Permit ' CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00728
- rii k, DEVELOPMENT SERVICES DATE ISSUED: 12/07/1999
13125 SW Hall Blvd.. Tidard, OR 97223 (503) 639 -4171 PARCEL: 1S134AB-03300
SITE ADDRESS: 10330 SW SCHOLLS FERRY RD
SUBDIVISION: ' ZONING: R -12
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation, alteration or relocation for 200 AMP service and add 4 branch circuits.
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 HMI 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:
MUSLIM EDUCATION TRUST ISLAMIC DAN MATES ELECTRIC
PO BOX 283 15120 NE CLACKAMAS
PORTLAND, OR 97207 PORTLAND, OR 97230
Phone: Phone: 256 -6286
Reg #: 00090071
ELE 26 -828C
SUP 3992S
FEES Required Inspections
Type By Date Amount Receipt
Ceiling Cover
PRMT DST 12/07/199c $85.65 99- 320221 Wall Cover
5PCT DST 12/07/199c $6.85 99- 320221 Elect'l Service
Elect'l Final
Total $92,50 ORI
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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 .Z) ISSUED BY:
WNER INSTALLATION 0 LY
The installation is being made on property I o n which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: 1J ✓r/l ll— DATE:
CO TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE: /a _'9 �1
LICENSE NO: 3 «a - S
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY CA F TIGARD
•
Plan Check #
131.25 SW HALL BLVD. Electrical Permit Application
Recd By
TIGARD OR 97223 Date Recd
Date to P E
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # LC / 9'
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development ME-:1 Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum
Address ( o 33 0 Skit S � fit' r7 124 4a. Residential - per unit
City/State/Zip ( � 4d2 4 O U 1000 sq. ft or less $ 117.75 4
ry p T Each additional 500 sq ft. or
���-�/// portion thereof $ 26.75 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 contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation
Electrical Contractor P1 A - '1 - G. S 1_ (-E C- (&
T I C 200 amps or less 1 $ 64 25 G `10 -7 5 2
,.
Address I j � I Z✓ Nr L(0. !. ( t1S 201 amps to 400 amps $ 85.50 2 401 amps to 600 amps $ 128.50 2
City ?o1" - - t odAd State 0 12 Zip 17 2,30 601 amps to 1000 amps $ 192 50 2
Phone No. 51/0 -411.4-2._ Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 24 "g 265 C Exp.Date 4c. Temporary Services or Feeders
OR State CCB Reg. No. goo 11 Exp.Date Installation, alteration, or relocation
COT Business Tax or Metro N . Exp.Date 200 amps or less $ 53.50 2
// 201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n e�LLQ't''e) 401 amps to 600 amps $ 100.00 2
Over 600 amps to 1000 volts,
License No. 3 9 q 2 c' a Exp.Date see "b" above.
Phone No. 2-5 - b 'L0 (0 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. I
Print Owner's Name Each branch circuit $ 5 35 a I. ! v 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 ' ! ' $ 5.35
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
(if required):* panL alteration or extension $ 60.00
3. Plan Review section
( 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
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: Q ^� �-
5a. Enter total of above fees $ O
* Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (08 X total fees) $
- 6 47 C55
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 $ '7,9. 5
i \dsts \forms \cicctric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
1 BUP
X
Date Requested MAI AM PM BLD
Location I 0' SCihO t S ceA/21 Suite � MEC
Contact Person Lt Ph 5) (0 (
/ / `7 Z PLM
Contractor Ph SWR G �i
BUILDING Tenant/Owner
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: n SGT
Slab ,, n —C 1] ®r- 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 / C/ A 4 2 °
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
P PART FAIL
ECTRIC
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
ASS 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 / 0 1 � � Ins
Other Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.