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Permit CITY O F T I G A R D ELECTRICAL PERMIT • PERMIT #: ELC2001 -00216 ' DEVELOPMENT SERVICES DATE ISSUED: 04/30/2001 r � I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S1 10 C D -03900 SITE ADDRESS: 15645 SW ROYALTY PKWY SUBDIVISION: KING CITY NO. 2 ZONING: BLOCK: LOT : 034 JURISDICTION: KIN Project Description: Change out of electric to gas furnace 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: BOTTINELLI, HELEN CANBY ELECTRIC INC 15645 ROYALTY PARKWAY 790 S IVY KING CITY, OR 97224 CANBY, OR 97013 Phone: Phone: 266 -7878 Reg #: LIC 26071 SUP 2123S ELE 3 -112C FEES Required Inspections Type By Date Amount Receipt Elect'l Final PRMT CTR 04/30/2001 $46.85 2720010000( 5PCT CTR 04/30/2001 $3.75 2720010000( Total $50.60 This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 -6699 or 1 -800- 332 -2344. Permit 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 A Electrical Permit Application Date received: t - 36 -0 1 Permit no.:Ele--.260/ — 01,A /k. 4 "• 1! City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I 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 ❑ Multi- family ❑ Tenant improvement 0 New construction 0 Addition/alteration /replacement 0 Other: ❑ Partial JOB SITE I NFORMATION Job address: /Roy5 ,IA) 0A 1., nAit:,, Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: I Su ivisio , : / Project name: I Description and location of work on premises: l'`i OVl I c..Aeie 47is- Estimated date of completion/inspection: CON7'RACI'OR APPLICATION FEE SCI IEDU;E Job no: Fee Max Business name: (e'i.g y g Description Qty. (ea) Total no. insp Address: New residential - single or multi-family per �'/� � / dwelling unit. Includes attached garage. City: ` 4 4 v I I ZIP -9/�/� Service included: Phone: _ 4,.I4. I E -mail: 1000 sq. ft. or less 4 i Each additional 500 sq. ft. or portion thereof CCB no.:a / '1 lec. bus. lic. no: 3- /)Z4_ Limited energy, residential 2 City /metro lic. no.: Limited energy. non- residential 2 -R' c / d � � , Each manufactured home or modular dwelling Signature of supervising elec tan (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 1 Owner installation: The installation is being made on property I own Temporaryservicesor feeders - . which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation: 20 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 am s 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 ,/ l✓ Phone: Fax: E -mail' of service or feeder fee, first branch circuit: , T� 2 Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): O Service over 225 amps-commercial 0 Health -care facility Each pump or irrigation circle 2 O 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, O System over 600 volts nominal more residential units in one structure alteration, or extensions 2 O Building over three stories O Feeders, 400 amps or more *Description: O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above: O Egress/lightingplan 0 Other. Per inspection 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 $ ..q O 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 %) .... $ ..? 75 Expires accepted as complete. TOTAL $ 5) Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (NONCOM) Electrical Permit Fees: Limited Energy Fees: Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY 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 ❑ 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 Fee for each system $75.00 200 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 2 Check Type of Work Involved: , Over 600 amps to 1000 volts, • see "b" above. r7 Audio a nd Stereo Systems Branch Circuits ❑ Boiler Controls New, alteration or extension per panel a) The fee for branch circuits with purchase of service or n Clock Systems • feeder fee. Each branch circuit $6.65 2 ❑ Data Telecommunication Installation . b) The fee for branch circuits • without purchase of service ❑ Fire Alarm Installation or feeder fee. . First branch circuit $46.85 Each additional branch circuit $6.65 El HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems Each sign or outline lighting $53.40 • Signal circuit(s) or a limited energy ❑ panel, alteration or extension $75.00 Landscape Irrigation Control , Minor Labels (10) $125.00' ❑ Medical Each additional inspection over the allowable in any of the above El Nurse Calls • Per inspection $62.50 Per hour $62.50 • In Plant $73.75 ❑ Outdoor Landscape Lighting Fees: n Protective Signaling Enter total of above fees $ ❑ Other • 8 % State Surcharge $ Number of Systems 25% Plan Review Fee * No licenses are required. Licenses are required for all other installations See "Plan Review" section on $ front of application. Fees: Total Balance Due $ Enter total of above fees $ ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ i :\dsts'.forms\elc- fees.doc 10/09/00 • • E_t_c acid l - COX1 • A lli Electrical Permit Application Date received: Permit no.: r te` `.f i�,i'. City of Tigard Project/appl.no.: Expire date: City of Tigard 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 ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial JOB SITE INFORMATION . �� �� _ Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: Block: Sur • vision: Project name: Description and location of work on premises: 4 k , ,,,,,r,,,.„,..._ t , . ,,, ' r Estimated date of completion/inspection: atAvertal.' mow.-, £( c.. r� CONTRACTOR APPLICATION FEE SCHEDULE Job no: Max Business name: Description Qty. Total no. insp New residential - single or multi- family per Address: - 5, 5 W &i , to I u dwelling unit. lncludesattached City: , /hpZfr Sta : r, ZIP: Setvice included: Phone: !/' I Fax: I E -mail: 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof CCB no.: e 26, 0 � I Elec. bus. lic. no: 3 _ 112 L 7 Limited energy, residential 2 City /metro lic. no.: Limited energy, non- residential 2 S tE 9-,r e jlCS e a,77ON / tA S l6;v6rLL/r'E •ir 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 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, 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 am. s 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: • ' 2 Phone: Fax: E - mail: Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): U Service over 225 amps-commercial O Health -care facility Each pump or irrigation circle 2 O Service over 320 amps -rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2 family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ❑ System over 600 volts nominal more residential units in one structure alteration, or extension' 2 O Building over three stories ❑ Feeders, 400 amps or more *Description: O Occupant load over 99 persons 0 Manufactured 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 u Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 76 • ePS 0 Visa O MasterCard expires if a permit is not obtained Plan review (at %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 3, '7 -s Expires accepted as complete. TOTAL $ ...SO ' 4. 0 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 /� Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items . Cost . Total y 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 Manuf'd 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 ❑ 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 Fee for each system $75.00 200 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 2 Check Type of Work Involved: Over 600 amps to 1000 volts, ❑ see "b" above. Audio and Stereo Systems Branch Circuits ❑ Boiler Controls New, alteration or extension per panel a) The fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee. . Each branch circuit $6.65 2 - , ❑ Data Telecommunication Installation b) The fee for branch circuits _ without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch circuit / $46.85 Y4. eS HVAC Each additional branch circuit • $6.65 Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems Each sign or outline lighting $53.40 Signal circuit(s) or a limited energy panel, alteration or extension $75.00 ❑ Landscape Irrigation Control' Minor Labels (10) $125.00 ❑ Medical Each additional inspection over the allowable in any of the above ❑ Nurse Calls Per inspection $62.50 • Per hour $62.50 • In Plant $73.75 ❑ Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total of above fees $ n Other • 8% State Surcharge $ 3, 7S 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. Fees: Total Balance Due $ $0 . Co 0 • Enter total of above fees • $ ❑ Trust Account # • 8% State Surcharge $ Total Balance Due S • i:\clsts\forms\elc-fees.doc 10/09/00 12/27/99 MON 09:59 FAX 503 598 1960 CITY OF TIGARD Z002 • CITY OF TIGARD Plan Check # Electrical Permit Application 13125 SW HALL BLVD. Rec'd By TIGARD OR 97223 Date Rec'd Phone (503) 639 -4171, x304 Date to P.E. '� Inspection (503) 639 -4175 Date to DST Ins p ( ) Print of Type Permit* Fax (503) 598 -1960 Incomplete or Illegible will not be accepted Called 1. Job Address: 1, 4. Complete Fee Schedule Below: j Name of Development tLA � pofA-y Number of Inspections per permit allowed • i Name (or name of business) Service Included: Items Cost Sum 1 ' Address 15 6'45 s. t i . kit 4.L4-y R aie),/.. W 4.4 r 4a. Residential -per unit ! 