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CITY ®F TIGARD ELECTRICAL PERMIT _
PERMIT#: ELC2001-00604
DEVELOPMENT SERVICES DATE "SUED: 12/4/01
13125 SW Hall Blvd., Ticiard, OR 97223 (503) 639-4171 PARCEL: 2S111BC-02600
SITE ADDRESS: 10310 SW CANTERBURY LN
SUBDIVISION: T'IC_ARDVII..LE HEIGHTS ZONING: R-3.5
BLOCK: LOT : 005 JURISDICTION: TIG
Froiect Description: Location of work: Canterbury Storage. Lighting retrofit.
—__RESID_ENTIAL UNIT _ TEMP SRVCIFEEDERS _ _—MISCELLANEOUS
100u SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF. 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ...NERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL 110):
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: 2 IN PLANT:
601 - 1000 amp: _ PLAN REVIEW SECTION
1000•+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect orsh: — —SVC/FDR >=225 AMPS: —_ CLASS AREAISPEC OCC: _--
Owner: Contractor:
TIGARD WATER DEPT OREGON ELECTRIC CONST/GROUP
877-( SW BURNHAM ST 1010 SE 11TH AVE
TIGARD. OR 97223 PORTLAND, OR 97214
Phone: 639-4171 395 Phone:
Reg #: LIC 203
SUP 44605
ELE 26-95C
_
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
--- ------------- Wall Cover
Elect'I Final
— — Total
This Permit is ;ssued subject to the regulations contained,n the Tigard Wnicipal Code.State of OR Specialty Codes and ail other applicable laws
All work will be done in accordance with approved plans T1 s 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 iaw requires you to follow rules adopted by the Oregon Utility Notification G°nter Those
rules are set forth in OAR 9r.2-00'i-001 0 through OAR 9.52-001.0080 You may obtain copies of these rules ordireci q,-estions to OUNC at 1503)
246.6699 or 1-800-332-2344
Permit Signature: Issued By:Lir _
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for salr-, lease, or rent.
OWNER'S SIGNATURE: ----_—_-_--_-- _ -- — DATE: --
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR ELEC'N: ��; ,jL{t ' lr--_--�- DATE:--- ---- —
1
LICENSE NO:
Cai! 639-4175 by 7:00pm for an inspection the next business day
=Y/
r� Electrlr-al Per '`�Ff)
rDale -eived:ll l Pertrllt no.;
Ci g of TigardNOV
't••
Cry,�frsard Address: 13125 SW Hall Blvd,'I�ilcl QFC 1 L#AKL Projcct/appDaceissucd:l•no.: pirodate;
ExEx
Phone: (503) 639.4171 H�DNO DIVISION Receipt no..-
Fax: (503) 598-1960 Case fila no.: Paymenttype:
Land use approval:
,
=New
y dwelling or accessory bl rrim.mer..ial/indust.rial d Multi family C:1 Tenant improvement.,t �:`
uctlon C��lddiuoNalteratioNreplicanent O Other, _, Q Ptttual
Job adt_',ress: 1 /'I� caliterbur�,-"_.. 131r�g,no,: 5uitc no.. Tax map/tax lot/accountDo.:
Lot; Block: Subdivision: �- - - --
Pro)ect narne: i j-v f T Ocscri tion and location of work on prrmises: r .
��1 Cjarr] _y P Canterbury S.fara�xe
Estimated date of r-otrtpletion/inspecrion:
1
i�h tut: S._1Z_._.._.--- Fie „mom '
Rosiness name: Ore n EleCtric Group - r>.eripdau ttn• (tea) total w.a lru�
Address; - tvcw tvildenttal-sin&or tanto--Gently per
1 01 0 S F_� dnelWt�trn1L IhrlUdn attached r�3rAi e.
City: UrtlaIlf3. Stated ZIP: 97214 ryiatnchrdcd
Phone: _ Fax: mail: 1000 sq�n or leu 4
CCB n .: - Y Elec.bus.tic.no:' 26-9 5C Each additional SW sq.ft or portion therwf - dna l
— - - Limited energy,residentitl
rt lie. O.:
Lindleden._v,non-residential _� 2
Each manufactured home or modular dwellinf:
ignaturc 7f s ervts' g`clectri tan ftequjtd
_ pate Scrviceand/orfeeder 2
sup elect n cpti 1: ark ~fine Ucenaeno- 44605 Sertcesorier rs-•itssfatfation,
alteration or rtlocation:
200 amps or Irsa 2
Name(pont): 20l amps to 400 amps _ q
- 401 amps to 600 caps 2
Mailing address:: 601 amps to Loon rrtrps 2
City: _ �:�;e: ZiP: --- - "
Over 1000 amps at YO1G •r 7r
E mail: _ Reconnectonlr.. t .
Owner installation:The lwtaUafion is being made on pmperty I own Trmpmary seWc—a orlkedets- n f
which is not intended fol sale,lease,rent,orexehang-according to Ireullahun,alteratloo,orretneratiom
ORS 447,455,479,670,701. 200 amps or less 2
201 amps to 400 amps 2
Ownct's $i nature: Date _ 401 to 600 a,nps - r
Branch elreuits•nen,alterratlon,
Name- or extension per pahels
-•--• _ A. Fre for branch cirmlis with purchase of
Address: _ sewice or foeder fee,each branch cirflrit
City: State: Zip; - e Fee for branch circuits without pum ase
Phone: i n c --- of service or'Wer fee,first branch circuit: 1 4 6.8 5 Z'
E-mail: -_.._ _ _
liaeh additio t twrhcircuit:
1 *119;i M-TTWI ' 771+14
' M[u.(SeMcR r;;ceder nal Incfn s '
U Service over 225 amps-commercial O Health-care facility Pach purno or Irrigation circle 2
0Service over 320amps-mnngof1&2 0Hawdouslowdon Fachsign oroudinelighung _ _ 2
r, lydwellings U Euilding over 10,000 square feet four or Signal circuit(s)or a limi!eJ energy panel,
U System over 6ll0volts nornmal more residential units in one strurture altcration,orextension• .2
O Building overdvee stories ❑Fnldem,400 amps or more •Deicri tion:
O Occupant land over 99 persons U Manufactured structures or RV park Bach additlonfl- pection over the allopable W my of the above:
O Egress/lightlngplan Cl Oder _ Pei allpection e:•
SttbUlt_sets of plata with any of the above. tnvestigation fee —�
The above are not applicable to temporary eonstinidlon service. ULher
Nor all lnriulk6om seeept uedt cents,pirav rill jruirdledon roc more Infamaden. Notice;'Phis permit application Permit fee.............:.......S
U Visa Cl MasterCard expires if a permit is not obtained Plan review(at _ %) $
audit cad number ,, // within 180 days after it has been State surcharge(8%) ...,$
— accepted as complete TOTAT. ......................Ir�
Name rt wrdbolder-ui6-ewe on t c�rrr - (�
�_ c'ardbotdec siprarrte—___- - Maim -P p� a404615(tJ00rcu>titl
OE8-� 900!900 d 1E1-1 0011 dE09 0111DO13 110ga10-M'M 90:80 10-CE-AON
CITY 4r 'rIGARD D LDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4115 Business Line: 639-4171 MST
f3UP
__Dale Requested / ( � AM_ I'M ___—__ RUP ---
Location '�" -5-��-5�� �' a' Suite _ v-1— — MEC --
Contact Person _ PFi —- PIM
Contractor � Ph SWR --,
BUILDING Tenant/Gamer vim_ ELC
Retaining Wall ELR
Footing Access
Foundation FPS
Ftg Drain `—"-
Crawl Drain Inspection Notes. SGN —
Slab �.� SIT
Post& Peam — -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler _--,^-
Fire Alarm --�
Susp'd Ceiling
Root Mise
Final
i
PASS PART FAIL —.— - ------_--- !- --
PLUMBING
Post& Beam -- - - --
Under Slab
Top Out - — - — ---
Water Service
Sanitary Sewer - — --
Rain Drains
Final _ --- --
PASS PART FAII._
MECHANICAL
Post & Beam
Rough In �^
Gas Line - --
Smoke Dampers
Final ---- ---
PASS PARI' FAIL
ELECTRICAL --
Service
Rough In
UG/Slab
Low Voltage —
Fire Alarm.
