Permit 4 DATE CITY OF TIGARD PERMIT
PERMIT #: ELC1999 -00609
DEVELOPMENT SERVICES
Ill
ISSUED: 10/15/1999
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134AC-02616
SITE ADDRESS: 11255 SW WILLOW WOOD CT
SUBDIVISION: ENGLEWOOD NO.3 ZONING: R -4.5
BLOCK: LOT : 173 JURISDICTION: TIG
Project Description: Add a first 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:
REIMEIER, HAL H DENISE A ELECTRIC GROUP INC, THE
11255 SW WILLOWWOOD CT 4726 SE MILWAUKIE AVE
TIGARD, OR 97223 PORTLAND, OR 97202
Phone: Phone: 232 -2499
Reg #: SUP 2546S
LIC 00043851
ELE 26 -445C
FEES Required Inspections
Type By Date Amount Receipt
Elect'! Service • PRMT DST 10/15/199E $37.50 99- 319099 Elect'l Final ,
5PCT DST 10/15/199E $3.00 99- 319099 /�
Total $40.50 ORIGINAL
, .
c ••
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 -1987. /
PERMITTEE'S SIGNATURE \4 / 4 ppuu.pi..i . ... .. 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: /6-751 9 7-
LICENSE NO:
aoss -S
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check #
13125'1W HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 '� / c Date to DST
Inspection (503) 639 -4175 Print of Type l" Permit # ��� O %t7 y'
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
d
N umber of Inspections per permit allowed
of Development
Name ( ie
/VAL Rein∎ - th Service included: Items Cost Sum 4
Address // Z5 -5W //(..La) Gf)OOD C7 4a. Residential - per unit
City /State /Zip 7'7"'-D 9 7 2.Z3 1000 sq ft or less $ 117.75 4
Each additional 500 sq. ft. or
portion thereof $ 26.25 1
Commercial ❑ Residential Limited Energy $ 60.00
Each Manuf'd 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 ba e). Installation, alteration, or relocation
Electrical Contractor a- E/e . : ri L C /' �/"per 1-'- , 200 amps or less $ 64.25 2
Addre s oZly �� �' � /�(cie
201 amps to 400 amps $ 85.50 2
City Pp r+ 1 x,,, State /9iQ.. Zip 92 O 1
401 amps to 600 amps $ 128.50 2
601 amps to 1000 amps $ 192.50 2
Phone No. a 3. - ay 9 9 Over 1000 amps or volts $ 363.75 2
Job No. 99 - R > Q Reconnect only $ 53.50 2
Elec. Cont. Lice. No. ?(0 Exp.Date � 4c. Temporary Services or Feeders
OR State CCB Reg. No. ' Exp.Date Installation, alteration, or relocation
COT Business Tax or Metro a . Ex. a at 200 amps or less $ 53.50 2
1 i 201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec', - - 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
License No.
t9069 � Exp Date /t2/ .2/27
see "b" above.
203 Z 3 Z z y fr' New, Branch Circuits
Phone No.
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
b) The fee for branch circuits
Address
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit / $ 37 50 37-=--
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 circuit(s) or a limited energy
3. Plan Review section (if required):*
panel, alteration or extension $ 60 00
Minor Labels bels (10) $ 107 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
Service and feeder 225 amps or more Per inspection $ 50 00
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: �
5a. Enter total of above fees , /� D� $ ,57�
* Submit 2 sets of plans with application where any of the above apply. - 577 Surcharge ( 05 X total fees) /! ! �" $ 3 ._
Not required for temporary construction services. Subtotal o v $ Sd
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 # t/
AT ANY TIME AFTER WORK IS COMMENCED Total balance Due $ /�
P IIA)C( A �- i \dsts \forms \clectric doc r
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
I UP
Date Re uested ///) 9 AM /)/)PM BLD
Location //c LO1 61,c) 6 d Suite EC / q5 5 -013
Contact Person MO 4114 Cet1- t ( Ph .- �'tC - (�U3 .-
Contractor Ph SWR
BUILDING Tenant/Owner ELC - 00 L2.0 C ‘
Retaining Wall ELR
Footing Access:
Foundation Al(/ C>e ? S FPS
� (/ .�v-
Ftg Drain 1 SGN
Crawl Drain
ZtiOngteSj
S Slab ✓Yt4 �j 144-1114V SIT
Post & Beam ,,- � ^ f-I - 1Y- , CC-F '� rD� fLl c hv►ia -
Ext Sheath /Shear 61-eC ( (
Int Sheath /Shear
Framing ( .= 1 =�= —Q `it ( r . AT ) —
Insulation
Drywall Nailing
Firewall
Fire Sprinkler 1 /� �^�/� l 1 /�
Fire Alarm {� -- DO ( 0 ,_05__i( � \ Cfa �C�L ` Liv�Cu��) —
Susp'd Ceiling \ ^ (� (�
Roof VL �.1�� _C1` v1K �� { A \ -C rk 6 \ 4
Final k W�
RT FAIL C
LUMBIN
Posh eam
Under Slab A /� '1 1 f ,(�
Top Out
Water Service (��' 1��"l G L V V�c1.1T'C I \ '\;V(� �1"� e.Gl�Qr
Sanitary Sewer 'o S n • ) 9
rains /\ C v n /)
PASS /PART, FAIL
TECHANIC)k ,
Pos Weam
Rough In
Gas Line � {
Smoke Dampers (� V U /� /
S PART FAIL lJ� ' .
ELECTRICAL / \ / ^ czkr
Service - l .�1�/� ae-c 5
Rough In
UG /Slab
Low Voltage /
Fire Alarm`;) Q v ✓ )
Final
PASS PART FAIL
SITE
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
Other Date I !� Inspector Y LA
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.