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10825 Sw DERRY. DELL Cr _
C QTY OF TI GAR D � ELECTRICAL PERMIT
PERMIT#: ELC2000-00637
DEVELOPMENT SERVICES DATE ISSUED: 11/16/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639••41 71 PARCEL: 2S103DA 01901
SITE ADDRESS: 10825 SW DERRY DELL CT
SUBDIVISION: DERRY DELI_ PLAT 2 ZONING: R-3.5
BLOCK: LOT : 019 JURISDICTION: TIG
Proiect Description: Installation of two branch circ0ts in garage.
RESIDENTIAL UNIT _ _TEMP SRVC/FEEDER_S_ _ _ _ MISCELLANEOUS
1000 SF OR LESS: 0 200 amp: Y PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/)ANEL:
MANE HM/ SVC/ FDR. 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDERBRANCH CIRCUITS
--- _ _— _., _ A_DD'L INSPECTIONS
0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT.
601 - 1000 arnp: PLAN REVIEW SECTION
1000+ armp/volt: T=4 RES UNITS: > 600 VOLT NOMINAL.
_ Reconnect cr. Iy: _ _.SVC/FDR >= 225 AMPS: --- -CLASS AREA/SPEC OCC:_
Owner: Contractor:
BAGLIEN, DONALD M AND RITA A OWNER
10825 SW DERRY DELL COURT
TIGARD, OR ')72.23
Phone: Phone:
Peg#:
^FEES` _ Required Inspections _
Type By Date _— Amount Receipt Wall Cover
PRMT CTR i 1/16/00 $53.50 2720000000( Elect'I Final
5PCT CTR 11/16/00 $4.28 2720000000(
--- -- Total — $57.78 — ----
This Permit is is:..ied subject to the regulations contained in the l igard Municipal Code. State of OR Speaalty Codes and all other applicable laws
All work will be done in accordance with approved plans This permit wil!expire if work is not starter within 180 days of issuance,or if work is
suspended for more than 180 days ATTENTION Oregon law requires you to follow rules a.loptc;; by the Orion Utility Notification Center. Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain topies:i these rules crdirect questions to GUNC at(503)
246-1987 /
I I
PERMITTEE'S SIGNATURE 'If tin'x
IS�VED B'(:
OWNER INSTALLATION ONLY _
The installation is being made on property I own which is not intended for sale. mase, or rent.
UWe;,l'S SIGNATURE: "
DATE:_..
CONTRACTOR INSTAL: AT'!UN ONLY
SIGNAI URE OF SUPR ELEC'N: _ _ _ DATE: —_—_
LICENSE N O: --
Call 6394175 ►)y 7:00pm for an inspection the next business day
Electrical Pcr>tnitApplication
�—- Dale received:11-141-00 Permit no.:�(.0 fj0�.BOG 3
City of 'Tigard Project/appl.no.: Expire date:
City ofligard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: Hy: Receiptno.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval'
1
iAA I &2 fainil'•dwelling_ nr accessory, lJ('ununercial/nulusitial U Multi-family U'i'enant improvement
U New construction gAdtation/aiteiition/rel, agement U(,cher:— U Partial
Joh address: "f' stir ,- �Wjj j Blog.no.: Suite no.: ITax map/tax lot/account no.:
IAW I Block: Subdivisio
Project name: Description and location of work on premises:
Estimated date of c ompletion/inspection: —�—�
1 1 1
Job no: Fee Max
Business nano, D scriltdon Qty. (ea.) Total nq.in%p
Address: - New residential-single or rmdtl-family per
dwelling unit.Includes al faclwd garaar.
City: I State: I ZIPService included:
Phone: I E-mail: 1000 sq.ft.or lc• 4
- Each additional 500 sq.ft.or portion dlereof
CCB no.: 61ec.bus.lie.no: Limited energy,residential
City/metro lic.no.; - Limi!edenergy,non-residential 2
_ Each manufactured home cr modular dwelling
Signature of supervising electrician(required) _ Date Service and/or feeder — 2
Sup.elect,name(print). License no: Services or feeders-Installation.
alteration or relocation: i
I /(n)amps or less I I
Name(print): j}Ci) !>, t Lir n,, 201 amps to 400 amps 2
Mailing address: .y U-1 i5r'Ri=(jam 401 amps to 100 amps 2
�� 601 amps to 1000 amps —2
—
CAT _t9 A I State:Off ZIP: c, Over 1000 amps Orr volts 2
Phone:••Z,3-y;j fax: I E-mail:kn,•;)7/!dr°&,p Reconoect onoy I
Owner installation:Ti,,;installation is being made on property I own W, Temporary services orfeWen-
which is not intended for sale,lease,rent,or exchange according to hutallatlon,alteration,orrelocation:
ORS 447,455,479,670.701. 200. aps or less _ 2
201 amps to 400 amps 2
Owner's si nature: / Date: 401 to 600 ams _ : _
kftM giant Branch circuits.new,alteration,
or extension per panel:
Name: A. Fee for I-ranch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: Slale: ZIP: — B. Fee for branch circuits without purchase
of service or feeder fee,first branch circuit: 2
Phone: =F It X E-mail:
Each additlonal branch circuit:PLAN 11111F.V11111 011eaiie check all that appli. ) _ 4
Mhc.(Service or feeder not included):
U Service over 223 amps-commercial U Health-care facility Each pump or irrigation circle _- 2
U Service over 320 amps-rating of 1&2 U Hazardous location Each sign or outline lighting 2
familydweilings U Buildingover 10,010 square feet four- Signal circuit(s)ter a limited energy panel
U System over r 00 v sits nomit,al more residential units in one structure alteration,or extension' 2
U Building rnerthree stories U Feeders !00strops ormom *Description:
U Occupant load ov,r 99 persons U Manufactured structures or RV park tach additional Inspection over the allowable in any of tit above:
U Egress/lightingplan U Other -� - [let Inspection _
Submit_._-sets ref plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
--� Permit fee........... $
Not all jurisdictions accept ctedir cues.please call jurisdiction for nx7infmnulion Notice:This permit application """"" -U Visa U MasterCard expires J a permit is not obtained Plan review(at __ %) $ 7hCredit card nunI61r within i8B days after it has beenState surcharge(8%)....$Nemo•of cardholder u ahosrn on credh cardaccepted as complete. TO'I AL ..J-Z.12....$
�"w4holder signature Amount 44(F4615(60"M)
x
Electrical Permit Fees: Limited Energy Fees:
-- — --------------
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESWENTIAL ONLY
/� Restricted Energy Fee.......................... ......................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total
Check Type of Work Involved.
Residential-per unit
1000 sq ft or less $145 1 y 4 Audio and Stereo Systems
Each additional 500 sq . or
portion thereof $3340 t � Burgiar Alai in
Limited Energy $7500
Each Manurd Home or Modular 1—I
Dwelling Service or Feeder $9090 7 LJ Garage Door Opener'
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 2 r—)
201 amps to 400 amps $10685 2 LJ Vacuum Systems'
401 amps to 600 amps $160.60 2 ❑
601 amps to 1000 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 Foe for each system......................... .............................. $75.00
200 amps or less $66.85 _ 1 (SEF:OAR 918-260-260)
201 amps to 400 amps _ $100 30
401 amps to 600 amps $133 75 7 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see"b"above. ❑ Audio and` ereo Systems
Branch Circuits
New,alteration or extension per panel Boiler Controls
a)The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $665 _ 2 Data Telecommunication installation
b)The fee for branch circuits
without purchaseofservice �1 Fire Alarm Installation
or teeder fee.
First branch circuit $4685 /c,
Each additional branch circuit _ $665 L] HVAC
Miscellaneous F I Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 Intercom and Paging Systems
Signal circult(s)or a limited energy
panel,alteration or extension $75.00 ❑ Landscape Irrigation Control'
Minor Labels(10) _ $12500
Medical
Each additional Inspection over
the allowable In any of the above r 1
Per in"rtion $6250 LJ Nurse Calls
f'er hour ---- $62.50 –
m $73 75 _ R__ n Outdoor Landscape Lighting'
Fees: L7 Protective Signaling
Enter total of above fees % $ � n Other
8%State Surcharge �� $ _ --- -
((( Number of Systems
25%Plan Review Fee
See"Plan Review section on l:o tic^is?s arq rerluR?d Licenses are required for all other installaticns
front of application '('� __
J (4.C- Fees:
Total Balance Due �� 7, s
Enter total of above fees $
❑ Trust Account#_ �f 814 State Surcharge $
�^ ^ Total Balance Due
i 4tsts\fomrs\cic-fees dcx 10'09'00
SE''?EH FEATHERS T&T PAGE 01 y
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CITY OF T!GARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Lina- 6394171 MST ---_---
0';% BLIP
Date Requested ' G_— k - AM O PM — BLD
Location--_ 1.�O S S,�J_ 1 Muite MEC —
Contact Person Ph PLM
Contractor _ Ph _ _ SWR
BUILDING Tenant/Owner — — ELC Z.4e- 'M,
Reta ning Wall
ELR
Footing Access: ---
Foundation FPS
Ftg Drain ----- -
Crawl Dain Inspection Notes: SGN
Slab
Post&Beam ----.,. _-------------- — SIT
Ext Sheath/Shear
Int Sheath/Shear - ------
Framing
Insulation
Drywall Nailing
-- - _-, --
Firewall
Fire Sprinkler
Fire Alarm -- - - -
Susp'd Ceiling
Roof -- --- --
Misc:
Final -- - --
PASS PART FAIL.
