The URL can be used to link to this page

11399 SW IRONWOOD LOOP V) d g t r ro I 11.399 SW IRONWOOD LP " CITY O F TIGARD MECHANICAL PERU IT DEVELOPMENT SERVICES PERMIT#: 19EC2002-G"543 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/3/02 PARCEL: I S134AC-01600 SITE ADDRESS: 11396 SW IRONWOOD LP SUBDIVISION: ENGLEWOOD ZONING: R-4.5 BLOCK. LOT: 044 JURISDICTION: TIG CLASS OF WORK: OTR, FLOOR FURN: E IAP COOLERS: W TYPE OF USE: SF UNIT HATERS: VEP;"r FANS: OCCUPANCY GRP: R3 VENTS WIO APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: FUELTYPES 0 - 3 HP: 1 DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: RTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 ", HP: CLO DRYERS: FURN < 100K BTU: _AIR HANDLING UNITS OTHER UNI fS: FURN >=100K BTU- <= 10000 cfm GAS OUTLETS: > 10000 cfm: Remarks. Install of exterior AC unit. Cannot be placed in the required setbacks. 0, -ler: _ -- FEES — NLLSON, ROBERT O SUSAN S Description Date Amount 11399 SW IRONWOOD LOOP — ----- TIGARD, OR 97223 1ME:CH] Penriit Fcc 12/3/02 $72.50 1"TAX] 8%Sl[itc'Rlx 12/3102 $5.80 — � — Phone: 503.590-9500 -- Total $78.30_ Contractor: SPECIALTY HEATING & COOLING 9528 SW TIGARD ST TIGARD, OR 97223 REQUIRED INSPECTIONS Phone: ')20-5643 Cooling Unt Insp Final Inspection Reg #: LIC 66578 This permit is issued subject to the regulations contained in the Tigard Municipal Code, Staim of Ore. Specialty Codes and all other apnlicable laws. All work will be done in accordance with approved plans. 1; is permit will expire if work is not started within 190 clays of issuance, or if work is suspended for more than 180 days. ATTLN'TION: Oregon law regt. res you ;o fallow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)2.46-6699. Issued By: d ` _ -I�c,�� Permittee Signature: i l C Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day t Mechanical It"Wl ivkkion � Date received: Permit ' Z - P i City U T gali a i, J 2 2001 Project/appl no.: Expire date: CotyofTigard Address: 13125 SW Hall Blvd1� t�tt�,%3W -- Phone: (503) 639-4171 a Dale issued: BY /i Receiptno.: Fax: (503) 598-1960 r3UILDING DIVISKYJ Case file no.: Payment type: Land t_se approval. — Building permit no.: I &2 fancily dwelling or accessory 0 CommerciWindustrial O Multi-funily 0 Tenant improvement New constructicrl �Addiuon/altention/replacement O Other:- Job address: _ Indicate equipment quantities in boxes below. Indicate die dollar Bldg,no.. _ Suite no.: value of all mechanical materials,equipment,lab,)r,overhead. Tax map/tax lot/account no.: profit. Value$ Lot: *See checklist for important application nformation and Project name: jurisdiction's fee schedule for resident) .I permit fee. City/county: T lyR2q' LIP: 47 Description and location of wore-on premises: r GcJOR 1= _ t For(Pa.) Total Est.date ofcomple:ion/inspection� _-- Ik-scription Qty. N.minty Res.only Tenant improvement or dl."ge of use: A(: Is existing space heated or conditioned?O Yes LiNo Air handling unii CFM Air conditioning(,sitep a_ntequlredl Is existing space insulated?0 Yes 0 No �le�ti ro,u e-�xtstingFlVsystcm -" "- �- 1 Hoiter/compressors - —T Business pamnc�C �� h �) State hailer permit no.: ---- Addres�5 �(,� f 2 r -` __ HF --Tons BTU/H _ it smo a amper