Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00156
1 ' DEVELOPMENT SERVICES DATE ISSUED: 04/07/2000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S113AB -00300
SITE ADDRESS: 16075 SW UPPER BOONES FERRYRD
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT : 036 JURISDICTION: TIG
Project Description: Electrical TI
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: 6 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:
AKERMAN, RICH/WATHEY, JAMES E DAVID JEROME ELECTRIC
16075 SW UPPER BOONES FERRY RD PO BOX 751
TIGARD, OR 97224 HILLSBORO, OR 97123
Phone: Phone: 503 - 648 -5144
Reg #: LIC 36051
SUP 2877S
ELE 34 -119C
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT BON 04/07/200C $69.60 0001247 Elect'l Final
5PCT BON 04/07/200C $5.57 0001247
Total $75.17 ORIGINAL
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 /li/li �� 1 ISSUED BY: ��.
11
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: &VA a-lei CAS DATE:
LICENSE NO:•
Call 639 -4175 by 7:00pm for an inspection the next business day
JOB#
Community Development ELECTRICAL PERMIT APPLICATION
A 1T
3125 SW Hall Blvd.
gard, OR 97223 s'e,C e® Planck/Rec. # jJP-
Q ( 0ermit # � l.!`.2 1 )tf? - MI Sl0
I' "I1I'I'' Phone (503) 639 -4171 $ " - D Issued ri -
" FAX (503) 684 -7297 i
CITY OF TIGARD TDD No. (503) 684 -2772 0 Onaued by 6, �✓�VI�1
Inspection (503) 639- 41300
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development T/l_2 i 41A4 C Number of Inspections per permit allowed
Address / kr° /.. JL.t/ ,60 (4 r I ervice included: Items Cost(ea) Sum
City /State/Zip TIGARD 0 R C? 22-Y 4a. Residential - per unit 4
1000 sq ft or less $110 00
—
Name (or name of business) / e-- Each additional 500 sq ft or
portion thereof $25 00 1
CornmerciatEr Residential ❑ Limited Energy $2500
Each Maned Home or Modular 2
Dwelling Service or Feeder $68 00
-
2a. Contractor installation only: 4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor D A J E R O M E ELECTRIC 200 amps or less cee -- 2
Address PO L I U X /51 201 amps to 400 amps $80 00 2
401 amps to 600 amps $12000 2
City HT I I S R (1 14 R Staten R _ ZIP _9.7-12-3 7 2 3 601 amps to 1000 amps $18000 2
—
Phone No. 648 -5144 FAX 548 -9723 Over 1000 amps or volts $34000 2
Contractor's License No. 34- 34-11qf Reconnect only $50.00
Contractor's Board Reg. No J 6 b 51 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n 200 amps or less $50 00 2
License No. 2 8 7 7 S Phon o. 6 4 R - 5i 14 4 201 amps to aoo amps $�s o0 2
401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner installations: see 'b' above
4d. Branch Circuits
Print Owne ame New, alteration or extension per panel
Address a) The lee for branch circuits with
City ate Zip urchase of service or feeder fee. r lip-- 2
p Each branch circuit uu ,20
Phone No. b) The fee for branch circuits without
The installation is be' : made on : • • erty I own which is purchase of service or feeder fee. 711r 2
First branch circuit $35.00 2
not intended fo = - e, lease or rent. Each additional branch circuit $500 r f
o n_•' ignature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40 00 2 - Each sign or outline lighting $40 00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40 00
4 or more residential units in one structure M Labels (10) $100 00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35 00 - Per hour $55 00
-
In Plant $5500
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees: ���,�,,,,,
NOTICE 5a nter total of abo fees ' $ self - �+ r,�
' 1,
. 04% Surcharge (X total fees) 4 $ 5
PERMITS BECOME VOID IF WORK OR. CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF. • • 5b: Enter 25% of lips A for _ . . _ .
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (S�e.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. ❑ Trust Account # $ -s;�
Balance Due �ra1,
rackeinyM.ycpmapp r 15t1 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 63 4171
BUP
Date Requested sp oo AM PM BLD
Location 6 ai L ite MEC
Contact Person V)(171 Ph 'ow-Si %. / PLM
Contractor Ph SWR , /,,
BUILDING Tenant/Owner —� ELC —`� C `0
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Inspection SGN
Crawl Drain of
. Slab �� 6� �r SIT
Post & Beam Sl
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
ERICA
Service
- ough •
ab
Low Voltage
Fire Alarm
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 /7 40 Ins Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.