Permit CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00085
� i & DEVELOPMENT SERVICES DATE ISSUED: 02/29/2000
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 110CC -10500
SITE ADDRESS: 15765 SW QUEEN VICTORIA PL
SUBDIVISION: KING CITY NO. 3 ZONING:
BLOCK: LOT : 018 JURISDICTION: KIN
Project Description: Install 1 branch circuit in single family dwelling.
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:
JENSEN, LAURA BONNELL TRUSTEE
15765 SW QUEEN VICTORIA PL
KING CITY, OR 97224
Phone: Phone:
Reg #: ORIGINAL
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT . KJP 02/29/200C $37.50 00- 321894 Elect'l Final
5PCT KJP 02/29/200C $3.00 00- 321894
Total $40.50
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 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 OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE A.- S ISSUED BY: A Pe _9
e / NER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: _0, i DATE:X °? - 0( _.,66e__A
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check # ■
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 • Date to DST
Inspection (503) 639 -4175 Print of Type Permit # 1.-C Le OO- 0)o AS
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development ' '"5J ,v Number of Inspections per permit allowed
Name (or name of business Service included: Items Cost Sum 4 -
Address / 57(9 5CJ LL V, / e r / " " 4a. Residential - per unit
• City/State /Zip � / � ( Or d 1000 sq. ft: or less $ 117.75 4
'!- Each additional 500 sq. ft. or
portion thereof $ 26.75 1
Commercial El Residential El Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling "Service or Feeder $ 72.75 2
• (Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). •Installation, alteration, or relocation
Electrical Contractor [)�J t- - 200 amps or less $ 64.25 2
Address 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
City State Zip - 601 amps to 1000 amps $ 192.50 2
Phone No. Over 1000 amps or volts $ 363.75 2
• Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. Exp.Date 4c. Temporary Services or Feeders .
OR State CCB Reg. No. Exp.Date Installation, alteration, or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
• Signature of Supr. Elec'n 401 amps to 600 amps $ 100.00 2
Over 600 amps to 1000 volts,
• see "b" above.
License No. Exp.Date '
Phone No. 4d. Branch Circuits
. New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or .
The fee for branch circuits
b) feeder fee.
Print Owner's Name � `- l i � r Arad N EL Each branch circuit $ 5.35 2
Addre l �7 ?fe7 9 W. V fit $j�'I/f without purchase of service
City CY ( r (-� State ? p Zip T _ or feeder fee. 7 e ,-�
Phone No. , 7 5 ) First branch circuit / $ 37.50 3 Ti ✓
Each additional branch circuit _ $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included) -
Each pump or irrigation circle $ 42.75
' Owner's Signatur- ,A� _ / / .- . /,_ Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited.energy
* panel, alteration or extension $ 60.00 •
3. Plan Review section (if requir- d): - Minor Labels (10) $ 100.00 '
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more • Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special, occupancy as
described in N.E.C. Chapter 5 5. Fees:
• 5a. $
a. Enter total of above fees
* Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ 3 _ 0 0
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for
NOTICE - Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # 5 oO
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ qv .
is \dsts \forms\clectric.doc .
3 /6 /00 Activities for Case #: ELC2000 -00085
8:48:15 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 APPlication received 3/6/00 ST DONE No Hold ST 3/6/00
ELCA003 Permit created 2/29/00 KJP DONE No Hold KJP 2/29/00
ELCA730 Elect'I Service No Hold KJP 2/29/00 •
ELCA799 Elect'/ Final 3/1/00 CD • PASS No Hold AKJ 3/1/00
ELCA500 (F) Issue permit 2/29/00 KJP DONE No Hold KJP 2/29/00
ELCA800 Case finaled 3/1/00 AKJ DONE No Hold AKJ 3/1/00
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- `'CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 3/1 0 AM PM BLD
Location r S)' S Q 0 i olovAsaite MEC
Contact Person Ph 69 ZY — S 0g PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC 2000 -oc0 9,5
Retaining Wall ELR
Footing Access: •
Foundation - FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: ,
Slab l' " (, , 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 irea
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
EC,ECTRf'CA
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
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 reinspec • 'n RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date f Inspector .act
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.