Permit • CITY OF T I G A R D ELECTRICAL PERMIT
RESTRICTED ENERGY
A r;� DEVELOPMENT SERVICES PERMIT #: ELR2000 -00239
''�" I ° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/17/00
SITE ADDRESS: 12287 SW QUAIL CREEK LN PARCEL: 2S103C6 -07900
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT: 028 JURISDICTION: TIG
Project Description: Installation of an all encompassing restricted energy permit.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
AARON ESPADRON -COKE OWNER
2831 SW DOLPH CT #8
PORTLAND, OR 97219
Phone: 503 - 293 -3185 Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 10/17/00 $75.00 2720000000 Elect'l Final
5PCT CTR 10/17/00 $6.00 2720000000
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal 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
require • • u o • • rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0'41-0010 throug OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) •
246 -1487. — –
Issue , by k � � 1�'J� l Permittee Signature
OWNER INSTALLATION ONLY I
The installation Is being made on pro erty I o rw / which is not intended for sale. lease, or rent.
OWNER'S SIGNATURE: � C ( —_ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
, At. Electrical Permit Application
Date received: Permit no.: j Q -009, ?
ma y, ii City of Tigard Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 'Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
AM & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
)'New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION -
Job address: /22 1?'7 t c c. ke„. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision: (' ),,,, th/I
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: Description Qty. (ea.) Total no. insp
New residential - single or multi- 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
Each additional 500 sq. ft. or portion thereof
CCB no.: I Elec. bus. lic. no: 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 - - 2
200 am ps or less
�
ff
Name (print): �D 65 a.d rvo- - (SIC -e-� 201 amps to 400 amps 2
2
401 amps to 600 amps
Mailing address: Li)1 y►,✓ I Cy ib7 601 amps to 1000 amps 2
City: f,1-// I State: &-, I ZIP: 572/1 Over 1000 amps or volts 2
Phone: 293.3 iiS' 1 Fax: I E -mail: ac. 0 e, - •Ke,i. 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:
ORS 447, 455, 479, 6741701. 200 amps or less 2
201 amiss to 400 amps 2
Owner's signature: v Date: it / 61-) 401 to 600 amps 2
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
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):
❑ Service over 225 amps- commercial • 0 Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ 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 ❑ M hufactured 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 .
Permit fee 5 -75, to v
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ O�
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ '
Expires TOTAL $ $ /' °D
accepted as complete.
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00/COM)
•
Electrical Permit Fees: Limited Energy Fees: -
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
•
11 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 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 I[ C I Other 4 Over 1000 amps or volts $454.65 2 Atifyvveilivi
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, 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. ❑
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 ❑
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. n Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 HVAC
Miscellaneous
(Service or feeder not included) 0 Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 I I Intercom and Paging Systems
Signal circuit(s) or a limited energy
•
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 Nurse Calls
Per hour $62.50
In Plant $73.75 ❑
Outdoor Landscape Lighting"
Fees:
❑ Protective Signaling
Enter total of above fees $
8% State Surcharge $
n Other
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.
Total Balance Due $ Fees:
Enter total of above fees $
❑ Trust Account # •
8% State Surcharge $
Total Balance Due $
i:\dsts \forms \elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / 7i - g AM PM BLD
Location /2 2--$7 5 w Qti 41 I Ct.GGk ":§') Suite MEC
Contact Person Ph ,53 - ( 8 2- 7 PLM
Contractor Ph P �( Z/ 7 SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR Z/OV G - 6 ' 2-7
Footing Access:
Foundation Z ] - vC-J- r
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:
ic2re)
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
OLECTRICAL)
Service
Rough In
UG/
ow Voltage Irv.)
ire Alarm
PASS RT FAIL
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
Approach /Sidewalk � /
Other Date / (1 Ins _ E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.