1000 sq. ft: or less $ 117.75 4 t City /State /Zip _ �` 1 Q r� Each additional 500 sq. ft. or ' portion Li it Energy $ 26.75 1 Commercial ❑ Residential Limited Energy $ 60.00 Each Manurd 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 ba e). Installation, alteration, or relocation Electrical Contractor but `El. c ..re.■•e 200 amps or less $ 64.25 2 i Address t, at o s • - az - u v 201 amps to 400 amps $ 85.50 2 City (ril4rr60 State t', 2 Zip 4("1 0 t -3 401 amps to 600 amps $ 128.50 2 • , Phone No. 5 0 - b, - 1 - 1 2f Over 1000 amps or volts $ 363.75 2 Job No. Reconnect only $ 53.50 2 Elec. Cont. Lice. No. `3- t. VI C- Exp.Date (0 / I /6 I 4c. Temporary Services or Feeders OR State CCB Reg. No. - 7_,L, ®`t I Exp.Date 1 f9..7 6 2 Installation, alteration, or relocation . z;',.-' COT Business Tax or Me No. I1G9 Exp.Date 6 //62... 200 amps or less $ 53.50 2 •. :, 201 amps to 400 amps $ 80.25 2 4j Signature of Supr. Elec'n I ( ,..�� rN , 401 amps to 600 amps $ 1oo.ao 2 ^a' Over 600 amps to 1 volts, see "b" above. ,' •li License No. `2_ k 2 - 6 S Exp.Date 10/ 1 A I 1 ; r 4d. Branch Circuits Phone No. *� n 3 - ' l ` 1 New, alteration or extension per panel ,' a) The fee for branch circuits ' ' ' 2b. For owner installations: with purchase of service or • feeder fee. t 1 Print Owner's Name Each branch circuit $ 5.35 2 • Address b) The fee for branch circuits without purchase of service I City State Zip or feeder fee. '''I Phone No. First branch circuit ( $ 37.50 3`l .5 r) Each additional branch circuit $ 5.15 ".1 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) `,, 4 Each pump or irrigation circle $ 42.75 •) `' Owner's Signature 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 required): * Minor Labels (10) $ 100.00 ;1'. Please check appropriate Item and enter fee in section 58. 41. 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 System over 600 volts nominal In Plant $ 59.00 i ?, Classified area or structure containing special occupancy as 4 described in N.E.C. Chapter 5 5. Fees: j 5a. Enter total of above fees $ 31.'513 `" * Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ 3.o 0_ ' . Not required for temporary construction services. Subtotal $ ' 1 5b. 5b. Enter 25% of line Sc for Plan Review if required (Sec. 3) $ A i as .v' PERMITS BECOME VOID IF WORK OR CONSTRUCTION AU Subtotal / i . : $ w 'i IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR ';1 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Accoyp '' J''4 AT ANY TIME AFTER WORK IS COMMENCED. Total b ance,•Due $ L4 0 .5 O G 1' 'c a i:tdsts \fonns\electric.doc ., , • :a K I N G CITY k _+ 15300 S.W. 116th Avenue, King City. Oregon 97224.2693 inSainalissimmu Phone: (503) 639.4082 • FAX (503) 639-3771 • Notice To Contractors Working 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 will 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 notiEcation. _"u y 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 stall 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 13126 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: C cs /P.Phifa-12 located at: /5 & .S- u 7�0 /3,4_1 P-0-4 / King City Representative 1 / - 30 - 6 I DSTS.::cINST DOC CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 l BUP Date Requested / AM PM Location / . 5 - 5 w 7 a I g 4,4 Suite MEC � /,3 . Contact Person AAi X Ph t 3 f. 7 Z Z U ' PLM Contractor 1T/ Ph Z SWR BUILDING Tenant/Owner 7 k C-44 i 1t • Z�1 /Z Retaining Wall 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 i 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 $TECH Post & Beam Rough In Gas Line Smoke Dampers Fig = t l� ). • RT FAIL — RICA ce Rough In UG /Slab Low Voltage Fire Alarm l PART FAIL 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date l ,/ Inspector E Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.