PLUMBING
Post&Beam - - --
Under S!ab -
Top Out -- - _
Water Service
Sanitary Sewer
- ---- — -
Rain Drains
Final ---- -
PASS PART FAIL
MECHANICAL.
--
Post& Beam ---
Rough In
Gas Line
Smoke Dampers
Final
T FAIL
ELECTRICAL -
Service
Rough In -
UG/Slab ?
Low Voltage - - — -- —
Fire Alarm
SS- PART FAIL
Backfill/Grading ----- --- --- ____
S,-nitary Sewer
Storm Drain [ ]Reinspection fee of$ re-aired before next inspection. ?ay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line f ]Please call for reinspcction RE:.--. — [ j Unable to inspect-no access
ADA
Approach/Sidewalk
Other Date ['' Inspector Ext
Final --
PASS PART FAIL j 00 NOT REMOVE this inspection record from the job site.
1
CITY �� T I���D — ELECTRICAL PERMIT
PERMIT#: ELC2001-00322
' DEVELOF,-IMENT SERVICES DATE ISSUED: 6/19/01
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARC"—::L: 2S103DA-01901
SITE ADDRESS: 10825 SW DERRY DELL CT
SUBDIVISION: DERRY DELL PLAT 2 ZONING: R-3.5
BLOCK: LOT : 019 JURISDICTION: TIG
Proiect Description: In:3tallation of 200 amp service and (2)branch circuit;. l
_RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ _ MISCELLANEOUS_ I
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L. 500SF: 201 - 400 amp: SI:,N/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/FDR: 601+amps - 1000 volts. MINOR LABEL (10):
SERVICE/FEEDER _ BRANCH CIRCUITS ADD'L INSPECTIONS__
0 200 amp: 1 W/SERVICE OR FEEDER: 2 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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 140MINAL
Reconnect only: SVC/FDR >= 225 AMPS: _ _ CLASS AREA/SPEC OCC:
Owner: Contractor:
SQUIRE ECONO ELECTRIC
10825 SW DERRY DELL. CT 5420 N MICHIGAN AVE
TIGARD, OR 97223 PORTLAND, OR 97217
Phone: Phone: 735-4705
Reg #: LIC 00067212
ELE 34-195C
SUP 2146S
FEES Required Inspections
T1,e ByDate Amount Receipt Rough-in
PRMT CTR C/;ar01 $93.60 2720010000( Elect'I Service
Elect'I Final
5PCT CTR 6/19/01 $'7.49 2720010000(
Total $101.09
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR Spedalty Codes and all other applicable laws.
All work will be done in accoroance 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 100 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center ,ose
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,.,,,5)
246.6599 or 1-800-332-2344
Permit Signature: Issued By: _lLd —Y1.ld .
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: 1 CTaJ� c 6 _ DATE:_
LICENSE NO: --
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit App 'c n
—�7'� Date received: p/ Permit no.: ij�jp/.. 2
City Of Z'1gA1'd ( tProject/appl.no.: Expire date:
City nfTj.ard Address: 13125 SW Hall Blvd,Tigard, AfZ13 Date issued: By: Receiptno.:
Phone: (503) 639-4171
Fax: (503)598-1960 Case file no.: Payment type:
Land use approval:
,dl &2 family dwelling or accessory U Commercial/in(lusu ial U Multi-family U Tenant improvement
U New construction U Addition/alteration/replacement U Oil er: U Partial
9
Joh address: ( SW 1j7V0271tCL (�, Bldg.no.: Suite no.: ITax niap/tax lot/account no.:
I_ot: Block: Subdivision:
Project name: Description and location of work on premises: 700 A _ N (141ECUm
Estimated date of completion/inspection:
APPLICATIONl
Job nn:_ Fee Max
Business name: -eO&O aE . etc_ Co 1k of Ion — (Ny. (ca) Total no.in,p
Address: FI( 1S N Ne"rrsldesuial-singk or mrdti-firm per
G N ' �_ dwcllinKmdt.lncludc•anachedgarago.