PAR T FAIL _—�--- —._..- - —-----SITE - ._----—------ ------- --
Backfill/Grading - - — ---
Sanitary Sewer
Storm Drain ( )Reinspection fee of$ —required before next inspection. Pay at City Hall, 13126 SW Hall Bled
Catch P.-asin
Fire Supply Line ( J Please call for reinspection RE:_ ---__ ( )Unable tc inspect-no access
HDA
Approach/Sidewalk
Other Date Inspector /--2�v�Itd J�1/�'�... Ext
Final
PASS PART FAIL 00 NOT REMOVE this inspection renord from the jots site.
� ELECTRICAL PERMIT
CITY
OF
T'GA R D
PERMIT#: EL.C2001-00557
DEVELOPMENT SERVICES DATE ISSUED: 11/8/01
13125 SW Hail Blvd., Tigard, OR 97223 (503) 633-4171 PARCEL: 2S111BC-02600
SITE ADDRESS: 103' S'-J t:ANTERBURY LN
SUBDIVISION: i IGARDVILI_E HEIGHTS ZONING: R-3.5
BLOCK: LOT • 005 JURISDICTION: TIG
Proiect Description: Electrical work for new pump station. Job No. 73CC.
RESIDENTIAL UNI",--- TEMP SRVCIFEEDE_RS _ MISCELLANEOUS
-1000 SF OR LESS: --� -0 - 200 amp: 1 PUMP/IRRIGATION: 2
EACH ADD'L 500SF: 101 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANE HMI SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER _ BRANCH CIRCUITS_____. _ _ ADD'L INSPECTIONS
0 - 200 amp: 2 W/SERV!CE OR FEEDER: 9 PER INSPECTION: --
201 - 400 amp. 1st W/O SRVC OR FDR: PE„ 1,i0UR:
401 - 600 amp: EA ADD'L BRNCH CIF.C. IN PLANT:
601 - 1000 amp: PL_ANR_E_VIE_WS_E_CTIO_N__
1000+ amplvolt: >=4 RES UNITS: — _ > 600 VOLT NOMINAL:
Reconnect oni SVC/FDR — 225 AMPS: _ CLASS AREWSPEC OCC:
Owner: Contractor:
TIGARD WATER DEPT TUALATIN ELECTRIC
8777 SW BURNHAM ST PO BOX 655
11GARD, OR 97223 WILSONVIL.L.E, OR 97070
Phone: 639-4171 395 Phone: 682-2955
Reg#: LIC 00065650
SUP 3483S
ELE 3-268C
�~ FEES Y — Rock-ed Inspections
Type By Date Amount Receipt Ceiling Cove
__-- _ -_-----.�__ Wall Cover
Underground Cover
Total Elect'I Service
Elecl'I Final
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 perndt will expire if work is not started within 180 days of is!z11ance, or if
work is suspended formore than 1 ays. TENTION: Oregon law requires you to fallow rules adopted by the Oregon Utility Notl�,nation
Center. Those rules are set forth R c,)5 ugh OAR 952-POI-0 You may obtain copies of these rules or 'red questions to
Permit Signature: > ; I suect By: ��
OWNER INSTALLATION ONLY --�
The installation is being made on property I own which is not intended for sale, lase, or rent.
OWNER'S SIGNATURE: ,_ DATE:
_ __ CONTRACTOR INSTALL.,,PION ONLY
SIGNATURE OF SUPR. ELEC'N _�_ `�� _ _ DATE:
✓✓��
LICENSE NO: cJ`J 6
Call 639-4175 by 7:00pm for an inspection the next business day
Nov OV 01 09: 17a STETTLER SUPPLY CO 50358 i G799 p. 2
l f 7-;.49 11'16"1;501
Electrical Perinit Applicat-iion
llate rccasved: Permit no.
City of Tigard Project/appl.no. _ Expire dace Y
uy,r/%7F rand Address: 13125 SW Hall Blvd,Tigard.OR 97223 Dna i%sued: 13v Rccetpt no..
Phonc: (503) 639.4171 — --
Fax: (503)598.1960 Case file no.. Payment type.
