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Permit
CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2000 -00585 a tlA DEVELOPMENT SERVICES DATE ISSUED: 10/12/00 � I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S1 11 AD -08900 SITE ADDRESS: 08785 SW REILING ST SUBDIVISION: SCHECKLA PARK ESTATES ZONING: R -4.5 BLOCK: LOT : 002 JURISDICTION: TIG Project Description: Heating, ventilation & air conditioning 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: SIGNAUPANEL: 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: 1 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: TUCKER - MCCOY, PATRICIA ANN A + J ELECTRIC 8785 SW REILING ST PO BOX 330 TIGARD, OR 97224 FOREST GROVE, OR 97116 Phone: Phone: 359 -5891 Reg #: LIC 959 SUP 489S ELE 34-1C FEES Required Inspections Type By Date Amount Receipt Rough -in PRMT CTR 10/12/00 $53.50 2720000000( Elect'l Final 5PCT CTR 10/12/00 $4.28 2720000000( Total $57.78 This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Speaalty 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 ISSUED 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: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day Electrical Permit Application Date received: 0--(2._--00 Permit no: I / ` •l „, - . • ,,, A .* .11 City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: • TYPE OF PERMIT � 1 & 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: i � g b ir 'i. C r Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: Block: Subdivision: V Project name: LA t: tee I Description and location of work on premises: Estimated date of completion/inspection: d /Z 0 0 • CONTRACTOR APPLICATION FEE SCI IEDU.E • Job no: Fee Max Business name: 4, 0 lief i<r /c ,.Ai L Description Qty. (ea.) Total no. insp New residential - single or multi- family per Address: �b ,'3 dwelling unit. Includes attached garage. City: e C i pue I State:0r ZIP: Service included: Phone: f(,Zrj / I Fax: I E -mail: 1000 sq. ft. or less • 4 CCB no.: 9' I Elec. bus. lic. no: (3y— f —_,_ Each additional 500 sq. ft. or portion thereof 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 200 amps or less 2 Name (print): 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: 601 amps to 1000 amps 2 City: I State: I ZIP: Over 1000 amps or volts 2 Phone: I Fax: I E -mail: Reconnect only i 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, or relocation: 200 amps or less 2 20 ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2 Owner's signature: Date: 401 to 600 amps 2 ENGINEER 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: i 2 Phone: Fax: E-mail: Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): 0 Service over 225 amps- commercial O Health -care facility Each pump or irrigation circle 2 0 Service over 320 amps- rating of l &2 0 Hazardous location Each sign or outline lighting 2 family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, 0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2 0 Building over three stories Cl Feeders, 400 amps or more *Description: 0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable In any of the above: 0 Egress/lighting plan 0 Other. Per inspection I Submit _ sets of plans with any of the above. Investigation fee • The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. 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 $ Name of cardholder as shown on credit card $ • Cardholder signature Amount 440-4615 (6100/COM) 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 Si' 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 E. 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 ❑ • 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 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. Branch Circuits ❑ Audio and Stereo Systems . New, alteration or extension per panel ❑ a) The fee for branch circuits Boiler 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. ❑ Fire Alarm Installation First branch circuit ) •$46.85 Each additional branch circuit i $6.65 (,, ❑ HVAC Miscellaneous • (Service or feeder not included) ❑ Instrumentation Each pump or irrigation circle • $53.40 Each sign or outline lighting $53.40 ❑ 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 Per hour $62.50 ❑ Nurse Calls • In Plant $73.75 ❑ Outdoor Landscape Lighting Fees: ❑ Protective Signaling Enter total of above fees $ , 42-3.0w . 8% State Surcharge $ 4 26 n Other • Number of Systems 25% Plan Review Fee See "Plan Review" section on $ • front of application. * No licenses are required. Licenses are required for all other installations Total Balance Due $ ■_2181 Fees: • ❑ Trust Account # Enter total of above fees $ 8% State Surcharge . $ • Total Balance Due $ i:\dsts\forms\elc-fees.doc 10/09/00 • 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) 6394171, x304 Date to DST Inspection (503) 639 -4175 Print of Type Permit # Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections per permit allowed Name (or name of business) Service included: Items Cost Sum 4 ' Address 4a. Residential - per unit City /State /Zip 1000 sq. ft. or less $ 117.75 4 Each additional 500 sq. ft. or portion thereof $ 26.25 1 Commercial El Residential ❑ 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 c • tractor license 4b. Services or Feeders information for COT data bas =,6 / / Installation, alteration, or relocation Electrical C % t - clot C A . i f ,,. A 200 amps or less $ 64.25 2 201 amps to 400 amps $ 85.50 2 Addres � , .4o, , �i 401 amps to 600 amps $ 128.50 2 Clty ✓.��L.;� , t . Zlp - te ... � 601 amps to 1000 amps $ 192.50 .2 Phon No 3 - , . 9 / 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 Metr• •. Exp.Date 200 amps or less $ 53.50 z 201 amps to 400 amps $ 80.25 2 • 401 amps to 600 amps $ 107.00 2 Signature of Supr. Elec n r/, .. / r ,,.y Over 600 amps to 1000 volts, y �J E x p.Date see °b" above. License No. 4d. Branch Circuits Phone No. New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or feeder fee. Print Owners Name Each branch circuit $ 5.35 2 b) The fee for branch circuits Address without purchase of service City State Zip or feeder fee. Phone No. First branch circuit i $ 37.50 Z 7, s 1L, Each additional branch circuit I $ 5.35 ,,, 3 ) 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 Signature Each sign or outline lighting $ 42.75 Signal circuit(s) or a limited energy . 3. Plan Review section i re ure : * panL alteration or extension $ 07.00 f id �. 4 � Minor Labels (10) $ 107.00 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. Enter total of above fees $ * Submit 2 sets of plans with application where any of the above apply. 5% Surcharge (.05 X total fees) $ 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 # AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ is \dsts \forms \e lectric. doc • CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 / /- BUP Date Requested l U - (f� AM PM BLD Location in 8-2- SGV API (I Sr Suite MEC Contact Person l dale Ph 7f7- t(5l/C PLM /47 r Contracto 2j' -7 (C Ph SWR — BUILDING Tenant/Owner ELC 2e,e - Ga - 5 k) 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 te./67 Fire Alarm Susp'd Ceiling Roof Misc: Final _/ r 4 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 LECTRICAt Service ora UG /Slab Low Voltage Fire Ala F' 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 reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk / D Other � ' /KO ©C7 Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.