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Permit CITY OF T I G A R D ELECTRICAL PERMIT PERMIT #: ELC2000 -00262 r A" • DEVELOPMENT SERVICES DATE ISSUED: 05/19/2000 1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110CC -14000 SITE ADDRESS: 15899 SW QUEEN VICTORIA PL PUMP SUBDIVISION: IdlNUCISEITY NO. 5 ZONING: BLOCK: LOT : 020 JURISDICTION: KIN Project Description: Install a 200 AMP service /feeder and four (4) branch ciruits for the new pump house. 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: 4 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: KING CITY CIVIC ASSOC DOUGLAS G. CLAPSHAW ELECTRIC 15245 SW 116TH 1722 17TH AVE KING CITY, OR 97224 FOREST GROVE, OR 97116 Phone: Phone: Reg #: ELE 34 -410C LIC 107185 SUP 3870S FEES Required Inspections Type By Date Amount Receipt Elect'l Service PRMT GEO 05/19/200C $85.65 0002307 Elect'l Final 5PCT GEO 05/19/200C $6.85 0002307 � A H Total $92.50 OR61N 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 xis c e / db iaa __ ISSUED BY: OWNER INSTALLATION ON The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: , .t ��� 4 CONTRA o CTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: ale 4 DATE: 5 _ J9 -OC) LICENSE NO: - s Call 639 -4175 by 7:00pm for an inspection the next business day 05/05/00 FRI 08:16 FAX 503 598 1960 CITY OF TIGARD -i i,., .. �' -.: CITY OF TIGARD Plan Check u <• 1 ''. 13125 SW HALL BLVD. Electrical Permit Application ; Recd By TIGARD OR 97223 "R ECEIVED Date Recd Date to P.E. Phone (503) 639 -4171, x 304 Date to DST Inspection (603) 639- 417MAY 12 2000 Print of Type Permit# SCe ROMP -OOR Z Fax (503) 598.1960 Incomplete or illegible will not be accepted Called COMMUNITY DEVELOPMmi 1. Job Address: •, �u'y � 'P �8� 4. Complete Fee Schedule Below: Name of Development K G f, e.pai , _ Number of Inspections per permit allowed Name (or name of business) Service included: Items Cost Sum 7 Address /S98 ©o'ee le{e.TOrt i.1 ✓e _ 4a. Residential - par unit . • City/State/Zip ( C/T 9 7 9 a -f 1000 sq. ft- or less 5 17.7s 4 y p Each additional 500 sq. ft or portion thereof $ 26.75 1 - Commercial Er Residential El Limited Energy $ 60.00 Each Marwfd Home or Modular - ;'; ; i 5 T ': ZA. Contractor installation only: Dwelling Service or Feeder $ 72.75 o f ^ k k ` f (Prior to permit issuance, applicants fq t ' v : c licvnsa 4b. Services or Feeders � , information for COT data base Installation, alteration, or relocation �S Electrical Contractor ��Q _5. D.LJ ojQr.7 J 20 a mps or less � $ 64.25 ' 2 ��• • Address Mrr• I , , 201 amps w 400 amps $ 85.50 2 401 amps 10 600 amps $ 128.50 2 City • .. - State CZ Zip 97//( _ 601 amps to 1000 amps $ 192.50 2 Phone No- 503-357- ,?i Over 1000 amps or volts $ 363.75 2 Job No. Reconnect only 5 53.50 2 Elec. Cont. Lice. No. , 3 q - 2/ /D C Exp.Date 10AllC } 4c. Temporary Services or Feeders OR State CCB Reg. No. ) t 7 I V S Exp.Date • ( P /23 /ca Installation, alteration, or relocation COT Business Tax or Metro No. Exp.Date 200 amps or less 5 53,50 2 201 amps to 400 amps $ 80.25 2 Signature of Supr. Elec'n Alt 401 amps to 600 amps $ 100.00 2 Over 600 amps to 1000 volts, License No. • O 7c S Exp.Date /0 6 , 0 1- n see ` "b" above. ,y 4d. Branch Circuits Phone No. go 3 - 3 5 -7- 'ri1 s( / /0 1_ 0J ���"""CCC...... New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or feeder fee. Q.° Print Owner's Name Each branch clrcult 4 $ 5 -35 i 2 Address b) The fee for branch circuits without purchase of service City _- State Zip or feeder fee. Phone No. First branch circuit $ 37.50 Each additional branch circuit 5 5.35 The installation is being made on property I own which is not ae. Miscellaneous intended for sale, lease or rent. (Service or feeder not included) Each pump or irrigation circle $ 42.75 Owner's Signature Each sign or outline lighting 5 42.75 Signal circuit(s) or a limited energy panel, a Labels alteration 10) or extension $ 60.00 3. Plan Review section (if required):* 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 5 50 -00 Per hour $ 50.00 System over 600 volts nominal In Plant $ 59,00 Classified area or structure containing special occupancy as r described In N.E.C. Chapter 5 S. Fees: Se. Enter total of above fees $ 5 . �7 • * Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ L QK Not required for temporary construction services. • Subtotal $ 5b. Enter 25% of One 6a for • NOTICE Plan Review if required (Sec. 3) 5 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 El Trust Account # 9 ° AT ANY TIME AFTER IS COMMENCED. Total balance Due $ !