City: �CT�Q Stated ZIP: - / service included.
Phone: 5= Fax:? • y E-mail: I(00sq.ft.orless I
CCB no.: '?2 1 Elec.bus.tic.no:
3 C Fcch additional 500 sq.ft.or portion thereof
�/ Limiredenergy,residential 2
Cit /metro tic.no.: �� Limited energy,non-residential 2
Foci;manufactured home or modular dwelling
Signa�f supervising electrician(rr ui ed) pate Service and/or feeder 2
Sup.elect name(print): [� �I Ucenseno: Servlcesorfeeders-installation,
/
aheration or relocation:
2W amps or less 2
Name(print): 201 amps to 4W amps 2
-- 401 amps to 600 amps 2
Mailing address: 601 amps to IWO amps — 2
City: _ State: ZIP_ over 1000 amps or volts 2
Phone: _ Fax: E-mail: Rrconnect only -- I
Owner installation:The installation is being made on property I own Temlmrary services or feeders-
which is not intended for sale,lease,rent,or exchange according to Insialtatlon,alteration,orrelocation:
ORS 447,455,479,670,701. 2W amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 ams 2
Branch circuits-new,alteration,
or extension per panel:
Nanta - — A. Fee for branch circuits with purchase of
Address.__ service or feeder fee,each branch circuit Z 2
City: State: ZIP: R. Fee for branch circuits without purchase
Phone:
of service or feeder fee,first branch circuit _ _ 2
Fax: Email: Bach additional branch circuit:
=0 is my I Risirm LIM FM HIM Misc.(Service or feeder not Included):
PUcever 225 amps-commercial U Health-care facility Each pump or irrigation circle
U Service over 320 amps-rating of 1&2 U Hazardous location Each sign or outline lighting 2
familydwellings U Building over 10,000 square feet four or I Signal circuits)or a limited enrrgy panel.
U System over 600 volts nominal more residential units in one structure alteration,or extension* 2
U Building over three stories U Feeders,40(1 amps or more *Description:
U Occupant load over 99 persons U Manufactured structures or RV park Foch additional Inspection over the allowable In any of the above:
U Egmss/lightingplan U other. _ Perinspectiou
Submit- sets of plans with any of the above. Investigatic I fee _
The above are not applicable to temporary construction service. other —
Not all jurisdiction accept credit crdv,please call jurisdiction 6x mrar inhxmatk Notice:This permit application Permit fee........ ..��--��3• D
U Visa U MasterCard expires if a permit is not obtained Plan review tat _ %) $
Credit curd number within 180 days after it has been State surcharge(8%)....$ y q
,N cardholder wa shown nn credit cold
Expires accepted as complete. TOTAL ......... $ — � f 0/.07
amt
Uardhoider slimature Amami 1 410-4615 i~'Ohi)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee Schedule Below: -- — --_ —
/� Restricted Energy Fee...................................................... ;75.00
Number of Inspectione per permit allowed F
� ( OR ALL SYSTEMS)
vice incitided: Items Cast 'fotLI
Check Type of Work Involved
Residential-per unit
1000 sq It or less $145 15 4 El Audio and Stereo Systems'
Each additional 500 sq ft or
portion thereof _ $33.40 _ 1 Burglar Alarm
Limited Energy $7500
Each Manufd Home or Modular r
Dwelling Service or Feeder $9090 l-1
_ 2 Garage Door Opener'
Services or Feeders Heating, Ventilation and Air Conditioning Svstem'
Installation,alteration,or relocation
200 amps or less $80.30 6, _ 2 r�
201 amps to 400 amps 2 l Vacuum Systems'
401 amps to 600 amps __ $160.60 2
601 amps to 1000 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,alter?rion,or relocation Fee for each system.......................................................... $75.00
200 amps or less $66.85 2 (SEE OAR 918-260-266)
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 �I
New,alleratior,or extension per panel u Boller Controls
a)The fee for branch circuits
wffh purchase of service or ❑ Clock Systems
loader lee.
