Permit CITY OF TIGARD ELECTRICAL PERMIT
• PERMIT #: ELC2001 -00092
k DEVELOPMENT SERVICES DATE ISSUED: 2/12/01
- 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 104 BC -04300
SITE ADDRESS: 14340 SW WALNUT LN
SUBDIVISION: HILLSHIRE WOODS ZONING: R -7
BLOCK: LOT : 054 JURISDICTION: TIG
Project Description:
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:
JENSEN, RONALD D +ANN H TRS SPARK ELECTRICAL CONSTRUCTION
14340 SW WALNUT LN 4508 NE 123RD
TIGARD, OR 97223 VANCOUVER, WA 98682
Phone: Phone: 701 -7822
Reg #: LIC 143886
SUP 4394S
ELE 26 -997C
FEES Required Inspections
Type By Date Amount Receipt Rough - in
PRMT CTR 2/12/01 $53.50 2720010000( Elect'I Final
5PCT CTR 2/12/01 $4.28 2720010000(
Total $57.78
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: • egon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 - 0010 through 0 'r 952 -0 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE i <44 ISSUED BY: tr
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
Electrical Permit Application
Date received: ,Q — L7 —OI Permit n o . : 6 ,1 6, 00/ zeoy�
A � � ,, r
_1,L .,• 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 PERM IT
1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family 0 Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: / r/O -a.-- u / , L * a ' l, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 'Block: I Subdivision:
Project name: I Description and location of work on premises: 244 tiA
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: � ��!�Jg` -/eg 41 y
Descri iron Qty. (ea) Total no. iacp
""T New residential - shy* or multi-family per
Address: 4 �of' t 1 ,f/6 /Z3 ,4e- dweffing unit. Includes attached garage.
City: (r� ,pa v l.� I Statetj -79.- ZIP: /j /er Service included:
Phone:fp.; - 7cy - ZP2L I Fax -4W- y7, -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: /VS 1/' . [Elec. bus. lic. no: 26 r
- fl 7C _ Limited energy, residential 2
City /metro lic. no.: pp.-0 .17 O Limited energy, non- residential 2
4 /�,.d / Each manufactured home or modular dwelling
Signature of su i�7� W - - uired) Date 8 L //2 / // Service and/or feeder 2
Sup. elect. name (print):/ - ,'/ License no: if .0,,,r"-- Services or feeders installation,
alteration or relocation:
PROPER TV OWNER 200 amps or less 2
Name (print): £Oil .97e A7 Se .7 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: vI .l cam./ 601 amps to 1000 amps 2
City: I State: 'ZIP: Over 1000 amps or volts 2
Phone: I Fax: 1E-mail: Reconnect only
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, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 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: 'State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 1 2
Phone: Fax: E -mail: Each additional branch circuit: /
I'LAN REVIEW (Please check all that apply) M [sc. (Service or feeder not included):
❑ Service over 225 amps- commercial O Health-care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of I &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:
❑ Egress/lighting plan ❑ 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 $
❑ Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card •
$
Cardholder signature Amount 440-4615 (6I00/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 `, 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. Fi 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. I �
Each branch circuit $6.65 2 I I Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee. O� •
First branch circuit $46.85 1 6t a
Each additional branch circuit I $6.65 --(p- ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy Landscape Irrigation Control
panel, alteration or extension $75.00
Minor Labels (10) $125.00
El Medical
Each additional inspection over
the allowable in any of the above Calls
Per inspection $62.50
Per hour $62.50 ❑
In Plant $73.75 Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ 5 3'S7 El Other
8% State Surcharge $ t i 2
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.
�y Fees:
Total Balance Due $ S7 b
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i•\dsts \forms\elc- fees.doc 10/09/00
Z/F
\COY OF TIGARD BUILDING INSPECTION DIV - • N
24our Inspection Line: 639 -4175 Business L' 6394171 MST ' _
BUP
Date Requested 5,20 AM ' PM BLD
Location /Cl3c/6 .5w 14}4 • uite MEC
Contact Person //i'Ns br% wovh Ph (Z Z PLM
Contractor . �C Ph SWR
BUILDING Tenant/Owner ELC 7 J -GOO `l
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Slab
Crawl Drain Inspection Notes: ox
/4„-(_)/717 �L�
SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler _ _ 4111P
�
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
(ELECTRICAL
Service
Rough In
UG /Slab .
Low Voltage
• e Alarm
PART FAIL
SITE
BackfilUGrading
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 fo reinspection RE: [ ] Unable to inspect - no access
ADA
Approach/Sidewalk Date 3 Z Inspector
Other nspecor E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
,CITY OF TIGARD BUILDING INSPECTION DIVISION
24 oM
ur spection Line: 639 -4175 Business Line: 6391 MST
O BUP
Date Requested 2 1 AM 1, PM BLD •
Location 1 4 3 q 0 sw a1 cv1� i,)Y Suite MEC
Contact Person Vic Ph 7s7/_ 7 71 i PLM
Contractor ���A - rY( £/r Arc c Ph SWR
BUILDING Tenant/Owner ELC , ) ' o 9 2_
Retaining Wall ELR
Footing Access:
Foundation /? FPS
Ftg Drain � '� r r� S C Z o 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
Ass BART FAIL
-
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Fi
(RAS,S. 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 Z /y D t Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.