Permit / CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00272
DEVELOPMENT r OR (503) 639 -4171
SERVICES DATE ISSUED: 05/24/2001
- 13125 SW Hall Blvd..
PARCEL: 2S 103BA -00800
SITE ADDRESS: 11865 SW WALNUT ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: UNERGROUND METER/MAIN. Job k #1240
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: 1 W /SERVICE OR FEEDER: 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:
BOOTH, DAVID + MARY P WILLAMETTE ELECTRIC INC
11865 SW WALNUT ST PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: Phone: 624 -3631
Reg #: LIC 75059
SUP 1965S
ELE 34 -283C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT CTR 05/24/2001 $80.30 2720010000( Elect'I Final
5PCT CTR 05/24/2001 $6.42 2720010000(
Total $86.72
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 -6699 or 1 -800- 332 -2344.
Permit Signature: ./ 4 Issued By:
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
a
SIGNATURE OF SUPR. ELEC'N: Th DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
ti p d
Electrical Permit pplication , •
.- - , :
41
F Da te received: Permit no. )�/ ,_.0,7,.-701. ,-i1, City of Tigard C ' Project/appi.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR ,97221001 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 �AY
Fax: (503) 598 -1960 • Case file no.: Payment type:
Land use approval: COtap�ONt pfvt
- , TYPE OF PERMIT
0 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: ) i kb j qw W. / N✓ r Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: O,t,,, 0 4„ Tom-- I Description and location of work on premises: (,{, D A bUJj / i,t�,�•
Estimated date of completion/inspection: a —/ r — O / /
CONTRACTOR.APPLICATION FEE SCIIEDU.E
Job no: 1 a V U Fee Max
Description Qty. (ea.) Total no. Imp
• Business name: I.), Ia ■P ti Ti e c tA.t /n
New residential - single or multi- family per
Address: / a A x 230 P -. dwelling tmN . Includes attached garage.
City: 7-„ a I State: G_ I ZIP: 9? Z&/ Service included:
Phone: 6 L v- 3 6 T i I Fax: 6 2 `f - Z5.6 I E -mail: 1000 sq. ft or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 9-s S y I Elec. bus. lic. no: 24 - LS 0— Limited energy, residential 2
City /metro lic. no.: Thy Limited energy, non- residential 2
p' Z Z — 0 / Each manufactured home or modular dwelling
° o f T Service and/or feeder 2
Signature of supervise g electrician (required) Date
Su elect. name (p rint): ' ,.... h, re License no: (9t . Services or feeders—installation,
Sup. alteration or relocation:
PROPERTY OWNER • 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps
Mailing address: 601 amps to 1000 amps 2
City: I State: I'ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
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 brstallation , 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 amps 2
ENGINEER 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: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
— PLAN 'REVIEW check' all- that apply) - - - -- - - -_ Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial • ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of I &2 O Hazardous location Each signor outline lighting 2
family dwellings ❑ Building over 10 ,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories O Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other: Per inspection 1 I I I
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 $ F(/ r'
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Z
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Ex accepted as complete. TOTAL $ Fs i , .�—
Name of cardholder as shown on credit card
$ •
Cardholder signature Amount •' .....r.1,_ •M)
0 . Cali"
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 `I' 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 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
200 amps or less $66.85 2 Fee for each system $75.00
' 201 amps to 400 amps $100.30 2 (SEE OAR 918 - 260 -260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above. ❑
Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n Boiler Controls
a) The fee for branch circuits
with purchase of service or
feeder fee. n Clock Systems •
Each branch circuit $6.65 2
b) The fee for branch circuits ❑ Data Telecommunication Installation
without purchase of service
or feeder fee. ❑ Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6 65 n HVAC
Miscellaneous •
(Service or feeder not included) n Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑ Landscape Irrigation Control'
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑
Per hour — $62.50 Nurse Calls
In Plant _ $73.7
Outdoor Landscape Lighting'
Fees:
n Protective Signaling
Enter total of above fees $
n Other
8% State Surcharge $
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ Fees:
Enter total of above fees $
❑ Trust Account #
8% State Surcharge $
Total Balance Due $
i:'dstsVomu\elc- Cees.doc 10/09/00
. - .CI OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
` BUP
C't Date Requested AM PM BLD
Location [ i! ,11/1 Suite MEC
Contact Person Ph 6,2 3/ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC `
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 �-C Y L// C
Misc: .. — Q Ste'
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 A PART FAIL
(EeEi I
Rough In .
UG /Slab
Low Voltage
Fire Alarm
Fig
"ART . ,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 Date 0
Other Inspector ds., 4��t0�. Ext
Final
PASS _PART FAIL- DO NOT REMOVE-this inspection record from the job, site.
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