uctsmo.e etectors �uu 1 d ?State:p oa 7� I (site plan required) _l 7'�I': Z 3 Hea:oum r Phone n-R/r, furnace/burnersfJ - CCB no.: 4 4�S 7 8' Including ductwork/vent liner U Yes U No ------ ---- - �• f L IS nstaorep ace/re oc.1Tc eaers–suspenCity/metro lic. wall, rfloor mounted vName(please print): ent ed, ' of a Cance ocher than furnace 1 e gerat on: -' Absorption units- BTU/H _Name: 1 C- /Y �l Yj 7 P Ik t hillcrs--- -- HP Address: Sa $' —SL43 /�! ST Co ressors — HP City:City: ��t/ Stale:GE ZIP: !� 7�„a.� mrrnnmental exhaust an tenUlnTn: -Pho c r " Appliance vent - 3 Gao SC, Fax 59i�'G�7/$' E-mail: Dryerex gust foods,"'yp-T c"I/ran IutcneNhazmai-v - - - -- hood fire.suppression system -ante: f �1�P O W _ Exhaust fan wi.::single duct(bath tans) 1{ M.Oinbaddress: 49 Exhaust stcina znfmmh-- heating or AC City: - state.. D ZIP:— ue p ping an ution up to outlets) 0— — Type LJIG --_ NG oil Phon ,jaO Fax: E-m:ul: uel P�.PPmK tach additional over 4 outlets roeeciplping(schematicrequire I Nome: Number of outlets Other W-e' a uceoor-''------ -- — - Addiess: PP equipment: Uecnrttive fireplace City: State: Z1P Ins ri-type ail: `- Woo st-3 ove!elletstove — Phone: � �ax: E-mail: Pe Applicant's ign re: Date: Q L Name (print',:U�14_ ("I tySoth OA C/' _ -------- —_ -. _J �n I junvrladoru arcept ati9t c•rdi,pleme con)uncdicnrn for more mfnrmminn. Permit fee......................g V sa O Masrerc:lW Jr Notice:phis permit application Minimum fee. ..............S .,red)(cud numher '. ( � �' �l expires 1f a permit is not obtained Plan review ;at -- %) S jh��r r f aria E:pore+ within 181)days after it ha-,been State sun:h fr t 8% Nance of c .b a A n an r c accepted as complete. g e( ) ••..$ - - llydt�i.t r s TOTAL .......................$ _—_---._..`_ arA Yetder ti 6e4alure Artlnunl - "0-4617(&WICOM) Z�i?td 096T86S20S:01 f'bLOT8920S 30IJAO 0d08S1-1IH:W0HA Ht72:TT 8651-b-NHf JAN-4-19988 5A FROM:HILLSBORO OFFICE 5036810793 TO:503F 1960 P:1 1 SITE PLAN PL, �� PL PL PL 31 STREET Specialty Heating & 'C:oolincr, Inc 9528 SW Tigard Street Tigard, OR 97223 Phone 50-3 .620.5643) Fax 503 .598.0718 Hillsboro Phone 503 .640.3607 Fax 503 .681 .0793 CITY o f T I G A R D ELECTRICAL PERMIT- `, RESTRICTED ENERGY DEVELOPMENT SERVICES -� PERMIT ELR2002-00114 13125 SW call Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/5/02 SITE ADDRESS: 11399 SW IRONWOOD LP PARCEL: 1S134AC-01600 SUBDIVISION: ENiLEWOOD ZONING: R-4.5 BLOCK: LOT: 044 JURISDICTION: TIG Proiect Description: Install ,411 Encompassing Low Voltage. A.RESIDENTIAL _! B.COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OU i DOOR L.ANDSC LITE: OTHER: ALL ENC)MP X HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL#OF SYSTEMS: _ Owner: — — Contractor: - NELSON, ROBERT O SUSAN S THEN THERE WAS LIGHT iNC 11399 SW IRONWOOD LOOP 24085 NE WILDWOOD RD TIGARD, OR 97223 NEWBERG, OR 97132 Phone: Phone: 50.,,-538-6645 Reg #: LIC 142987 ELE 36-93C SUP 4526S FEES - Required Inspect 7ons Typc By Uate Amount Receipt _ Low Voltage Inspection PRMT CTR 6/2.5/02 $75.00 2720020000 Elect'I Final 5PCT CI R 6/25/02 $6.00 2720020000 Total $81.00 This; Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. r11 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 