Permit AL _;,,.,C I TY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC2002 -00449
1� DEVELOPMENT SERVICES DATE ISSUED: 9/6/02
" .,� I = 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2 S 103 BA -00600
SITE ADDRESS: 11765 SW WALNUT ST
SUBDIVIbION: ZONING: R -4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 2 - 200amp panels. Elec. contr. is installing panels only. Owner is doing own wiring.
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 /IgEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 2 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:
GEORGE DRAKE WILLAMETTE ELECTRIC INC
11765 SW WALNUT PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: 503 - 521 -1567 Phone: 624 -3631
Reg #: LIC 75059
SUP 1965S
ELE 34 -283C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 9/6/02 $160.60 2720020000( Elect'I Service
Elect'I Final
5PCT CTR 9/6/02 $12.85 2720020000(
Total $173.45
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 rule or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Permit Signature: — reiy)/(MaA0 Issued By: g 1 ..
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:: OZ-1 al* DATE:
LICENSE NO: 19//76 S
Call 639 -4175 by 7:00pm for an inspection the next business day
Permit no.:
j Electrical Permit Application ��
® Date received: g 6, t.. �a� —09/ ' 9
., " ,. • mu ' ' F n7,\ z :� Project/appl. no.: [ Expire dale:
r � II City of Tigarik l „,, ( r �.) 0 c i , ;
tOR 97223 By: Receipt no.:
CityofTigard
Address: 13125 SW ha " ; ,.., - _ , d, Date issued:
Phone: (503) 639 - 4171 ,1��2 Case file no Payment type:
Fax: (503) 598-1960 SEP 0 , �
Land use approval: 1 = .:- t' ! SToO�
� r‘TR „,.r?A`
I & 2 family dwelling or accessory O Commercial/industrial O Multi - family U Tenant improvement
New construction
❑ Addition/alteration/replacement U Other: U Partial
JOB SITE INPOIL IATIUN •
Job address: 0 a•- to Qt.) w titer c Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: !Block: !Subdivision: -
Projecl•name: C, e. 6 ,�1CA. j Description and location of work on premises: C.(, 2
Estimated date of completion /inspection: PEE SCI1[ 1)lrt l
CONTRACTOR APPLICATION Fa Max
Job no: Ly ? Description Qty. (ea.) Total no. tnsp
Business name: (l), II A Ave (J ( Vi e if 7 4 , L bid c_
New residential - single or multi- family per
/ Ct /3 c'
Address:
2 T0 S'I 7— dwelling emit. Includes attached garage.
C11Y: 1 n s N Z r]
( State:O,t 1 ZIP: 97 z.4- 1 Servicelncluded:
1000 sq ft. or less 4
lax: 6 7 z 7b -1 13 - mail:
Phone: 6 Z�I - 34 3 r 1 Y' 9 Each additional 500 sq It. or portion drcrcvr
CCD no.: 71 s ei 2 ,
'Elec. bus. lie. no: 3 y - z,F 3. ` Limited e nergy, residential 2
City /m tro lie. no.: / Syr. Limited energy. non- residential
_ 3 Z Each manufactured home or modular dwelling 2
� Service and/or feeder
Signature of supery ising nlclan (required) Dille Senlees orfeeders— Installation,
Sop. elect. name ( print): OA. F. Lleensero: / 9G r -s -
alteration or relocation:
PIROPERTY : 11 200 amps orless 2_ 40 2
201 amps to 400 amps -_ 2
Name (print): 401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps .. _ 2
( State: 1 ZIP: Ove 100 amps or volts 2
City:
Phone: (Fax: 1E-mail: Reconnect only I
Temporary. services or feeders -
Owner installation: The installation is being made on property I own Installation, alte tion,orrelocation: ./
which is not intended for sale, lease, rent, or exchange according to Y00 amps or less 2
ORS 447, 455, 479, 670, 701. . • • . , 201 amps to 400 amps 2
Owner's signature: ___ _ ______ __
Date: 40110 600 am s 2
I;NG I N E I :It Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of 2
Address: service or feeder fee, each branch circuit .
