Permit C ELECTRICAL PERMIT
ITY OF TIGARD
PERMIT #: ELC2001 -00374
011 DEVE H PMEN� r SERVICES (503) 2 639 -4171 DATE ISSUED: 7/24/01
PARCEL: 2S 103AA -00101
SITE ADDRESS: 10865 SW WALNUT ST
SUBDIVISION: ZONING: R -4.5
BLOCK: • LOT : JURISDICTION: TIG
Project Description: Installation of (12) branch circuits. Job No. FOW2032
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: 11 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:
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
SUP 3989S
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 7/24/01 $120.00 2720010000( Wall Cover
Elect'l Final
5PCT CTR 7/24/01 $9.60 2720010000(
Total $129.60
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Specialty Codes and all other applicable Ins.
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 ru a opted bythe,,Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtai copies of these rules •r direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Permit Signature: P Issu Bl 114 / 4
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
A.
Date received: 7 e O/ Permit no.: Ei l -0037
j_11 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 PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement Cl Other: ❑ Partial
JOB SITE INFORMATION
Job address: f pib5 ,G t o LAD c Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: Fo 1ot,Ee_ J 9... .01 &i+ I Description and location of work on premises: i -O -.24v Pow et2- To v.5•'-J 5.
Estimated date of completion/inspection: 7. 2(0.01
CONTRACTOR APPLICATION '`''',: FEE SCIIEDU.E
Job no: Fo iJ 2°32 Fee Max
Business name: i.k8 c t ,t,-fp„� t - i,p 1.-1-4.. !Description Qty. (ea.) Total no.insp
New residential - single or multi family per
Address:
po vis 4 dwelling unit. Includes attached garage.
City: mac,t.�A i....;:=. I State: pl - I ZIP: Q..O Service included
Phone: („9 . VI 00 I Fax: 1 FA15 I E -mail: 1000 sq. ft. or less 4
CCB no.: f 3 -2 o 2- I Elec. bus. lic. no: 3 - 1 F 5l C'' Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic Limited energy, non- residential 2
7...9.0 / Each manufactured home or modular dwelling
Si ature of supervising electrician (required) /0 - --4 / Date Service and/or feeder 2 .
Sup. elect. name (print): R . (2404 R...-r License no: 378 ' S Services or feeders - installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
201 amps to 400 amps 2
Name (print): - ri&A. ��Ipp(, ZAS'Ta-tr-T 401 amps to 600 amps 2
Mailing address: 1 31'7 51,0 PFtCtGIL H'wY 601 amps to 1000 amps 2
City: Ti l, A,0. I State: 0 t2.+ I ZIP: Over 1000 amps or volts 2
Phone: 461 . 4000 I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary senices or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
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
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
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
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 . (Serviceorfeedernotincluded):
O Service ovr 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,
'0 System over 600 volts nominal more residential units in one structure alteration, or extensions 2
O Building over three stories ❑ Feeders, 400 amps or more 1Descnption:
❑ Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection' L
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 ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ ` O
Expires accepted as complete. TOTAL $ / /' CP
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 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 ❑ Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n 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. 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. r "
Each branch circuit $6.65 2 n Data Telecommunication Installation
- b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee.
First branch circuit . I $46.85 • L ko . 8J n
Each additional branch circuit I I $6.65 r3 , HVAC
Miscellaneous n Instrumentation
(Service or feeder not included) '
Each pump or irrigation circle $53.40 1
n
Each sign or outline lighting $53.40 Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n 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: ❑ Protective Signaling gl"
Enter total of above fees $ 1 2-0 n Other
8% State Surcharge $ q . 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.
Total Balance Due $ 12-1
bo Fees:
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts \forms\elc- fees.doc 10/09/00 ■
. tii)ITY•OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639-4171 � BUP
Date Requested // 2 f AM PM 41BLD
Location 1 l U Gish Suite MEC
MEC
Contact Person Ph 7 / -7 V' z PLM
Contractor Ph SWR
BUILDING Tenant/Owner F2 miler J r • 14,5 ELC Pi,/' 37
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 n
Drywall Nailing l/ /T ✓ / /i O X e s - /T- C cop/ r /
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
PASS PART FAIL
..E CTR
Service
Rough In
UG /Slab
Low Voltage
. Fire arm
SS PART FAIL
lit
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 7 �� I
Other Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.