Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00075
A.4,..0.1& DEVELOPMENT SERVICES DATE ISSUED: 2/5/01
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 25111 DA -15000
SITE ADDRESS: 08850 SW PIPPEN LN
SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R -7
BLOCK: LOT : 143 JURISDICTION: TIG
Project Description: Installation of one branch circuit for a/c unit.
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: 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:
MATRIX DEVELOPMENT CORP GARNER ELECTRIC
6900 SW HAINES ST STE 200 21785 SW TUALATIN VLY HWY #C
TIGARD, OR 97224 ALOHA, OR 97006 -1249
Phone: Phone:
503 - 648 -4552
Reg #: LIC 121159
SUP 3707S
ELE 34 -305C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 2/5/01 $46.85 2720010000( Elect'I Final
5PCT CTR 2/5/01 $3.75 2720010000(
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 - 001 -0080. You may obtain copi these r : or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE ' ___ A„,/ ISS D 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:Q 0- v` DATE:
LICENSE NO: 7O75
Call 639 -4175 by 7:00pm for an inspection the next business day
a
• Electrical Permit Application
Date received: , S-ey Permit no.: 0 �04,
. :'■ 11 City of Tigard Project/appl.no.: Expire date:
City ofgard Address: 13125 SW Hall Blvd, Ti gard, OR 97223 Date issued: B I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OE PER111T
1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
%New construction ❑ Addition/alteration/replacement 0 Other. O Partial
.I011 SITE INFOIti11ATION
Job address: $$5 61,0 sp(4 FJ 1_0 Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: 14-3 I Block: (Subdivision: .'P ,Ncp p fciZ j
Project name: I Description and location of work on premises:
Estimated date of completion/inspection: •
CONTRACIOIt AI'l'LI('AIION I'VE S('IIEMILE '
Job no: Fee Mmc
•
Business name: 6' 0//) £0 p ,.l �'�PtlO° Qty. (ea.) Total no. Lisp
Address: ,z/ ? ,P6 �'lf Newnafdential- dngleor multi-family
C�ty: S IStateo4I ZIP: 9'2v! s
P h o n e • / l , j J ` I Fax: o j - y9,e -mail: 1000 sq. tt or less • 4
C : ,'o.: / i TV TV I Elec. bus. lic. no: 8y 4 j63 c �dentt. rportionthereof
Limited energy, ttyii:' ;f' • • ' /r • , 3 7 Limited energy, non- residential 2 2
tlInf %1 ' 17 / Each manufactured home or modular dwelling
1 . : .' supervts r g el 'clan (required) Date Service and/or feeder 2
Sup. elect name (print): Cd 4 „,, License no: Q Services or feed= — lastrtllatlon,
alteration or relocatloor
200 amps or less 2
Name (print): L B S 201 amnpsto 2
address: amps to 600 amps • 2
Mailing 7 70-3 S w G9' i4 � - - 601 amps to 1000 amps 2
City: 'T q , / � . 4 I Staten J 71P: x11 Over 1000 amps or volts 2
Phone: Go'2G i edd I Fax:s1F tit 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeder's -
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Pe - _ . i A (/,', a . ' : g O I 401 to 600 amps 2
ENGINEER I N E L It Branch'elrenits - new, alteration, -
/ or extension per panel: Name: Y . - %. n g • A Fee for branch circuits with purchase of
Address: g 7 7 p- g y /p. service or feeder fee, each branch circuit 2
City:y • pyti / �+" I Statevel I 711)17-2.1-- B. Fee for branch circuits without purchase
Phone: • • — of service or feeder fee, fast branch circuit 2 .
!� Fax: E - mail: Each additional branch circuit
• PLAN REVIEW (Please check all that apple) Misc. (Service or feeder not lneluded):
O Service over 225 amps - commercial 0 Healthcare facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 18c2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square fat four or Signal circuit(s) or a limited energy panel.
0 System over 600 volts nominal mom residential units in one structure alteration, or extension* 2
O Building over three stories Cl Feeders. 400 amps or more •Desciptios
O Occupant load over 99 persons 0 Manufactured structures or RV park
Each saldWonal Inspection over the allowable In any of the shove:
O Egress/lighting plan 0 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 Judsdl m cdo accept credit cards, ma
ds, please call Jurisdiction for more infortion. Notice: This permit application Permit fee $
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8%) .... $
Expires accepted as complete. TOTAL $ `� J�� X20
Name of cardholder as shown on credit card
$ •
Cardholder signature Amount 440-4615 (6N0/COM)
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
4. Complete Fee Schedule Below:
Number of Inspections per permit allowed Restricted Energy Fee ........ .........._...........,........ • $76.00
•
Service included: Items Cost Total (FOR ALL SYSTEMS)
4a. Residential - per unit Chedc Type of Work Involved:
• 1000 sq. ft. or less $147.15 4
Each additional 500 sq. ft. or ❑ Audio and Stereo Systems
portion thereof $33.40 1
Limited Energy $75.00 ❑ Burglar Alarm
Each Manirrd Home or Modular
Dwelling Service or Feeder . $90.90 . 2 ❑ Garage Door Opener*
4b. Services or Feeders
Installation, alteration, or relocation ❑ Heating, Ventilation and Air Conditioning System*
200 amps or less $80.30 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 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
4c. Temporary Services or Feeders •
Installation, alteration, or relocation Fee for each system.............................................. $76.00
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 . Check Type of Work Involved:
Over 600 amps to 1000 volts,
see 'b" above. ❑ Audio and Stereo Systems
4d. Branch Circuits .
New, alteration or extension per panel ❑ Boiler Controls
•
a) The fee for brunch crcuits
•
with purchase of service or ❑ Clock Systems
• feeder fee.
Each branch circuit $6.65 2 ❑
b) The fee for branch circuits Data Telecommunication Installation •
without purchase of service ❑
or feeder fee. -- • Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $8.65 ❑ HVAC
•
•
4e. Miscellaneous
•
•
(Service or feeder not included) El Instrumentation
Each pump or irrigation drde $53.40
Each sign or outline lighting • $53.40 •. ❑ Intercom and Paging Systems
Signal circuits) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control'
Minor Labels (10) $125.00 .
4f. Each additional inspection over El Medical
Ea
the allowable in any of the above ❑
•
Per inspection $62.50 Nurse Calls
Per hour $62.50 Outdoor Landscape Lighting'
•
In Plant $73.75 ❑ -
5. Fees: ❑ Protective Signaling
5a. Enter total of above fees $ •
8% Surcharge (.08 X total fees) $ ❑ Other
Subtotal $
6b. Enter 25% of lane 5a for Number of Systems
Plan Review If required (Sec. 3) $
Subtotal $ • • No licenses are required. Licenses are required for all other installations
j ❑ Tiust Account # FEES:
•
Total balance Due $ , ENTER FEES $
8% SURCHARGE (.08 X TOTAL ABOVE) $
TOTAL . $
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour In Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested o7 ` G / AM PM BLD URN
Location W'..5 /2/ - Suite MEC �� �17
Contact Person Ph PLM
Contractor Ph SWR _
BUILDING Tenant/Owner ELC paG5 -• vau 7.1
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
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
Service G /KCc,�
Rough In
UG /Slab
Low Voltage
Fire Alarm
•
PART FAIL /\)
I
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA 1 /- 7
Other p 7
Approach /Sidewalk D at e / ( /U / Inspector / `� / Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.