Permit r -
ELECTRICAL PERMIT CITYOFTIGARD
RESTRICTED ENERGY
A.=-Iwi& DEVELOPMENT SERVICES PERMIT #: ELR2001 -00190
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/11/01
SITE ADDRESS: 10865 SW WALNUT ST PARCEL: 2S103AA -00101
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
Project Description: HVAC control wiring.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SCHOOL DISTRICT NO 23 J HIBBARD CONTROL WIRING LLC
13137 SW PACIFIC HWY 10749 OAK ST, SUITE 1
TIGARD, OR 97223 DONALD, OR 97020
Phone: Phone: 503 - 678 -5900
Reg #: LIC 134202
ELE 3-456C
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 7/11/01 $75.00 2720010000 Elect'I Final
5PCT CTR 7/11/01 $6.00 2720010000
Total $81.00
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 dire t uestions to OUNC at (503)
246 -1987. ,I
Issued by Permittee Signatur
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 7:00 P.M. for an inspection needed the next business day
'i
Electrical Permit Application
Date received: 9// Permit no.:�� ZpO/ -do/go
j :A I l City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9 Date issued: B4, pT Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: _
't TYPE OF PERMIT
❑ I & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction .' Addition/alteration /replacement ❑ Other: ❑ Partial
-- JOB SITE INFORMATION
Job address: O 5 Su) u 0Alft lit Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name:..,.. ;. tit jr, p , h Description and location of work on premises: &l G C ®aa1 Ye. ®L. i,3 t Q t o -i
Estimated date of completion/inspection: 7. ZS. 0
CONTRACTOR APPLICATION . '' `,. '',.. FEE SCHEDULE
Job no: r - 2:e26 - Fee Max
Busin,ss name: ., a bb a e{ Coe, two( too tt-9R9 1 LUC., Description Qty. (ea.) Total no. insp
New residential - single or multi- family per
. Address: t•. :•∎ dwelling unit. Includes attached garage. •
City: boat, gJ State: 09 — ZIP:T 0$..O Service included:
Phone. 4) ,,72, 51o0 Fax: 67E3 seas E -mail: 1000 sq. ft. or less 4
CCB no.: - Elec bus lie no: Each additional 500 sq. ft. or portion thereof __
"�'— Limited energy, residential ___ 2
City/metro lic. no.:
y Limited energy, non-residential 1111• 2 .
5 '402. 2/ 2s/o3 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
Name (print): VA, 41.4 pi , : DI A -ict to e,t, \ 201 amps to 400 amps ___ 2
401 amps to 600 amps ___ 2
Mailing address: 513 ` 5ta) 41e a 601 amps to 1000 amps ___ 2
State: ba, ZIP: Over 1000 amps or volts ___ 2
Phone: % ,J oo Fax: E -mail: Reconnect only 1.111� 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 htstauation ,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 MEMO 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: State: 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):
❑ Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle ■■ 2
❑ Service over 320 amps - rating of 1 &2 0 Hazardous location Each sign or outline lighting ___ 2
family dwellings ❑ 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
❑ Building over three stories 0 Feeders, 400 amps or more *Descri .tion:
❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑'Egreess/lighting 0 Otter. 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 $ - TS •d0
❑ 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 %) .... $ b.00
Expires accepted as complete. TOTAL $ B d • 00
Name of cardholder as shown on credit card
$
Cardholder signature Amount 4404615 (6/00 /COM)
r
1) `
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 y 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 n 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 i $80.30 2 ❑ «
201 amps to 400 amps $106.85 2 Vacuum Systems • , r
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. 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 n Fire Alarm Installation
or feeder fee. /
First branch circuit $46.85 ,— ,{
Each additional branch circuit $6.65 I MI 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
Each additional inspection over ❑ Medical
the allowable in any of the above n Nurse Calls •
Per inspection $62.50
Per hour $62.50
In Plant $73.75 ❑ 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 $ No licenses are required. Licenses are required for all other installations
front of application.
Fees: -y
Total Balance Due $ 1 5
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
S
I00
Total Balance Due $ °
i:\dsts \fomu\elc -fees doc 10/09/00 ,
i
CITY OF TIGARD BUILDING INSPECTION DIVISION MST i
24=Hourtnspection Line: 639 -4175 Business Line: 639 -4171
BUP
• Date Requested 7 - ' 1 7 AM PM BLD
Location /0 D ce Suite MEC
Contact Pers 5 __ P� v2 Ph 7f f- ,Y& U PLM
Contractor 6 . r 650 rd Ph SWR
BUILDING Tenant/Owner / \ /Jt 1 (5 A/ ELC
Retaining Wall ELR Zoe)/ -GU If 0
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 // C �' ,� s , S
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 _ / r F
Final
PASS PART FAIL
MECHANICAL
Post & Beam -
Rough In
Gas Line
Smoke Dampers •
Final -
PASS PART FAIL
9gr
Service
Rough In
UG /Slab
cr_ow-Vott Cliff
Fire Alarm
# ‘ 11 43 44 01, 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
O D 7 : — /? ..---() nspecor / Inspector � i
Other Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. -