�(,�' i:1dstsltorins1cl ccr.rr c. dnc , . - KING CITE 15300 S.W. 116th Avenue, King City, Oregon 97224-2693 Phone: (503) 639 -4082 • FAX (503) 639 -3771 Notice To Contractors Workin In King City Due to an intergovernmental agreement with the City of Tigard, many building related permits for projects in King City are issued and inspected by the City of Tigard. If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the appropriate application legibly and submit it to the King. City staff. The King City staff will collect all fees and fax the application to the City of Tigard. City of Tigard staff «ill then create the permit, issue the permit, and perform inspections. Please indicate on the permit application whether you would like the Tigard staff to call you when the permit is ready for issuance or whether you prefer it to be mailed without any notification. Any incomplete or illegible application will be returned to King City staff for correction and no processing will occur until a complete, legible application is received. If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a King City staff person. King City staff will simply sign this form indicating land use approval. Take this signed form to the City of Tigard Development Services Counter located at 13125 SW Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are available at 639 -4171 Ext. 304 should you have any questions concerning submittal requirements. All permit fees will be assessed and collected at the City of Tigard. The City of King City hereby authorizes applicant to pursue permits at the City of Tigard Building Department for the following project: t 4U„Ac.. (5-rA g �! lc cat ,y.. located at: 15 2 (45 '(..v 1 ■ L Prue. "% , . / • /�_allII King City Re , ,resentative IPDSTSU<UNST. DOC CITY OF TIGARD BUILDING INSPECTION DIVISION MST • 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested (P /i -1/ 00 AM PM BLD 1 Location IS o`7 QUA/ i MEC Contact Person 1.4fpr ( Ph PLM Contractor 03 Ph g 23 "(P9 /' / SWR BUILDING Tenant/Owner ELC /00-D OO�COz 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 RICAL Service Rough In UG /Slab Low Voltage Fire Alarm i AS 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 eins ection RE: I AP [ ] Unable to inspect - no access ADA Approach /Sidewalk Date / Inspector Other _ �/ _ _ — Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested (0/9/00 AM PM BLD - Location t7 ( I ( [AUK. V ■61'O✓1 -Suite - MEC 19i�u Contact Person t Ph 3 i PLM • Contractor Ph SWR BUILDING • Tenant/Owner ELC 7, - 1902Co Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab Plitelph/DWaC 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 P RT FAIL 11LLECTRICA Service Rough In UG /Slab Low Voltage Fir larm anal SS PART i s SITE 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 [V1' lease call for reinspection RE: - a ble to inspect - no access ADA Approach /Sidewalk Other Date IP j err) Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 5 /ll /QOAM �J j PM BLD Location I S — 1 quttivv\ U 6 vv MEC Contact Person On U � Ph 3S PLM Contractor Ph SWR BUILDING Tenant/Owner ELC 1050 — CO Z(OZ Retaining Wall ELR Footing Access:. Foundation �j 2.1471/1::, FPS Ftg Drain t `9/Ar� SGN Crawl Drain Inspection Notes: // / Slab / � � C f 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 PAS P FAIL erv Rough In UG /Slab Low Voltage Fire Alarm F'•- 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 Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date — 6 4 v Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.