch circuit $6.65 ❑ HVAC Miscellaneous (Servos or feeder not Included) ❑ Instrumentation Each pump or Irrigation circle $53.40 Each sign or canine lighting $53.40 ❑ : - Signal dreuit(s) or a limited energy Intercom and Paging Systems panel, alteration or extension $75.00 Minor Labels (10) $125.00 ❑ Landscape Irrigation Control' Each additional inspection over ❑ Medical the allowable In any of the above Per Inspection $62.50 Per hour $62.50 ❑ Nurse Calls In Plant $73.75 ❑ Outdoor Landscape Lighting' • Fees: • • ❑ Protective Signaling Enter total of above fees $ • 8% State Surcharge $ ❑ Other 25% Plan Review Fee Number of Systems See of application. . Tian Revie section on $ front • No licenses are required. Licenses are required for all other krsrallations Total Balance Due $ Fees: 0 Trust Account Enter total of above fees $ . 8'/. State Surcharge $ Total Balance Due $ • i:'dsts\fomsklc- fecs.doc 10/09/00 CITY OF TIGAI Q 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST -, INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested 8 AM PM BUP Location / e l 52 Suite 1 MEC Contact Person Ph ( ) PLM Contractor Ph ( ) 6? - 343/ SWR BUILDING Tenant/Owner ELC —6r0 3 Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT ,� . Post & Beam 'V Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall 1 t C b Fire Sprinkler 'J Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab 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 larm r Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SITE ❑ Please call for reinspe tion RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date i — d Z Inspe or � Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL