Permit Avi CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00332
1 DEVELOPMENT SERVICES DATE ISSUED: 06/27/2001
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103BD -00200
SITE ADDRESS: 11710 SW WALNUT ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Fire repair. Installation of (1) service /feeder and (15) branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 15 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
a' 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
CAPPOEN, RAYMOND J ROSE CITY ELECTRIC CO INC
SUZANNE 4012 NE CULLY BLVD
11710 SW WALNUT ST PORTLAND, OR 97213
TIGARD, OR 97223
Phone: Phone: •
Reg #: 2O -61fA7S
LIC 3567
ELE 26 -113C
FEES Required Inspections
Type 7, By Date Amount Receipt Rough-in
e l Final
PRMT r, CTR 06/25/2001 $46.85 2720010000(
51 CTR 06/25/2001 $3.75 2720010000(
PRMT, ' CTR 06/27/2001 $133.20 2720010000(
(additional fees not listed here)
Total $194.45
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 rul direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Permit Signature: � i �- Issued By: / /' 4
(/ OWNER INSTALLATION ONLY
The in al_lation 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: -'I
Call 639 -4175 by 7:00pm for an inspection the next business day
l 0 .--- 7 lJ
i i .,
1 Electrical Permit Application
_ . _ Datereceived�Q�� Permit no. . .c !)J. UO3 J
� ,L :. City a Tigard RECEIVED Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: :: / Receipt no.:
Phone: (503) 639 -4171 JUN 2 7 200'
Fax: (503) 598 -1960 1 Case file no.: . ,... - Payment type: .
Land use approval: COMMUNITY DEVELOPMENT .. .
. TYPE OF PERMIT
r. & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 ew construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION. '
Job address: I I 1 I 0 S i j) ��j n 1 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: Lk)j y y‘ (export .e..1 Description and location of work on premises: V \V - t✓ V -pQ AA)
Estimated date of completio inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: l -7 -1 • Fee Max
Business name: ROSE CITY FT,ECTRTC CO TNC Description Qty. (ea.) Total no.iasp
New residential - single or multi- family per
Address:
4012 NE CULLY BLVD dwelling unit. Includes attadtedgarage.
City: PORTLAND I State: OR I Zl'7213 Serriremcluded:
Phbt(3 287 616 4 I r) 3 282 1l: 1000 sq. ft. or less 4
CCB no.: 356 7 I Elec. bus. lic. no: 26 113 C Each additional 500 sq. ft. or portion thereof
t Limited energy, residential 2
City/ o iC } 2 9 Limited energy, non - residential 2
r /2lu' Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): R L Go th am License no:
2127 S Services or feeders — installation,
alteration or relocation: 3(,
. PROPERTY OWNER 200 amps or less R D .— 2
Name (print): ,/jl I_ " .Q� �J) y� 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 1) 7 / v (/)ct /et ucr 601 amps to 1000 amps 2
City: a vrk,_ $tat ZIPg7 2, Over 1000 amps or volts 2
Phone: I Fax: E -mail: Reconnect only 1
Owner in ion: 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:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of 73
Address: service or feeder fee, each branch circuit 15 qg 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not Included):
O Service over 225 amps-commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1 &2 O Hazardous location Each sign or outline lighting 2
family dwellings 0 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 extensions 2
O Building over three stories O Feeders, 400 amps or more *Description:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection I I I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other 11 //,,
Na jurisdiction all jurisdictio accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ I / { ( �
credit card number: / / within 180 days after it has _ been State surcharge (8 %) .... $ L �V
$ -f /� /
Expires accepted as complete.
TOTAL I n
Name of cardholder as shown on credit card ` 1
S 0
Cardholder signature Amount V 440-4615 (6r00ICOM)
v 6
,,,,,,...„:....i..:4..,..5,45---
r •
Electrical Permit Fees: - Limited Energy Fees:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee - $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total . 4, Check Type of Work Involved:
• Residential - per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof • - $33.40 1 ❑ Burglar Alarm
Limited Energy - $75.00
Each Manuf'd 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. n .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 n Clock Systems
feeder fee.
' Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ F ire Alarm Installation
or feeder fee. ;`
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
• l
Miscellaneous ❑ Instrumentation
(Service or feeder not included) •
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53 40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125 00
Each additional inspection over .
n Medical
the allowable in any of the above ❑ Nurse Calls
Per inspection $62.50
Per hour $62.50
In Plant $7:' 75 0 Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ in Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Accour)t # 8% State Surcharge $
Total Balance Due $
- ,
i:\dsts\fornu\elc- fees.doc 10/09/00
- - . ,, A
06/25/2001 14:06 ROSE CITY ELECTRIC 4 5035981960 NO.236 P01
.`•-
Electrical Permit Appli ation
i lh Date received: PeftY►it no.:E/70/j/ -n0i.D-
Of Tigard �� �1 pP Expire U ' ,'', i Ci �1 g ectle I. no.: (ro date;
City of T gor4 Address: 13125 SW Hall Blvd, Tig 23 Date Issued; , By: I Receiptno.: •• . .
Phone: (503) 639 -4171
Fax; (503) 598 -1960 Caen file no.; Payment type:
Laud use approval: - •
'INN Of I'iltAl I i'
-v- . & 2 family dwelling or accessory 0 Comme cial/ipduatnal 0 Multi- family Q Tenant improvement
C) New construction O Addition/alteration /replacement Q Other; . U Partial
.1011 SITE IN I Oit11IA'1 14 )N
Job address: • • / - r. Bldg. no.: Suite no.; Tax map/tax lot/account no.:
Lot: Block: Subdivision; I .
Project name: 4L'E r r Mill Descri lion and location of work on premises: ye, ' • / . A
Estimated dace of cam .leti. 'a. on:
I'ON'I 111(1 011 ,til'i'I,I(.'Al ION I'I,:I: l' III :i til.t:
Demi viral OrY• SI Toted PR
Z- •, N • ► Now residential - or mail! -QsmIy ter
Address; 0 . .. C _i_ _ P dwelling twit Includes otmetmdgarage.
City; PORTLAND State; OR 27213 Senieetaeluderk
Fi Ittiie *t tilEta Unill 1=111.1111111 1000 4 • - fl. or Imo 4
Each additional S00 ft. or •orlon thereof _�
CCB no.: Elec. bus, lie, no: • C l.itnircd , ,ieaidential MM i>• 2
t • 1;unlied mew, nen- residential MEN 2
A�_rq fl>t. i►*g. • „Efffi Bach manufactured home ormodulordwelling ■■.
Signature of s • - rvlsin s electrician re • uired) Date Service sndlar feeder
Sup, elect. mono (Pont): - 0 t am EMEEntria al r el tl tlon, NI sl0er -nstolln I n Vit4'et' h:lt I1 011 N11( 200am• orlaas Name (Print): r 201 ,ato400am•a rMe= 2
401 amps to 600 am• �
Mailing address: �i � 1! A[� [ :I. 601 am • • to 1000 snips =NM 2
/' / ` ZIP /r' . 7 Over 1000 am • • or volts =lin IlLIE
Phone: MEM Fax: - - .. .
11111111M Ma.
Owner in '" --'on: The installation is being made on property 1 own Tetnporary®rvim or feedere-
which is not intended for sale, lease. rent, or exchange according to bulailatt °a
as lass
ORS 447, 455, 479, 670.701.
200 amps or 2
2Ulam.ta400 0own•s �it•� 2
Owner's signature: Date; 401 01600am• i♦0.111i11111. 2
l 'N ( : I N I • ; I . I t Branch circuits - new, atroradan,
. or vocation per poach
Name: A. Fee for branch circulte with porch= of • Address: oarlike er feeder teey each branch circuit r
City; State: • ZIP; B. Fee for brunch circuits Without purchase
ofsonlo e fee, firstbranch circuie � 2
Phone: Fax: E -mail: 13eah additional branch circuit Mil•
VI, .1N t11. ;VII.'11' (Pl.r :. .'14.-el.. :III eh:u :11.+11) t sc , (Swift or feeder col lnehlded): ME
0 Servim over 12S smps-aonurearatal ' 0 hearth -tajo faeiUty Bach • om • or irri : e1Jo° circle 2
O Servos aver 320 amps - raring of l&2 0 tlarardous location Each si n °rooting U : help • �I — 2
family dwellings Q Building over 10.000 square feet four or Slim) circait(s) of a limned energy Panel.
Q system over600v011sneminal mom residential urdtsIn one structure alteration, ormansion
Q Building ova dace atones 0 Feeders. 400 amps or more *Magri • Gan: •
O Occupant load over 99 pera ms O Manufactured macrame or RV park Poch . • UN ape • • • • • n over the allowable to soy of d le above
QEgrr llighllnppion O Olhoe gins• - flan MN ∎IMin
Submit ` sets of plans with any of the above. lnvesti :uianfes
The above are not applicable to few . • vary construction service. Other 0 7
Nat a0 Jmlydiadaev semi court cords. pleam all Jurisdiction fa mere infor oeoce' Notice: This permit application Permit fee $ •1I
Q V O Mauieteard expires if r permit is not obtained Plan review (a[ — %) $ t ' -f (
Li. Doti tend weal=
t. N / within 180 days after it has been surcharge (8%) $ /
Name or oal6alibe as Mown on =dr writ
accepted as , • p . TOTAL � .
s < L P,��, /3
Cepyeldes aisosser Amass • 440.4615 (61mICOM)
/' N3-'
CITY OF TJGARD BUILDING INSPECTION DIVISIOI`
24 -Hour h spection Line: '6: 175 Business Line: 639- . I ! MST
p� BUP
Date Requested — uested L 2b AM P M BLD
Location it 7( L. )0 J241 Lie Suite MEC
Contact Person Ph ? 7 PLM
Contractor Ph 3 2, S"6 ( SWR
BUILDING Tenant/0 er ELC rV D X33.
Retaining Wall ELR
Footing • Access:
Foundation FPS
Ftg Drain SGN
• Crawl Drain Inspection Notes: C
Slab SIT
Post & Beam
Ext Sheath /Shear
- Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler •
Fire Alarm
Susp'd Ceiling
Roof r
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
R Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line -
Smoke Dampers
Final -
C LECTRICAL FAIL •
Sluice
Rough In
UG /Slab
Low Voltage
Fire Alarm .
C3 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 - Inspector `_„� �ii�!� Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.