Land use approval:
TYPE OF
U 1 8c 2 family dwelling or aeccssury aSCommercial/industnal U Multi family Tenant improvement
Q New construction ❑AddiuotValteration/replaccment U Other U Partial
1 '
Job address: (O'3 i0 t..4lullE I Bldg.no.: Suite no.: Tax map/tax 1OV3ccount no.:
Lot: Block: Subdivision:
Project name: ASe 5vtirvaoDextiption and location of work on premises: tMW KAfitif I.,y,_-,-I
Estimated date of completion/inspection:
Job no: 7 Z g G Fee
Dcsrrl ion Qty. (es.) rotas no.in:
Business name: jL4,s,-,&-rjj (G s L Nevi resid.,etiad-angleormatn rtmitt pet
Address: 6M ( dsvelliagunit.Mud"attac"garage.
City: State:3,p:- 'LIF: 10"1 %vice inckded:
Phone: F x:(,?8-17(,3 E-mail: I ono%g.ft or less 4
CCS no.: 3-'LIP 9 CZ IlFlec.bus.lic.no: (0 7(p,5p Each addnnoncl 500 sq ft.or ponion thereof
umredenergy.residential 2
City/me ilii n l.Urmiedenergy.non•residential 2
' 1) 7 DI Each manufactured home or modular dweiliog
Snafuse of sit rvist electrician(required) Dare Service and/or feeder 2
i
Sup elect.na (prion M11 e: O�GRr`rE+ r� Licenxno: '483.3 Services orfeetkn-IMallotton,
Itenatlon or relocsition: J
200 amps or less 2
7M.i
lint): ITI,l cT 71t�,r�R.iD 201 amps to 100 strips 2
401 am s to 600 o s 2
ng address: 1311.7 f t.4f 601 amps to 1000 amps
City: Slate Imp: Over loon amps or volts 2
Phone. Fax: E-rail: Reconnectonly I
Owner installation The installation is being made on property T own Temporary services or feeden-
which is not intended for sale,lease,rent,or exchange according it) Installation,alteration,or relocation:
ORS 447,455,479.670,70). 200 amps or les:. 2
201 amps to 4(x)amps 2
Owner's Si naturt _ Date: 401 to 600 ams 2
Branch circuits-nets,alteration.
Name: or extension per panel:
A. Fee for branch circuits wn,h purchase of '�
Address: )bels \�1e,A /1J�i nlE service or feeder fee.each branch circuit 1 2
City l-4an'v State: • ZIP: a'I i'>3 6- Fee(at branch circuits without purchase
Phone: 5v) 5^, Fax: X2'1 b1[x'a I E Mall: of service or feeder fee,first branch circuit 2
Each additional branch circuit.
Mitt.(Service or feeder not included):
J Service over 225 amps cummernal J lirslib•^tie facility Each pump or rmganon circle 2
7 Service over 320 ampt•tmmg of IA2 J 1h rardous location Each sign of nythne Itghtieg 2
fainly dwellings 3 Budding over 10,00o square feet fouror Signal circuit(%)or a hm.ted energy panel.
U Systemover 600 volts nominal incite residential units in one%tructute attention,or extension* 2
7 Building overthreestories ❑Feeders.400.rapsormore •De.tcnpoon _
:3 Occupant load over 99 persons U Manufactured strictures or RV parts FAch additional Istspection over the allowable In
nay of tto above. T
:]6gresslhghungplan J(Nher _-. Per inspenon _
Submit_sets of plan with env of the above. Investigation fee_Y
The above we nos applicable to temporary construction service. Omer v
hiltall pmtdreuar nett"credit cards.please cast runtdi[oon la more vdormation Notice.This perria applic ititm Permit fee ...................S
7 Visa O MasterCard expires if a permit is not obtained Plan review(81
C,edii card number —_LL_ within 180 days after it hiss;been State surcharge
accepted as complete TOTAL _
N�nkkr
as[M,vn nn credit[arA
S
rudb de,[rprarme - Atmmnr 440.4615(6xialf.OM)
Q
r
1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -- --
BLIP
��• Date RequestedAM f M - BLD
Location_ -(2310 .�/ �t1 L �U�re — MEC
Contact Person ��— Ph -_ PLM
Contractor _ nV 'f Pn -1-�_ Ph --. SWR --- ---___.