State: I ZIP: B. Fee for branch circuits without purchase 2
City: of service or feeder fee, first branch circuit:
Phone: Fax: E-mail: Each additional branch circuit: —
PLAN REVIEW (Please check nil that nppll') Misc. (Senleeor feeder not Included): 2
pump or in circle
0 Service over 223 amps- comm Each amps- commercial .0 Ileallh-care facility Signal Each pump or
outline lighting n 2
rc
O Service over 320 amps-rating of 1 &2 U hazardous
azardous location sign or o ) in a imlimited ed energy p
family dwellings U Building over 10.000 square feet four or alteration, c alion, or ex or a l ir• 2
0 System 600 volts nominal more residential units in one structure
O Building over duce stories U Feeders, 400 amps or more •Description:
O Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
O Egreasllightingplan U Other: Per inspection I I I I
Submit _ sets of plans,with any oldie above. Investigation fee
The above are not applicable to temporary construction service. Other , 40
P fee f `2-- —
Not a11)arladcdm h
o accept credit cards. please call Jurisdiction for more dormarloa. Notice: This perm app f lan review (at _ %) $
O Visa O MasterCard expires if a permit is not obtained State surcharge (8%) E / Z' _
Crept card oamber: •• • / / within 180 days after it has been •
TOTAL $ I 4�
El'
aplrea accepted as complete.
Name cardholder as shown on credit card $
4 10-4615 0100RAM)
Cardholder signature $ Amonm
Electrical Permit Fees: Limited Energy Fees: .
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service Included: Items Cost Total + � Vii
Check Type o f.Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. II. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular El Garage Door Opener'
Dwelling Service a Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning Sysk n r'
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑
201 amps to 400 amps $106.85 2 Vacuum Systeme
401 amps to 600 amps $160.60 2 [j] 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 relocation or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
krslaeation, alteration, a
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.
Branch Circuits n Audio and Stereo Systems
New, alteration or extension per panel ❑
a) The fee for branch circuits El Controls
with purchase of service or
feeder fee. n Clock Systerrrs •
Each branch circuit $6.65 2
b) The fee for branch circuits ❑ Data Telecommunication installation
without purchase of service
or feeder fee. n Fire Alarm Installation
First branch drcult $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous
(Service or feeder not Included) ❑ instrumentation
Each pump or Irrigation circle $53.40
Each Sign or oatline lighting $53.40 i
Signal dreult(s) or a limited energy ❑ Intercom and Paging Systems
panel, alteration or extension $75.00
Minor Labels (10) $125.00 n 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 $73.75 ❑
Outdoor Landscape Lighting'
Fees: ,
Enter total of above fees _ $• ❑ Protective Signaling
8% State Surcharge $ _ n Other
25% Plan Review Fee Number of Systems
See 'Plan Review/' section on $
front of application. ' No licenses are required. Licenses are required for all other Installations
Total Balance Due . , - $ , , � . Fees:
CI Trust Account 0 . . Enter total of above fees $ •
8% State Surcharge - I $
•
Total 'Balaiice Due $
iMsts\fonnsNelcdas.doc 10/09/00 .
CITY OF TIGARD 2 4- Hour` , -
BUILDING �`� Inspection Line: (503)"639 -4175 f- M oZ —b o a
INSPECTION' DIVISION Business Line: (503) 639 -4171
L BUP
Rece Date Requested � / ° AM PM BUP •
Location . , /1 7 Ce.,S` d— .Gct .),Z Suite MEC
_
Contact Person �.r ►��- a -�c.Ph ( ) 5 iS -a 1 1 1 PLM
Contractor Ph ( ) SWR �
BUILDING: , . (x Tenant/Owner ELC R 0 q q q
Footing ELC
Foundation Access: , O g O
Ftg Drain" ' / rv 1 ELR
Crawl Drain'
JSlab Inspection Notes: D SIT
Post & Beam lP./�[ o .d
Shear Anchors 4
Ext Sheath/Shear a-tee — d \ PA I., 7475 . e 4 o'
Int Sheath/Shear
{. Framing
H Insulation
Drywall Nailing.
Fi rewall
,. Fire Sprinkler
' Fire Alarm
(- Susp'd Ceiling
Roof
Other:
J'1
1g-'r PART FAIL
P • BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole . •
Storm Drain
Shower Pan
PART FAIL .
- ANICAL
Post& Beam
�. Rough -In
V
1 Gas Line
r' Smoke Dampers
S Final
PASS PART FAIL
ELECTRICAL
Service / . <-
Rough-In p r-
UG/Slab % 5
Low Voltage 0
Fire Alarm/ \
a•
0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
:4_11111! PART FAIL
SITE fl Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Date S- 2 - O3
Approach/Sidewalk Inspector Ext
Other: '
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL