Permit • CITY OF TIGARD ELECTRICAL PERMIT
0,;(1 DEVELOPMENT OR SERVICES DATE ISSUED: 06/116/98
13125 SW Hall Blvd., Tigard, PARCEL: 1 S 12i5DL3 0E3Gi00
SITE ADDRESS„ ° ., :0719121 SW SHADY LN
SUBDIVISION. ° .. :SHADY DELL NO. 2 ZONING :R -4.5
BLOCK. .. °...°•.. LOT. . ° °. ° ° ° ° ° ° °° : 12131 JURISDICTION: TIG
Project De ion: Add electrical to an existing single family dwelling.
—RESIDENTIAL UN I T -_ -_ -- - -TEMP SRV C /FE.EDERS -• - - -- ---------M I SCEL.!._ANE OUS___ - -_
1000 SF OR LESS. ° .: 0 IZr - 200 amp... • ...: 121 PUMP/IRRIGATION....: 121
EACH ADD' L SIZIeSF. • .: 121 21211 - 4121121 a m p . , . , , . . 121 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY.....: 0 41211 - 600 amp° ...... 0 SIGNAL/PANEL.......: 171
MANF. HM/ SVC /FDR..: IZI 61211 +_ 11Z'012) volts.: O MINOR LABEL 10)...: 10
----SERVICE/FEEDER---- - -_- __BRANCH CIRCUITS----- -- -ADD' L INSPECT I ON S - - --
- 2.0171 amp... • 10 W /SERVICE OR FEEDER: IZr PER INSPECTION--; 101
201 - 400 amp 0 1st W/O SRVC OR FDR.. 1 PER HOUR...........: 0
401 -- SO121 amp......: 121 EA ADD' L BRNCH CIRC: 1 IN PLANT...........: 121
601 - 1000 amp.....: 0 -PLAN REVIEW SECTION
1000+ amp/volt.....: 0 )=4 RES UNITS..... ° .... ) 61210 VOLT NOMINAL.:. :
Reconnect only.....: 1'1 SVC /FDR ) = 225 AMPS..: CLASS AREA /SPEC OCC. :
Otner: -- _ - - - - -- - -- -- •---- •- --- -- - - -- -------------- .---- .._. -_..._ _ - _..__... _ FEES --- ._- ._.._..._.....- - - - -- -
CLARENCE L CHILSON type amount by date recpt
7190 SW SHADY LANE PRMT $ 4171.012' GEO 106/16/96 98-- 31216562
T I GARD OR 97223 5PCT $ 2.00 GEO 06/16/98 98-306562
Phone #:
THE ELECTRIC GROUP $ 42.1210 TOTAL
4726 SE MILWAUKIE AVE
_.____ -_.__ REQUIRED INSPECTIONS _._._. - -__
PORTLAND OR 97202 Elect' 1 Service
Phone tk: 232-2499 Elect' 1 Final
E=2 e g #k ° ° . 000436 __ _.._.._...�— __.__..
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 Bore than 180 days. ATTENTIONS Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 95 - 001 -0010 through OAR 952- 001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling t` -' 246 -1587,
Permittee Signature: _ _ __ Issued Bye
The installation is being made on property I 0 ti4 ri Which is not intended For
sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
---------- __-- .__ -:.-- _CONTRACTOR INSTALLATION ONLY-_._________._ ___...__._._______..___._..__._
SIGNATURE OF SUPR. ELEC' N: _ 6 DATE: ‘":"/‘:: - -_ _.
LICENSE NO _
++ +i- ++ + + + + +++ + + +- 1-44-1 --; + ++ + +-{ +++++++++++++• 1-+ + +-i- + + + + + +-I- + + + + + + + + + + + +1 --1- +mo + + + -I -4. +-t --1• ++
Call 639-4175 by 7 :00 p.m. for an inspection needed the next business day
+-1 - - +++ +-l- +- t- 4- 4- ++- 1_.I- + ++ +•i +i- + +-1 + + + + +-F ++++++ + ++ + ++ ++ + + + +-I- ++ ++-E--I- +++ + ++ 1-4- -4.1- 4-4.4 -I -4-1-4 --1-+
L; ,, - ; , '
,
CITY OF TIGARD Electrical Permit Appiiq korg) Plan Check #
13125 SW HALL BLVD. Rec'd By
Date Rec'd
TIGARD OR 97223 JUN 1 6 1998 Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
pe
Inspection (503) 639 -4175 Print or Ty tl1fJIUi�ITY DEVELOPMENT Permit # Bt-e-$ -63R G
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: /� /,, ��i 4. Complete Fee Schedule Below:
$5'» 4
Name of Development P1 Number of Inspections per permit allowed
Name (or name of business) el4 re -vc'e- i�,� / / SO'(9 Service included: Items Cost Sum
Address ‘7/90 sece __5- L. - -e' 4a. Residential - per unit
City/State/Zip � 0.o � 0 9 7,7_3 1000 sq. ft. or less $110.00 4
ty p Each additional 500 sq. ft. or
Commercial El Residentia portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all c rrent licenses) 4b. Services or Feeders
Electrical O tractor i - a G .0 ' ■ Installation, alteration, or relocation
� 200 amps or less $60.00 2
Addre s 77 7,/ C ' A/ Y �/ u)A ;., /9✓e» 201 amps to 400 amps $80.00 2
City 0/4l a,lcP State /)i(2. Zip 97 e Dp, 401 amps to 600 amps $120.00 2
Phone No. 2 3 Z 2 - '7'S9 601 amps to 1000 amps $180.00 2
Job No. q'S° -7/ Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. C, SI SC Exp.Date
OR State CCB Reg. No. 1 -1.3535"/ Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No.lfrZ/ E Date Installation, alteration, or relocation
200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec n .,�/ 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 1 .05-S- S Exp.Date see "b" above.
Phone No. 7 2 2 /
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
-
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit / $35.00 -s 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable In any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: yD
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $ ` -
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ 1 /2
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
G BUP
Gv ma Date Requested —) 3 ° 0 AM PM BLD
Location '7 / SvJ Sh(jA - Suite / / MEC
Contact Person WA, �7L_ v Ph . `4- 793 7` PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC 7? - 03 2 •6
Retaining Wall ELR
Footing / FPS
Foundation ACC @S 71/../it / i f C �� ; 2
Ftg Drain
Crawl Drain Inspection Notes:
SGN
Slab ( �� SIT
Post & Beam L�� L /�1.Q_- c .4.L)
Ext Sheath /Shear
Int Sheath /Shear
Framing
Drywall on � ✓��-- 1
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING INEMIS
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
FAIL •
CTRICAL � - ;
Service �
Rough In �t
UG /Slab Low Voltage r j u iptIC)
�,
FireAlarm L _
dW ill 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 9/
Othe�ach /Sidewalk Date 7 - 42 ' 9 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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