BLIILDIWG Tenant/Owner ELC , cool QU
Retaining Wall ELR
Footing Access --` ---- T--
Foundation FPS
Ftg Drain -___.__-----
�GN
Cldwl Di gin Inspeuliui i Notes: -- -- - ---------
Slab ---- - ------------- --- _ -- SIT
Post& Beam --- --- -----_
Ext Sheath/Shear
Int Sheath/Shear — - - - —
Framinq --,-_ - -- - _-�._- --- - -----
Insulation
Drywall Nailing _-
Firewall
Fire Sprinkler e,.--i.o^ -
Fire Alarm � �-- ----- - _-
Susp'd Ceiling ,��.�€- - --- _- _- -
Roof
Mise - -- ----- --- - -- -
Finall—
PASS PART FAIL ------
PLUMBING
Post&Beam
Urder Slab
Top Out -- -- ---- - — ---- ____ ----- --
Wdi,:r Service
Sanitary Sewer - ----- ---------- ---- -------
Rain Drains
Final _—
�'
PASS PART FAIL
MECHANICAL 7L
Post& Beam
Rough In i
Gas Line - - - - - -- --- --`-
Smoke Dampers
Fin,il - - - ---- -..
PASS PART FAIL
ELECTRICAL -- - - - -------
Service _
Rot gh In -
UG/Slab _
Low Voltage
Fire Alarm
PART FAIL ----------
SITE
Backfill/Grading -- -- — -- -- - _---
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$ requited 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�_- ate Inspector �� C! �- �� Ext -^
F mal
PASS PART_ FAIL DO NOT REMOVE this inspection record from the job site.
CITY
OF TIGARD , ��__ ELECTRICAL PERMIT
PERMIT#: ELC2004-00010
DEVE'.OPMENT SERVICES DATE ISSUED: 1/12104
13125 SVS Hall Blvd., Ticiard, OR 97223 (503) 639-4171 PARCEL: 2S111BC-02600
SITE AF-')RESS: 10310 SW CANTERBURY LN
ZONING: R-3.5
SUBDIVISION: TIGARDVILLE HEIGHTS
BLOCK- LOT : 005 JURISDICTION: TIG
Project Description: 14064-91143 Install 1 branch circuit for gate access.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS _MISCELLANEOUS
1000 SF-0 F1 LESS: 0 200 amp: �PUMP/IRRIGAI ION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNALWANEL:
MANE HMI SVC/FUR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 200 amp: WISERVICE OR FEEDER: PER INSPECT ION:
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 RFS UNITS: >600 VOLT NOMINAL:
Reconnect only:___ SVC/FDR—225 AMPS: _ CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD WATER DEPT BROADWAY ELECTRIC-COC[IRAN INC
8777 SW BURNHAM ST 626 SE MAIN
TIGARD,OR 97223 PORTLAND,OR 97214
Phone: 639-4171 395 Phone: 503-234-6564
Reg #: LIC 72942
SUIT 34475
FEES _ III 37-546C
Description Date Amount
Required Inspections
1I:I.I1RIVIT] Ia.('I'ennit I.' iia $46.85 �–
ITAXI R°h Slate Surcharer I I' i t $3.75 Rough-in
Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire it work is not started within 180 days of issuance,or if work is
suspended for more than 180 days ATTENTION. Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)
246-6699 or 1.800-34 2344.
Issued By: �Jc�,���u ac_, S���.�C.E r". t. Permit Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: ___ DATE:
CONTRACTOR IN TALLATION ONLY
SIGNATURE OF SUPI?. ELEC'N: _ __ — DATE:
LICENSE NO:
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Application -
.r
Date received'/_ /� _p � Permit no,•, i _
City of Tigard IIQ ECEIVE® Project/appl.no.: Expiredate:
City of"Pigard Address: 13125 SW Hall Blvd Ti �R 1423 Date Issued: By-. Receipt no.:
Phone: (503) 639-4171 Sorf,
AN 1 2$� ---
Fax: (503) 598-1960 Case file no.:_ Payment type
Land use approval: CITY OF TIGARD '
(A I A, 2 family dwe!linb or accc:s:,ry U Commercial/iuduAi ial U Multi family U Tenant improvement
U New construction U Addition/alteration/replacement U Other:_ U Partial
liSITEINFORNIA]ION
Joh address: �d` � >t a CN1J TC:,(z tj o taut Bldg.no.: Suite no.: Tax map/tax lot/account no.:
Loc((.)3i O I Block: Subdivision: __
Project name: C_n%L Au_(As Description and location of work on premises: WATY�Z ZoW�c�t
Estimated date of comptelion/inspection: \gLLU tT
FEL SUI I)t,l,k
Job no: 4 - i Fee 11tax
Business name: 131ZU q,7\,� -�Cc.Z'l2JtC_ _ nescription 2 . (-.a.) Total no.Insp `
`, A New residential-single or rrnrhi-family per
Address: ''tel\(` dwellingratit.Includes attached garage.
City: p iZ7 lJ State:�m ZIP: ZI -service
Phone: rJp _(, Fax:Ce j-j, "2o`j mail' 1000 sq.ft.or less _ A —
CCB no.: -1'Z Elec.bus.lic.no: `-I )4(o C— Each additional 500 Sq.ft.or Portion thereof
Limited energy,residential 2
Qty1meUV 4c. o.: Limited energy,non-residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician(required) Date Service and/or feeder _
iup.elect.name(print): 'r"'C I_icenseno: Services or feeders-Installation,
alteration or relocation:
200 amps or less
Name(print): 201 amps to 400 amps - 2W-
401 amps to 600 amps
Mailing address: 601 amps to IOW amps
City: State: ZIP: Over 1000 amps or volts 2
PI!)ne: Fax: I E-mail: Reconnectonly 1
Owner installation: The installation is being made on property I owr Temporary senicesorfeedem
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,orrYhxzdon:
ORS 447,455,479,670,701. 200 amps or less
x01 amps to 400 amps
Owner's signature: _ Date: 401 to 600 ams z
Branch circuits-eat►,alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase rmf
Address: service or fender ftc.each branch circuit 2
City: - Stale: ZIP: B. Fee forbranchcir-uitswithoutpurchasa
Phone: _ Fax: l-.-mail; of service ort'eecierfee,first branch circuit: W.e. n/(,0- 2
Each additional branch circuit:
M4c.(Senlce or feeder not Included):
❑Service over 225 amps-commercial U Health-care fatality Each pump or irrigation circle 2
❑Service over 320 amps-rating of 1&2 U Hazardous location Each sign or outline lighting 2
familydwell ings U Building aver 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
U Building over three stories O Feeders,400 amps or more •Descrition:
U Occupant load over 99 persons U Manufactured s• tctures or RV park Each additional inspection over the allowable In any of the above:
U Egressnighting plan O tither _ petinspection _ F
Submit__sets of plats with any of the above. Investigation fee ! _
The above are not applicable to teiuporary cotttlstntction service. Other
Nat all jeiadictitns accept credit cards,please call jurisdiction for mace lnfamtlion. Notice:This permit application Permit fee.....................$ `i(r S
O Visa O MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit cad numbe� _I_I_ within 180 days of .: it has been State surcharge(8%)....$
Expires accepted as complete. TOTAL .......................$
—`Dime of cardholder a qua credit card '
_S
Cardholder sipmrre____ Ansow, 440-4613(61 WOM)
Electrical Permit Fees: J. Limited Energy Fees:
-- TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee..... .............................................. $75.00
Number of inspections per perm t allowed (FOR ALL SYSTEMS)
Service included: Items Cost Tota' Check Type of Work Involved:
Rysidentlal-per unit
1000 sq ft or less $145 15 4 Audio and Stereo Systems
Each additional 500 sq it.or
portion thereof $3340 _ 1 Burglar Alarm
Limited Energy _— $75.00 ___--
Edd I tvldjiunj l lu „ to :;lar n Garage door Opener'
Dweiling Service or f eeder $90.90 •-
Services or Feeders E] Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation 2
200;Ops or less $80.30 Vacuurn Systems'
201 mps to 400 amps — _ $106.85 — _. 2
401 arips to 600 amps _ $160.60 _– other
601 amps to 1000 amps — $240.60 2
Over 1000 amps or volts _ $454,65 —_ 2
Reconnect only $6685 2
TYPE OF'JYC)RK INVOLVED -COMMERCIAL ONLY
Temporary Services or Feeders Fee for each system..................................... .................. $75.00
Installation,alteration,or relocation (SEE OAR X18-260-260)
200 amps or less $66.85
201 amos to 400 amps $100.30 —�_ 2 Check Type of Work Involved:
401 an ps to 600 amps _ $133.75 __— 2
Over 600 amps to 1000 volts, C� Audio and Stereo Systems
see"b"above.
br:^rich Circuits E] Boiler Controls
New,aiteration or extension per panel
a)Tie fee for branch circuits Clock Systems
with purchase of s-rvlce or
/cedar lee. —Each Granch circuit $665 7. Data Telecommunication I tstallation
b)The lee Lx branch circuits
without purchase of service E] Fire Alarm Installation
or feeder fee.
First branch circuit _ $4665 _ HVAC
Each additional branch circuit $6.65 ---------
Miscellaneous
___-__Miscellaneous E:] Instrumentation
(Service or feeder not included)
Each pump or irriyation circle $53.40 u IntercL .nd Paging Systems
Each sign or outline lighting _ $5340
Signal circuit(s)or a limited energy n Landscape irrigaLon Control'
pan31,alteration or extension $75.00
Minot Labols(10) $125.00
Medical
Each additional inspection over
the allowable In any of the above Nurse Calls
Per inspection --__ $62.50
Per hour _ __ $6250 _
Ouldr
In Plant —_-- $72 75 xtr Landscape Uylrliny
Fees: F] Protective Signaling
Enter total of above fees $ _._ F] Other l______._ --- --_•
8%State Surcharge $ _Number of Systems
25!x.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 p_- _�.__— 81!:State Surcharge $ -
-"" --- — – Total Balance Due —
I Wsts\fornulelc-fees doc 10/09/00
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171 __—
BUP
Received _ _ __Date Requested 3 AM PM __ _ 601P
Location �n�, _ S �' Suite MEC
Contact Person ��—� ��_ Ph��1 ) i� -`l $� PLM _
Contractor. —_ _ _— Ph(--) SWR _
BUILDING — Tenan+lOwner -__ EL Q4 C� D _
Footing ELC
Foundation Access:
Fig Drain ELR
Crawl Drain —• -
Slab Inspection NntNs: 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
PASS PART FAIL.
MECHANICAL
Post&Beam
Rough-In
Gas Line
Smoke Dampers
Final
P4kS4t_ RT FAIL
LECTRICA
Se __
Rough-In
Ura/Slab
Low Voltage
FWLAIarm
E ❑ Reinspection fee of s.--_ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
RT FAIL_
SITE _. [J Please call for reinspection RE: A F1 Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidew,jikdatie —L---J-- Inspector Ext
Other i
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
(A FY OFT-IGAHD 24-Hour
BUILDING Inspection Line: (503)C139-4175U.
INSPECTION DIVISION Business Line: (503)639-4171 MST
BLIP ---_ -
Received .Date Requested AM._ PM _ BUP --`
Location L>J Suits. MEC
Contact Peron �
. it
al PLM
Contractor -- -- --_ _ — Ph(_ ) SWR
t Tenant/owner _ — - -—--- `
oval a
Footing
Foundation ELC _
Fig Drain ELR
Crawl Drain
Slab Inspectlon Notes: SIT
Post&Beam►
Shear Anchors;
Exi SheatIVShear
Int SheattVShoar
Framing ------
Infiulation
Drywall Nailing --------_._-_-_ - -------.—
FlrewaG
Fire Sprinkler - - - --- -- --- -- ---
Fire Alarm
Susp'd Ceiling --
Roof
Other: ----
Final
PASS PART FAIL - -_ _--_ - -----.------_._`-- ---___-
Post b F3eam
Under Slab ___�-------.__--
Rougli-In
Water Service ---
Sanitary Sewer -- - ---
Rain Dralns - ----,.�-- - .. - -- ---- -------- - - _
Catch Basin/Manhole
StormDrain ----------- - -- --- - ----- ---- ------ - - - - ---
Shown.Pan
Other: — -- ----
Final
PASS PAAT FAIL
Post& Beam -- -
RougtvIn -
t3ae Line
Smoke Dampers
Final
RT FAIL - ----
Rough-In
UG/Slab _
Law Voltage
PAsi. PART FAIL �_] Re'r,spection fee of$--.-------required before nett Inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE Unable to Inspect-no access
Fire Supply Line
ADA
AppmactVSidewalkQot*' 1--!l- -__ _.�- Inso et _. !ut
Other. '
Final - DO NOT REMOVE this Inspection r'eco role the jooi site.
PASS PART FAIL-
-all
AIL,d ._—__ I (It'c n I xauull M'! F-1-21 I i t7UUj3 91 unf.