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Permit
Ci pi OF T I G A R D ELECTRICAL PERMIT PERMIT #: ELC2001 -00078 ,oI4, DEVELOPMENT SERVICES DATE ISSUED: 2/6/01 I r= ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103BC -00700 SITE ADDRESS: 12220 SW WALNUT ST SUBDIVISION: ZONING: R -4.5 BLOCK: LOT : JURISDICTION: TIG Project Description: Kitchen remodel. 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: 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: MASON, JON D. & KARI METZGER ELECTRIC INC 12220 SW WALNUT ST 8780 SW LEHMAN ST TIGARD, OR 97223 TIGARD, OR 97223 Phone: 503 - 590 -5757 Phone: 244 -9025 Reg #: LIC 96805 SUP 3130S ELE 34 -167C FEES Required Inspections Type By Date Amount Receipt Rough -in PRMT CTR 2/6/01 $46.85 2720010000( Elect'I Final 5PCT CTR 2/6/01 $3.75 2720010000( Total $50.60 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 = _ -_ �/- \, � IS UED BY: OWNER I i STALLATION ONLY The installation is being made on pro', - r y I own which is 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 I'�, - w Electrical Permit Application Date received: 0 2 0 Permit no.:�� , / -JO 0 7, 0 _. , .�II� City of Tigard Project/appl.no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: ".,, 'eceiptno.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction u Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION _ Job address: / 2.2 5 .� / 7( 4 . Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: Subdivision: Project name: I Description and location of work on premises: Estimated date of completion/inspection: CONTRACTOR APPLICATION - ',C, FEE SCHEDULE Job no: Fee Max Business name: e t ems- f e , / _ _ Description Qty. (ea.) Total no. insp / New residential- single or multi- family per Address: 87 0 A L- zt At dwelling unit. Includes attached garage. - City: -77 ar-GT I State: GPI ZIP: 9722 3 Service included: Phone: Z 9t7 Fax: I E -mail: 1000 sq. ft. or less 4 CCB no.: I Elec. bus. lic. no: Each additional 500 sq. ft. or portion thereof Limited energy, residential 2 City /metro lic. no.: Limited energy, non- residential 2 Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2 Sup. elect. name (print): License no. Services or feeders — installation, alteration or relocation: PROPERTY OWNER 200 amps or less 2 7 4 Name (print): 014. ,D MjQs49-I-, 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: Z t V5 5' 6.,J _S mIn Pv Cr e 17 601 amps to 1000 amps 2 City: / (c( I State:: ff /t\ I ZIP: 9 72Z 3 Over 1000 amps or volts 2 Phone: C ) -5'7$Z 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 installation, alteration, or relocation: ORS 447, 455, 479 01. 200 amps or less 2 201 amps to 400 amps 2 Owner's signature: I i # ✓ Date: Z t © 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' (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 O 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 0 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: O Egress/lightingplan O Other. Per inspection I I 1 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 $ ylo Ps O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 3 , - 75 Expires TOTAL $ --.0 , c , O accepted as complete. Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00 /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 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 Manufd Home or Modular n Garage Door Opener' Dwelling Service or Feeder $90.90 2 Services or Feeders 0 Heating, Ventilation and Air Conditioning System' Installation, alteration, or relocation 200 amps or less $80.30 2 111 201 amps to 400 amps $106.85 2 ,Vacuum Systems 401 amps to 600 amps $160.60 2 n 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, n .. see "b" above. Audio and Stereo Systems Branch Circuits n 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 ❑ Fire Alarm Installation or feeder fee. , / , First branch circuit I $46.85 ` , Each additional branch circuit $6.65 n HVAC - Miscellaneous . n Instrumentation (Service or feeder not included) , Each pump or irrigation circle $53.40 n 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 ❑ 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 n Outdoor Landscape Lighting Fees: ❑ Protective Signaling Enter total of above fees $ - D' n Other 8% State Surcharge $ 3 7 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. Fees: Total Balance Due $ Enter total of above fees $ El Trust Account # 8% State Surcharge $ • Total Balance Due $ i:'dsts \forms\elc- fees.doc 10/09/00 CITY OF TIGARD BUILDING INSPECTION DIVISION . MST 24 -hour Inspectton Line: 639 -4175 Business Line: 639 -4171 •- /' BUP 6 Date Requested -- z- / AM PM BLD Location (Z2-20 S w 4 / 411 "t--/ - Suite MEC Contact Person Ph PLM Contractor Ph SWR �/ Tenant/Owner ELC 2k/ - ?Y etaining 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 Misc S 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 ECT .. 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 Date C l ^ Q/ Inspector Ext Other nspecor x Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. - •