952-001-0060. You may obtain copies of these rules or direct questions to OUNC at (503) 246-1987 �l Issued by , L./Lt �, - Permittee Signature OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale. Ie,.se, or rent. OWNER'S SIGNATURE: DA1 E: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SJPR. ELEC'N � �z' > .' �^, � DATE: LICENSE NO: Call 639-4175 by 7:00 P.M. for an inspection needed the next business day 2.115 5382728 EDUCATIONAL TRAVEL PAGE 61 Electrical Permit Application Datereceived: / e?'l Permit no.: City Of 'Figardr �fj OXYM'' 1f W Project/appi.no.: Expire date: CidyvjTiRa.d Adriress: 13123 SW HAI$1vdt gR`912d3'') Uateissued: By /` Receipt no Phone: (503) 639-4171 Fax (503) 598-1960 Case file no.: Payrneettype. Land use approval: 1 &2 family dwelling of accessory U Commercial/ind•istiial U Multi-fancily U Tenant improvement Now construction U Additi(nValtrrat.on/repla�enient U Other: U Partial Job address: ` 5� 1/7c,ry (.Kx,� > 81dg• nt�.: Suite no.. Tax m1t tt lot/account no.: Block: Subdwision: -- ProjcctDes(:ription and location of work on premises: N-��d(-+' Lti.�, of �- Estimated date of eompletion/inspection: _ - r f�'7,2 . RIME[&AM ISLAM Job no: �T �� Mac Business name: r �l�j `ict�,n, ea Total no.In. tusm rrlaesrW-**er s-111-arAy per Address: — (.l��d �^'t� awtluoQr�.treltMr'att.dragir.p. City: 6A,)b - 7Jp: 7/-J 5enl�Mclaae� Phone: I Fix: -Mail: sq,III,or ICISS 4 r -3Each additional% or gnion thereof CCS no.: /H& � yElec hus.he.Ico: -2r¢_!23 Ci limited enet>3Y,residential - 2 City/metro lie.no.; /U-01 - Limited energy,_tion-residential 2 - -- y�L / C✓ Each manufactured home or modular dwelling Si astute of nal rvlsln ek..tnc an r wee;' Dare /•0 Service and/or leader - 2 _ E __17A._—� S_�9. — 1- -- Sup,elect-name(ptint), I �t itn E IJcense tro; $1 Services or fuedeta ti ntrallatlar, allerattea a rYlocatloa: 200 amps or lees _ 2 Narne(Print 201 strips to 400 arae - -— - 2 —p 401 to6Wams 2 M log addrt'sta: 601 attps to_ _ p - - - -- - - � 1000 amps 2 y: ��1=late: ZIP: _ over 1000 amps or volts---- 2 - Phor.c: )'ax: E ttlail: Rcconnamonl 1 fhvirer in4tallation••ilio inmudialion is bein);made on property l own Iemporm-yowThworfeedrta which is not 'Intended for.calc,lease,teal,of exi'hanpt According to twullatioa,alMratim,orreloeatba: f►RS 447,455,47r1,00. 701. 20(lampsorle" _---. _ 2 20I amps to 400 smpx 7 OWllet-'9 9lgtllhur: Dale: 401 to 600amps - _ 2 branch Nrcults-nen,dMratlon, or rxltiolon per panel: Nance: A. Fee for bnmch circuits with purchase of Address _ _snvIca or feeder fists,each branch circuit - 2 I Clfy: l.`hale J.I I' B. Fee for branch circuits without purchase --- -- of service or feeder fee,first branch circuit, 2 Phone: fRX; I. :natl: E1elfoddiarntdbrutchcircnlr -- Mime.(Semee ar feeder not InclWed): Each pun or irritation circle 2 7-� 7 S unpauttttrterrad U Health-caro faculty �_ — __ .__ 70 amps-ming of i R7 U tlaLtrelnlla tocstiOn Ea.h si nor oudlt5e 2 gs U Hullditsg Over 10,000 tilusrr feet four nr Signal circuit(s)or a limited ei.-Ygy panel. NI vola notrtittal rtnae residential units ht Oar slrucmrc dtention,of extension* _tt 2 - - - U By IIding over three stories U Feeders 400 amps of tmrr 013wd tion; _ J t x cur.rt u.rd over SW persons U Manufactured structure*of RV park Each addhional inerpoeflon ov,r tin allowable bl In any of dream above: — U Ityrrsillightingplan U Other __— Primspection Sttl6Mlt sets of pWu wltlr any of the aboTe. lnves-__t�auo fee 1 Yw above tete not applkiliMe to temrpot•ary coostructMa"HO- Other - — - ---- - Permit fee............ .S— N,r apt)ttdttrlicUaa or""rpt red.,plew call)ttrimfictiot fm ewe Infoonsrinn Notice:This permit application 0 v;ss ❑MasterCard expires if a permit is not obtained Plan review(at ` %) S _ t'mru ref arnfner _ --____ ,, —l- within IAO days after it hon been Stite surcharge(9%)....$ Rime u r�wldw u r ew�rt tNr d �" accepted as cMltpleiC -- s J__ �irtlholdet dteaorc ---��-. ArrNnust 4404613(6Kiat:oM) CITY OF TICARD 24-Hour BUILDI 4 Inspection Line: (503) 639-4175 INSPECTION DIVISONr Business Line: (503)639-4171 MST —. BUP — Received --_---- Dasa Requested AM-------__--PM- -- BUP ...--- ___---_-- Location _ _ 3 — __- ,O-rff� Suite _ MEC Contact PersorPh �--- (--) �Z�-�� PLM - Contractor - --— - -- -- - Ph( -) --- ---- SWR ------- BUILDING Tenant/Owner _-�Q4C� _- ELC Footing t� - % 5 f _ ------ Foundation G�-�~�'� rj ELC --_ Ft Drain Access: — Crawl yCo wl Drain ! ELR - Slab Inspection Notes: / Post& Beam )I h i' � _i �_:+ _� -►-!G�^ Shear Anchors' --d-N _ .�3\r R b 0 - Ext Sheath/Shear Int Sheath/Shear -- Framing -- - -- -------------- -- --------- --- Insulation �- DryNall Nailing ----- - ----- ----___--_ - Firf wall Finr Sprinkler --- Fire Alarm Susf;'d Ceiling ---- ----..- --- -- -- - -- Roof Other. - _..-. —.------ --- ----- Final --Final ^ PASS PARTFAIL PLUMBING _ Post R Bnam Under Slab Water Service Sanitary Sewer - Rain Drains - - - - ----- - Catch Basin/Manhole 1 Storm Drain ------ Shower Pan Other. -- - - - —.- ----- - — Final AS3 PART FAIL _M_ECHAN_ICAL Post& Beam Rough-In - - - - - - ----- -- - - --- Gas Lir. Smoke L yrs - - .- Final PASS PART FAIL - -- - --- ELECTRICAL — Service Rough-In - ------- UGiSlab — — A�Ita -T - -- ---- -------- --- - -- Fire Alarm PART FAIL L] Reinspection tee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for reinspection RE: _ - _ Cj Unable to inspect-no access Fire Supply Line ADA -, �J ,� C• Approach/Sidewalk Dote _ c'� Inspector '`""-7"� -_Ext Other / Final DO NOT REMOVE this Inspection record from th6 job site. PASS PART FAIL CITY OF TIG,ARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST — 11NSPECTION DIVISICV Business Line: (503) 639-4171 ---"—�-- BUP --_-- Received __ _-____ —Date Reque edAM_--.-.-.. PM__ _ BUP Location _____._____ �_ < < __ __. _ 40;�2-Suite __- AEC Contact Person __�_ --_ Ph( _) _._ —_ Pt_WI Contractor - Ph — _— SWR BUILDING Tenant/ r -� /S,e ��.� ELC Footing _ — _--- �� _ U � ELC __._...------------ Foundation Access: Ftg Drain ELR - Crawl Drain Slab Inspection Notes: SIT _-- Pos'&Bean, Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing -- - --- .-- - - Insulation Drywall Nailing -- --------- - -- Firewall Fire Sprinkler - -- - - --- -- Fire Alarm Susp'd Cei mg - - -- - Roof Other- Final ther 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 PA T FAIL --- _ CHANICA PosN Beam Rough-In - -- Gas Line .qmoke Dampers - - - --- - ----- --- - ------_ tEkAL ART_FAIL - - ------ - - - --- ---- -- .