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CITY
O� �'G��D ELECTRICAL PERMIT
(V_ PERMIT#: ELC2002-00281
DEVELOPMENT SERVICES DATE ISSUED: 6/2.1/02
-- 13125 SW Hail Blvd., Ticiard, OR 97223 (503) 639-4171
PARCEL: 25110AU-08700
SITE ADDRESS: 10670 SW CANTERBURY LN C 1-4
SUBDIVISION: CANTERBURY APARTMENT'S ZONING: P.-12
BLOCK: LOT : JURISDICTION: TIG
Pruiect Description: Reconnection rote for unit CA
RESICcNTIAL UNIT TEMP S_RVCIFEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 200 am-r: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 400 amp' SIGNIOUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNALWAN171:
MANF HMI SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10):
_ SERVICE/FEELER _ BRANCH CIRCUITS _ ADD'L INSPECTIONS
0 - 200 amp: W/SERVICE OR FEEDER: ^� PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR.
1 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp- _ PLAN REV-'EW SECTION
1000+ ama/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: 1 _ SVC/FDR >= 22.5 AMPS: CLASS AREA/SPEC OCC: f
Owner: Contractor:
TANNER, NANCY TRUSTEE OWNER
307 POND RIDGE LN
UBANA, IL 61801
Phone: Phone:
Reg#:
FEES Required Inspections
Type By Date Amount Receipt Elect'I ServFinaice
PRMT CTR 6/21/02 $66.85 2720020000(
5PCT CTR 6121102 $5.35 2720020000(
Total -- $72.20
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 plane. This permit will expire 9 work is not started within 180 days of Issuance,or if
work Is suspended for more than 180 days. ATTENTION: Oregon law requires yod to follow rules adopted by the Oregon Utility Notification
Center. Those rules are set forth In OARffi2.001-oolu ihrough OAR 952-001-0080. You may obtain copies of these e�or irect questi:ms to
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Signature: �• /, �,. IssueBy:
�� ZL•���J
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
ATE: —._CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: — – DATE: _LICENSENO:
Call 6394-175 by 7:00pm for.i n inspection t�- next business day
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Electrical Perlmit Application
—'-- Dale received: /•%���� I'err.:i'no.• _�,Y�%��
City of Tigard Project/appl.no.: E 're,!ate:
Address: 13125 SW Ball Blvd,Tigard,OR 97223 Date issued: B Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
IM WMT10
U I & 2 family dwelling or accessory ❑Commercial/industrial U Multi-family U Tenant improvement
U New construction U Addition/alteration/replacement U Other: .__-, U Partial
JOBSITFINFORMATION
Joh address: V�( �/I Bldg.no.: suite no. -( Tax snap/tax lot/account no.:
Lot: Block: Suhdivision:
Project name: IDesc ption and location of work on per inkcs_ jj(�---
Estimated da,1!O'completion/inspection:
CON URM-11'Oft APPLICATION
Job no: Fee Max
Business mantel: Description Oty. (ca.) '1'olal no.hes r
\rl,lresti: - — New residential-single ormolu-famiiyper
- _ _- dwelling will.Includes attached garage.
(11V: Slate: Zle: Sersiceincludel:
I Rune: I ax: E-mail: 1000 sq ri r r less a
Each additional 500 sq.n.or pot tion thereof
CC B no.: Llcc.bus,lic.no:
Limited energy,residential 2
City/metro lic.no.: Limited energy,non-residential 2
Each manufactured home or modular dwelling
5'tgnuutre of supervising electrician(requited) talc 'Lltvice and/or feeder 2
Soh alert nrunc(plow 1 r,,,,,,,,.no: Se�vlcesorfeeders-inslallatlon,
alteration or relocation:
t t 2(x)aaips or less 2
Name(print): `; (. ) f ) 201 attfis to 400 amps _ 2
--�--- 401 amps to 600 amps 2
Mailing nd_dress: -- 001 amps to 1000 amps 2
City: � l � Stale: (_ 12IP: OverlOWampsorvolts r- — 2
Phone , ax:t, 7 -Mail; Rceonnectonly -- I
Owner installation:The it tallation is heing made on properly I t)%%it Temporary services or feeders-
which isnot intended fo le, e ,rent, r exchange according 1u it oallailon,alleratlon,orrelocation:
2W anq,s ur lest, 2
ORS 447,455,4.14,671` ( 201 amps to 4(R)amps 2
Owner's sin 1 e: &V/1 11alt: 401 to h0(1 amns
Branch circults-new,dleration,
or extension per panel:
Name: A. Fee for branch circuits with pun arse of
A tidress: service or feeder fee,each:tram It circuit
City: Stale: ZIP: H. Fee for branch circuits without purchase
- - - of service or feeder fee,first branch Circuit: 2
Hach aldilional branch circuit
PLAN check 4111 Mite.(Service or feeder not Included):
U Service over 225 amps ronunerciul V I lcadth carefacility Hach pump or irrigation circle 2
O Service over 320 amps-ralingtit 1&2 U Ilaxardouslocation Each sign or oulline lighting 2
family dwellings UBuilding over l0,(XX)square feet Four or Signal circuit(s)oralimited energy panel,
Q System over 6110 volts nominal more residential units in one structure alteration,or extension* 2
Q Building over three stories U Feelers,400 amps or nxrm "Description:
U Occupant load over 91)persons U Manufactured structures or RV park hitch additional Inspection over the allowable In any of the above:
U Egtess/lightingplan U Other: —__— Per inspection
Submit--sets of plants with any of the above. Investigation fee
11he above are nut applicable to temporary construction service. Other
Not all jurisdictions scapi credit ands.please cnli rin%Dion Six mixt information Notice:'t•his permit applicntion PCrnlll fee.....................$
Q Visa Q MasterCard expires il'a permit is not obtained Plan r.:view(at — 7h) _'-
Credit card number: Ll— within IRO days after it has been State surcharge(8%)....$
Expires accepted as complete. TOTAL .......................$
Nam c I u s wn nn crnlll c ---
S
Cardholder signature Amount 440J61S(&UWOM)
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ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES.
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
RestrictedEnergy Fee...................................................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Servico included: Iterns Cost Total _T Check Type of Work Involved:
Residential-per unit ❑
1000 sq ft or less $145 15 f Audio and Stereo Systems`
Fach additional 500 cq.ft.or
portion thereof _ $33.40 _ _ f C� nurgiar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ g Gara a Dour opener'
Dwelling Service or Feeder $90.90 _ 2 p
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 r
601 amps to 1000 amps $240.60 2 I Othnr
Over 1000 amps or volts $454,65 _ 2
Reconnect only $66,85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Fee for each system.......................................................... $75(1(1
Installation,alteration,or relocation
200 amps or less $66.85 2 (SEE OAR 918-260-260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
ee"b"above. Audio and Stereo Systems
❑
s
Branch Circuits ❑ Boiler Controls
New,alteration or extension per panel
a)The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder lee.
Each branch circuit $665_ ❑ Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder lee.
First branch circuit _ $46,85 - ❑ HVAC
Each additional branch circuit $6.65
Miscellaneous ❑ Instrumentation
(Service or loader not included)
Each pump or irrigation circle $53.40 __. ❑ Intercom and Paging Syst9ms
Each sign or outline lighting $53.40
Signal circuit(s)or a limited energy
panel,alteration or extension $75.00 ElLandscape Irrigation Control'
Minor Labels(10) $125.00
Medical
Each additional Inspection over ❑
the allowable In any of the above ❑ Nurse Calls
Per inspection $62.50 _ l
$62.50
�eP�Plant $73.75_ ❑ nutdoor Landscape Lighting`
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other
9%state Surcharge $ Number of Systems
251s Plan Review Fee ' No licenses are required. Licenses are required for all other installations
PpVlow"noclion of, $
fnnd of:ip Accn'on -
Fees:
Total Balance Due $ :
_--- + Enter total of above fees • -
❑ Trust Account k _ _ 894 State Surcharge =
Total Balance Due
All Now Commercial Buildings require 2 sets of plans.
i'fists\ferms\eIc-fees.doc 08/30.'01
i1
F'ITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503) 639-4171
BUP
Received Date Requested— �' - — AM PM BLIP
Location —__- 1 �' fir✓ Zlo ..�
.cG�I �A -Ai-4 Suite C MEC
Contact Person 1-Ca� Ph
Contractor_ __ Ph( ) SWp _---- -
BUILDING - lenant/Owner _— _ - ___- ELC
Footing _ _ ELC
Foundation Access: �C ,Q
Ftg Drain C� ELR
Crawl Drain -
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors --
Ext Sheath/Shear
Int Sheath/Shear /
Framing t-�-
Insulation V
DrywaSl Nailing -
FI;awall
Fire Sprinkler - - — - -
Fire Alarri
Susp'd Ceiling ---
Roof
Other: --- ---- _ - - - - - -
Final
PASS PART F_AiL _29 C
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 T
MECHANICAL __
Post& Beam
Rough-In
C s Line
Smoke Dampers
Final
PASS PART FAI
ELECTRICAL
Service
Rough-In ���� --- --- ---- - ------- - - _
UG/Slab p
Low Voltage
-farm
ElA J PART FAIL Reinspection fee of$_, ___ required before next inspection. Pay at City Hall, SS
, 13125 W Hall Blvd
SITE Please caii for reinspection RE: Unable to inspect-no acces
Fire Supply Line _
ADA �-
Approach/Sidewalk Date L G)� Inspoctor - -_ -�' - Ext ---
Other:
Final DO NOT REMOVE 1.5%19 Inspection record from the job site.
PASS PART FAIL