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Permit A. CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2000 -00319 l& DEVELOPMENT SERVICES DATE ISSUED: 06/12/2000 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135CC-00100 SITE ADDRESS: 10200 SW TIGARD ST SUBDIVISION: ZONING: R -4.5 BLOCK: LOT : JURISDICTION: TIG' Proiect Description: Installation of two branch circuits for new 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: 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: RODGER DAY OWNER 10200 SW TIGARD TIGARD, OR 97223 Phone: Phone: AL OR‘GN Reg #: FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT DST 06/12/200C $42.85 0002858 Elect'l Final 5PCT DST 06/12/200C $3.43 0002858 Total $46.28 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 ado ted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain co s of these les or direct questions to OUNC at (503) 246 -1987. PERMITTEE'S SIGNATUREr . ISSU BY: y 6 OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: / f ���'� DATE: 6 - 42- -O 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 eck , �: 13125 SW HALL BLVD. Rec' By . � TIGARD OR 97223 Date Recd - /� Od Date to P E. Phone (503) 639 -4171, x304 Date to DST Inspection (503) 639 -4175 Print of Type Permit# ELF (l 0,9.5/7 Fax (503) 598 - 1960 Incomplete or illegible will.not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development ,1*41 Number of Inspections per permit allowed Name (or name of business) /0 4e Dot_. Service included: Items Cost Sum 4 Address /0) car) 9 w T' Le_. 5 4a. Residential - per unit Pp( 1000 sq. ft. or less $ 117.75 4 City/State /Zip T at Pi( a Each additional 500 sq ft or J portion thereof $ 26.75 1 Commercial ❑ Residential cm 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 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 $ 107.00 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 feeder fee. Print Owner's Name / e,q e-' .0Q.t, Each branch circuit $ 5.35 2 Address /0)00 5'fi Tj et.. *-6( 574- - b) The fee for branch circuits without purchase of service City T� y q r-,( l / Sta 02 Zip 9] .22.'f or feeder fee. /� Phone No. c9 / (e 7Q - /74/- � First branch circuit / $ 37.50 1/ / 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 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 re Ired): * Minor Labels (10) $ +fiff7e6 Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over /00.00 4 or more residential units in one structure the allowable in any of the above Per inspection $ 50.00 Service and feeder 225 amps or more 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: $ A, �� 5a. Enter total of above fees * Submit 2 sets of plans with application where any of the above apply. �p ti° 'Surcharge (:9&X total fees) $ Not required for temporary construction services. Subtotal • or $ 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 Y / , a - 7 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # C (J AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ • i \dsts \forms \electric doc CITY OF TIGARD BUILDING INSPECTION DIVISION MST • _ 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 7 z. `( AM PM BLD Location /0 Z.G -5 7" - 4vd St' Suite MEC Contact Person Ph G 7G /70 y PLM Contractor Ph SWR BUILDING Tenant/Owner ELC .2t & - 7& 3f Y 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 ELECTRICA ce Rough In 4,.,� Vz UG /Slab ' y Low Voltage Fire Alarm Fin • S 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 Other Date 2-9/1912 Inspector Ext Final PASS PART FAIL 0 NOT REMOVE this inspection record from the job site.