Permit OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC2002 -00368
it DEVELOPMENT SERVICES DATE ISSUED: 8/5/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S104DB -04000
SITE ADDRESS: 13203 SW WELLINGTON PL
SUBDIVISION: AMESBURY HEIGHTS ZONING: R -4.5
BLOCK: LOT : 040 JURISDICTION: TIG
Project Description: Install 1 branch circuit.
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:
RICCI ROSE CITY ELECTRIC CO INC
13203 SW WELLINGTON PL 4012 NE CULLY BLVD
TIGARD, OR 97223 PORTLAND, OR 97213
Phone: not on application Phone:
Reg #: 20-61$7S
LIC 3567
ELE 26 -113C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 8/5/02 $46.85 2720020000( Elea! Final
5PCT CTR 8/5/02 $3.75 2720020000(
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 -6699 or 1 -800- 332 -2344.
Permit Signature: 0 �. Issued By: ��
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: G ( 2CJ. DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
-
� ~' Electrical Permit Application
'` — Datereceived: y Permit no.: _,_ 6 ' , g
t City of Tigard �'+� Project/appl.no.: Expire date:
Ci of Address: 131 Blv ,Ti OR 97223 Date issued: Byra a - Receipt no.: . .
Phone: (5 ) 639 -4171 JUL 3 1 2007
Fax: (503) 5 - Case file no.: Payment type:
Ci.1 ilk kiUA i) • -
Land use approval: nT t it rm.r,r_ rt pft..n i - - : ..
TYPE OF PERMIT
n' 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other. ID Partial
JOB SITE INFORMATION
Job address: 1 JJJ t v ` Bldg. no.: Suite no.: Tax map /tax tot/account no.:
Lot: Block: Subdivisio : t ,
Project name: Vt cc t ✓ Ibe ription and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: ( Di- Description Qty. (Fee Mn
ea.) Total no. lase
Business name: ROSE ('T1V • ET,ECTRTC CO TN( New residential - single or multi- family per
Address: 4012 NE CULLY BLVD dweliagtudt Includes attached garage.
City: PORTLAND I State: OR I ZW7213 serviceincltraed:
Ph5t @3 287 616 4I F5 3 282 146®0: 1000 sq. ft or less 4
CCB no.: 3567 Elec. bus. lic. no: 26 113C Each additional 500 sq. ft. or portion thereof
U., y Limited energy, residential 2
City/ • . ' . O •:, 1 Limited energy, non - residential 2
-d1�� �J ' f 0� Each manufactured home or modular dwelling
Sig a ° • s . ising electrician (required) Da Service and/or feeder 2
Sup. elect. name (print): R L Gotham License no: 2127S Services or feeders- installation,
alteration or relocation:
- PROPERTY OWNER 200 amps or less 2
Name (print): l e, (' e__c, 201 amps to 400 amps 2
Mailing address: /3. � S L j ,(,(� M a_ 401 amps to 600 amps 2
—�- "� . 601 amps to 1000 amps 2
City: t, I - ,( yr ( I SlaffO ( I V 2_ Over 1000 amps or volts 2
Phone: I Fax: E -m 1: Reconnect only 1
Owner ' lation: 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
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
Ci : I te S: • ITT: - B. Fee for branch circuits without purchase J L
Phone Fax: E -mail of service or feeder fee, first branch circuit: 1 2
.... _ _.._ -_.. . Each additional.brancb 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 extension* 2
O Building over three stories _ 0 Feeders, 400 amps or more *Description: .
0 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 O 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 . g-3
Not all jeriscicdan accept aeda cards, please call jurisdiction for more infamatice. Notice: This permit application Permit fee $
0 visa 0 MasterCard - expires if a permit is not obtained Plan review (at _ %) $
Credit card muter: / / within 180 days after it has been State surcharge (8%) .... $
Exp1Ci
accepted as complete. TOTAL $ - -_ E
Name d cardholder as shown on aedit card "
$
Cardholder signals= Amount 440-4615 (6i00IVOM)
Electrical Permit Fees: Limited Energy Fees:
T YPE 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 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 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 Check Type of Work Involved:
401 amps to 600 amps $133.75 2
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.
- . 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 $46.85 ❑ HVAC
Each additional branch circuit $6.65
Miscellaneous n 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 Landscape Irrigation Control
panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑
Medical
Each additional inspection over
the allowable in any of the above El Nurse Calls
Per inspection $62.50
Per hour $62.5
In Plant $73.75 0 Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other
8% State Surcharge $ 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 $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:Wsts\forms cic- fees.doc 10/09/00
CITY OF TIGARD 24 -Hour
BUILDING 0 Inspection Line: (503) 639 -4175
INSPECTION ThVISIc 1N Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / AM PM BUP
Location 3 — 2.d a 3 �-v , d� P`-- Suite MEC s �
Contact Person Ph ( ) , r PLM
Contractor Ph ( ) 2-E7 `(I (7 SWR '
BUILDING Tenant/ Qa� -� �j ELC e736 p
Footing S- - 3 8' 1 l ELC
Ftg Drain
Foundation
ra non Access:_•� Oc /!p�°_/� ELR
Crawl Drain 0.2
Slab Inspection Notes: SIT
Post & Beam -
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final /
PASS PART FAIL / /
PLUMBING / /
Post & Beam
_ Under Slab
Rough -In
Water Service /
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
FAIL
ECHANICAL
Rough -In
Gas Line
S eke Dampers
T FAIL
Se T 7-7.1.1111 ."
Rough -In
UG/Slab
Low Voltage
Fire Alarm
1E16 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
- ASS PART FAIL
S ❑ Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line 'Fri ADA
Approach/Sidewalk Date / (-/ l o 1 ---Inspector Eat
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL