Permit . CITY O F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00256
j DEVELOPMENT SERVICES DATE ISSUED: 05/17/2000
401, `� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 114AC -00800
SITE ADDRESS: 09111 SW WAVERLY DR
SUBDIVISION: WAVERLY ESTATES ZONING: R -12
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Install 1 branch circuit in single family dwelling.
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:
CASEY RICHMOND SHARPE ELECTRIC INC
9111 SW WAVERLY DR 22605 SW RIGGS
TIGARD, OR 97224 BEAVERTON, OR 97007
Phone: Phone: 642 -7937
Reg #: LIC 000815 OR I C I N A L
SUP 3344S
ELE 34 -217C
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT KJP 05/17/200C $37.50 0002239 Elect'l Final
5PCT KJP 05/17/200C $3.00 0002239
Total $40.50
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 irect questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE y Low 4.a 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: DATE:
LICENSE NO: Szy
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Recd
Date to P E.
Phone (503) 639-4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # ZCC ZcNt)-' 002-S1.
Fax. (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) 4_41%. �� /� Service included: Items Cost Sum 4
Address WU SW WW ' Jr 4a. Residential - per unit
City/State/Zip � Cl Q- qz . # 1000 sq ft or less $ 117.75 4
ty P I [ Each additional 500 sq. ft or
portion thereof $ 26.75 1
Commercial ❑ Residential Limited Energy $ 60 00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data bas p). _ Installation, alteration, or relocation
; r/j
Electrical Contractor / t f CL �]i!�C.- 200 amps or less $ 64 25 2
Address �26-- QS -) tt) / .-6 l'C-r 201 amps to 400 amps $ 85.50 2
City ) -# - trY1 State 0 Zip q 7C" 1
7 401 amps to 00 amps $ 128 50 2
y4.-. r5.-.. 601 amps to 1000 amps $ 192 50 2
Phone No. O. 7 % 3 7 Over 1000 amps or volts $ 363.75 2
Job No. K 7 0 " ,, Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 3 V -.) /7G Exp.Date /O /oi/DO 4 c. Temporary Services or Feeders
OR State CCB Reg. No. Sr /.67 Exp.Date S G /O / - Installation, alteration, or relocation
COT Business Tax or Metro No. 5 f Exp.Date 200 amps or less $ 53 50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'nQ��llt '/ 401 amps to 600 amps $ 100.00 2
22
Over 600 amps to 1000 volts,
'' /I see "b" above.
License No. 0 `i -3 Exp.Date /6/0/ /O ,I 4d. Branch Circuits
Phone No. -5 3 .p f/..? - ?y 3 7 New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5 35 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee. - 7 5'
Phone No. First branch circuit I $ 37.50 3 `'
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42 75
Signal circwt(s) or a limited energy
panel, alteration or extension $ 60 00
3. Plan Review section (if required): * Minor Labels (10) $ 100 00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Per inspection $ 50 00
Service and feeder 225 amps or more
Per hour $ 50 00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N E C. Chapter 5 5. Fees: 3 1 6°
5a. Enter total of above fees $
* Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ 3 . vo
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for ,
NOTICE Plan Review if required (Sec 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 1"' $Th
I \dsts \forms \cicctric doc
CITY OF TIGARD BUILDING INSPECTION DIVISION ^� MST
24 -Hour Inspection Line: 639 -4175 Business Line:- 639 -4171• '.Ci"'
BUP
l
Date Requested 5/ / SAM PM1 BLD
Location 71/ I (A) uite MEC a co/g7
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenan ms" C (� �-- � ELC ?OO C) �o�S(
Retaining Wall ELR
Footing Access: 9 Foundation FPS
Ftg Drain DJ/LA*14i
•
Crawl Drain Inspection Notes: SGN
Slab L� ��L�� IL . — SIT
Post &Beam
Ext Sheath /Shear /1 '
Int Sheath /Shear
Framing
Insulation
Drywall Nailing / E/7
0 /' 7
Firewall
Fire Sprinkler �
Fire Alarm /
Susp'd Ceiling ��`�"C� —
Roof
Misc:
Final
PASS PART FAIL
PLUMBING dlibi
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line f ,
Smo e Dampers
PART FAIL
CTRICAL
Service
Rough In p `
UG /Slab
Low Voltage
Fir- Alarm
0 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
D J 72C/27.) Inspector , Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.