--- Service - Rough-In UG/Slab Low Vc•itage - Fire Alarm Final u Reinspection fee of$_---_—_.__required before next inspection. Pay ui City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call to reinspe.tion RE:_ __-__-__-___.___-_.___-_____- �_ Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date __ _� --'/ I.� _ n Inspector __--- �_ --_ - Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CI1 Y OF TIGARD BUILDING INSPECTION DIVISION MST 74-Hour Inspection Line: 639-4175 Business Line: 639-41'r S BUP Date Requested CG AM___ PM BLD Location � � � � 1 :r"I�s� Lj r - 3--*' Suite MEG Contact Person R-C. Ph S!y PLM Contractor eki tAe C , Ph _ — SWR BUILDING — Tenant/ vnorr _ >< r� �, ELC UGC /- _ 7 Retaining Wall ELR _ Footing Access: Foundation FPS _ Ftg Drain SGN Crawl Drain Inspection Notcs: /� -- - Slab (�s'� L L.0-�-Cfi SIT Post R Beam Ext Sheath/Shear 7Lt �- Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler �� •-- /1L�C� _- - — Fire Alarm Susp'd Ceiling Roof Disc -- f-incl PASS PART F,".!L — --- -- . P'_UMBING Post& Beam — Under Slab G'1 G \ Top Out � L-_—_.. Water Service Sanitary Sewer -- - -- - Rain Drains Final - -------- ----- - PASS PART FAIL MECHANICAL Post& Bearn ------ -_---_ —_--- _ Rough In Gas Line -- ------ --- --- ------- -- — Smoke Dampers Final - ------ _-_ PASS PART FAIL ELECTRICAL service Rough In ---------- --- _--__ UG/Slab Low Voltage Fir Alarm PASS ART FAIL Backfill/Grading --------' - - -- --- ------ Sanitary Sewer Storm Drain [ ]Reinspection fee of$ -_required before next inspection. Pay at City Hall, 13125 SW Hall Blvc Catch Basin Fire Supply Line f ]Please call for reinspectior RE: _______ [ )Unable to inspect-no access ADA Approach/Sidewalk Date Other _ _� Inspector. _ Ute_ c_.� � Ext Final PASS PART FAIL] DO NOT REMOVE this inspection record from the job site. CELECTRICAL PERMIT CITY O F T a G A�D _ PERMIT#: ELC2001-00377 "A DEVELOPMENT SERVICES DATE ISSUED: 7/25/01 13125 SW Hall Blvd..Tipard, OR 97223 (503) 639-4171 PARCEL: 1S134AC-01600 SITE ADDRESS: 11399 SW IRONWOOD LP SUBDIVISION: ENGLEWOOD ZONING: R-4.5 BLOCK: LOT : 044 JURISDICTION: TIG Prviect Description: Installation of(2)branch circuits. RESIDENTIAL UNIT _- TEMP SRVC/FEEDERS _ MISCELLANEOUS 1^00 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 40U amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL. MANr FSM/SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10): _ SERVICEIFEI_DER�— _ 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: 1 IN PLANT: F01 - 1000 amts: ___ _PLAN REVIEW SECTION _ __� 1000+ amp/volt: >=4 RES UNITS: > 300 VOLT NOMINAL --Reconnect only: _ _ SVC/FDR >=225 AMPS: _ CLASS AREA/SPEC OCC:— Owner: Contractor: NELSON, ROBERT O SUSAN S THEN THERE WAS LIGHT INC 11399 SW IRONWGOr) LOOP 24085 NE VVILDWOOD RD TIGARD, OR 97223 NEWBERG, OR 97132 Phone: Phone: 503-538-6645 Reg#: LIC 142987 ELE 36-93C SUP 4526S _ FEES Requ red Inspections- Type By Date Amount Receipt Rough-in PRMT CTR 7/25/01 $53.50 2720010000( Wall Cover Elect'l Final 5PCT CTR 7/25/01 $4.28 2720010000( - Total $57.78 This Permit is issued subject to the regulations contained in the Tigard Munidpal Code.State of OR Specialty Codes and all other applicable laws All work will be done in accordance with approved plans This permi, .sill 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 rulesaddpted by the Oregon Utility Notificatior Center Those rules are set forth in OAR 952.00!-0010 through OAR 952-001-0080 You may obtIfi copies of these rules or direct questions to OUNC at(503) 2.46-6699 or 1-800-332-2344 f Permit Signature: _ fr, Issued By: . -OWNER INSTALLATION ONLY _ TIie installation is being made on property I own which is not intended for sale, lease, or relit. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTAJLLATION ONLY L�LI��L It l2 4�- - ay� SIGNATURE OF SUPR. ELEC'N: 1��—_�_— �_ DATE: LICENSE NO: `/<�1G S - --- ---- -- ------ - Call 639-4175 by 7:00pm for an inspection the next business day Electrical Permit Application Date rcceiveJ: 'If 5 i/ Permit no.: Ix -00 "7 City of Tigard Project/appl.no.: Expire date: _ Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 639-4171 — Fax: (503) 599-1960 Case file no.; Payment type: Land use approval:)10 &2 family dwelling or accessory U Con tmercia[lindustrial U Milli-family U Tenant improvement U New construction LI %ddilio.-V,+,ration/replacernenl U Other: U Partial MMIMM Job address: sw ".Ikn.a�tay `�_— IiIJg. n0, smic.nu.: _ Tax Wrap/tax lot/account no.: ,— Lot: Block Subdivision: Project name: Description and location of work on premises: pr�T- �gc,.a"i A rL D u1�' c� S Esti"..aced date of completion/ins ectiow I C, t FeeMax Job no: _ _ N� Dcscrlplion Ory. (ea.) 'total no.Insp Business name: "I fljL 0 /K-k wA`� t ' L r t New rvsifrmtial-single or rmdtifamily per Address: e G �Wt c") dwelling unit.Include%attarhedgar-age. City: &I Ckj b c---k, I State:o ZIP: 7r3 >` serviceinclu": 1000 Sq.ft.ol less Phone:,S&7-r Fax: - E-mail: Each additional 500 sq.ft.or purtion thereof CCB no.: d Elec.bus.tic.no: 2 q L Limited energy,residential 2 City/metro fic.no.: Limited energy,non-residential Each manufactured home or modular dwelling Sig atu a of supervising electrician(required) Date ze- / *'/ Service and/or feeder 2 Services or feeders-installation, Sup.elect.nome(prim) r[Iv^41 6At,t�•*e w.- License no: Z6 s alteration or relocation: W 91 A 1111111= 200 amps of less 2 201 amps to 41N1 amps 2 Name(print): p „- S�_>_�N N Er.5t+�! 2 401 amps to 600 amps Mailing address: (M-sLAS I Roos W.JeW o i— OOr 601 amps to 10N)amps _ 2 City: .T 10 a OLD State:p a— Z1P: Over 1000 amps or volts - -- 2 Phone: r—..tx I E-mail: Reconnectonly I Owner installati-on:The installation is being made,on property I own Temporary services or feeders- installation,alteration,orrelocation: which is not intended for sale,lease,rent,or exchange accordingto 20O amps or less ' ORS 447,455.479,670,701. 201 amps to 400 amps 2 owner's si rnature: Date: 401 to 6(N1 ams 2 Branch ei:cults-new,alteration, or extension per panel: Name: A. Fee for branch circuits with purchase.of Address: service or feedu lee,each branch circuit — 2 f'it Stale: ZIP: B. Fee for brant i circuits without purchase ' of service or t•!eder fee,first branch circuit: 2 Phone: I ar U mail: Fachadditional hrenchcircuit PLAN JtVVjjrl�'(Plenoie cheirk all that apply . Misc.(Service or feeder not Included): Each pumpor irrigation circle 2 U Service over 225amp,cumme,c,al 'J Ilenith-care facility Fac2 •Service over 320 amps.rating of 1&2 U Ilazaidouslocatioe Each sii:noroutline lighting family dwellings U Building over I00H)square feet four or Signal(ircuit(s)or a limited cn^rgy panel, U System over 600 volts nominal more residential units in one structure alierati m.or extension* 2 U Building over three stories U Feeders,400 amps or more *Description: _ — ❑Occupant load over 99 persons U Manufactured structures or RV park Eich additional Inspection over the allowable In any of the above: U r-gress/lightingplan U Other: _ — Perjnspection Submlt _ - sets of plans with any orthe above. Investigation 6 he above are not applicable to temporary construction service. _ OtLei __ J -- — Permit fee.....................$ Not a0 jreisdicaons accept credit carch,please call jurisdiction tar mm infamtauon. Notice: I'his permit application Plan review(at _ %) $ U Visa U MasterCard expires if a permit is not obtained O redn card number _L—L- within 180 days atter it has been State surcharge(99,)....$ Explrer accepted as complete. TOTAL .............. ........$ _ Name of c ores s own on cte t card Cardh.dder signature $ Amouii 44(14615(610arCOM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: TYPE 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 I 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 Manufd Horne or Modular Dwelling Service or Feeder $9090 2 ❑ Garage Door Opener" Services or Feeders Heating,Ventilation and Air Conditioning System' Installation,alter alion,or reloration 200 amps or less $80.30 _ 2 201 amps to 400 amps $10685 2 J Vacuum Systems' 401 amps to 600 amps _ $160,60 _ 2 601 amps to'000 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 2 401 amps to 600 amps $133.75- 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see"b"above. �❑ Audio and Stereo Systems Branch Circuits New,alteration or extension per panel r`l Boller Controls a)The fee for branch circuits with purchase of service or ❑ Clock Systems feeder lee. Each branch circuit $6.65 2 �❑ Data Telecommunication Installation b)The fee for branch circuits without purchase of service ❑ Fire Alarm installation or feeder lee. First branch circuit $46 85 _ Ear additional branch circuit $6,65 �� HVAC Miscellaneous �� Instrumentation (Service or feeder not included) Each pump or irrigation circle $53,40 Each sign or outline lighting _ _- X53 40 _ ❑ Intercom and Paging Systems Signal circuit(s)or a limited energy panel,alteration or extension ^^ $7F 00 ❑ Landscape Irrigation Control` Minor Labels(10) $12500 Medical Each additional Inspection over ❑ the allowable in any of the above Per inspection $62.50 _ _i Nurse Calls Per hour $62.50 In Plant $73.75 ❑ Outdoor Landscape Lighting' Fees: LJ Protective Signaling Enter total of above fees $ Other 8%State Surcharge $ _ _ Number of Systems 1 25%Plan Review Fee See"Plan Review' section on $ Nu licenses aie required Licenses are required for all other Installations front of application ------- Fees: Total Balance Due $ Enter total of above fees $ �� ❑ Trust Account tY.__ 8%State Surcharge $ _� Total Balance Due $ iAdsts\fornuklc-fces.doc 06/07/01