Each brands circuit $665 2 ❑ Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service ❑
or feeder fee. Fire Alarm Installation
First branch dreuit _ $46.85 _ ❑
Each additional branch circuit $665 HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑
Each sign or outline lighting $5340 Intercom and Paging Systems
Signal cirajit(s)or a limited energy r,
panel,alteration or extension $75.ou _ LJ Landscape Irrigation Ccnlrol'
Minor labels(10) _ $125.00 _
Each additional inspection over ❑ Medical
the allowable in any of the above ❑
Per inspection ___ $6250 Nurse Calls
Per hour $62,50
In Plant $73 75 ❑ Outdoor Landscape Lighting'
Fees: 4,15, ❑ Protective Slgnaiing
Enter total of above fees $ _ 0,�) ❑ ;ether_
e•6 State Surcharge $ __ /' 10
—.------Number of Systems
25%Plan Review Fee
See"Plan Review"section on $ No licenses are required. Licenses are required for all other installations
front of application - -
Fees:
Total Balance Due $ e
Euler total of above tees =� _
Trust Account q
-- 8•/.Stale Surcharge S
Total Balance Due $
i:WstsVrnmsklc-fees doc 06/07/01
tiectrical Permit Application rlanunerx#
13125 SW HALL BLVD. Recd By
TIGARD OR 97223 Date Recd
Date to P E.
Phone(503)639-4171. x304 - ^-
Date to DST
Inspection (503)639-4175 Prh It of Type Permit fi
Fax (503) 598-1960 Incomplete or illegible will not be accepted called- -
1. Job Address: 4. Complete Fee SL hedule Below:
Name of Development
Number rf Inspections per permit allowed
_ -
Name(or name of business'_ ig u i re _- LService included, Items Cost Sum
Addrnss 10825 SW Derry Dell ^t• ,.- 143. Residential-per unit
�rri __ 10 d or lass � � 117 7)
City/State/Zip T i gadditional
- - a
Eachad
h ditlonal 500 sy.h.or
portion thereof 5 26.:5 1
Commemini❑ Residential Limited Energy -- $ 60.00 -
Each Manufd Horne or Modular
2a. Contractor installation only: Dwelling Service or Feeder --, $ 72.75 _ 2
(Prior to permit Issuance,applicants must provide contractor license 4b.Services r or Feeders
Information for GOT data base). Installation,alteration.or relocation /
Electrical Contractor Econo Electric Co. inc. 200 amps or less _1_ S 64.25 6v2/2
Address 5424 N- Michigan Ave_ 201 amps to 400 amps _ S 8550 2
Ci Portland State ZJ 9 7 21 7 401 amps to 600 amps $ 128 50 2
ry �L- -- p 601 amps to 1000 a os S 192.50 2
Phone No. 5 d3_ 71; 47nR _ Over 1000 amps or volls _ S 36375
Job No. Reconnect only $ 53.50 2
Elec.Cont. lice. No.,14-1 9Sr- _Exp.Date 10-01 -61 4c.-famporary Services or Feeders
OR State CCH Reg. No. 67212 Exp.Date 7-1 I3-U.1 Installation,alrerallon,m relocation
COT Business Tax or Metro No. 2 7 Exp.Date /�-pe 200 amps or less $ 5..50 2
201 amps to 400 amps $ 80.25 ..
Signature of Supr Eledn t-: 401 amps to 600 amps _ $ 100.00 -
Over 600 amps to 11,00 volts.
License No. 21 4 7 S _Exp Cate 10/011002 see"b"abr.ve.
Phor'e No. 503 735 4705 -`- 4d.Branch Circuits
----- - ----- - Now,altAratlon or extension per panel i
a)The fee for branch r rcults
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name _ Each branch circuit _-� S 5.35 r(, ,L_ 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
Each additional brand,cuculf _ _ S 535 _
The installation is oeing made on property I own which Is not 4e.Miscollansous ^
Intended for sale, lease or rent (Service or feeder n'.t included)
Each pump or kr;:9!'^n circle $ 42.76
Owners Signature_-, _ _ Each sign or,uulline fighting -^ _ $ 42.76
Signal clrcull(s)or a limited energy
if re uired :* panel,alteration or extension $ 60.00
3. Plan Review section
Q � Minor labels(tO) 5 100.00
Please check appropriate item and enter fee in section 58 4f.Each additional Inspection over
_ 4 or more residential units in one structure the allowable in any of the at-,•-
s Service and feeder 226 amps or more Per inspection S 50.00
Per hour _ � $ 50.00 _
System over 600 volts nominal In Plant S 59.00
Classified area or structure containing special occupancy as
described in N E.0 Charter 5 5. Fees: `
Be.Enter total of above fees -
+ Subn4 2 eats of plans with application where any of the above apply. 8%Surcharge(08 X total fees) S
Not required for temporary construction services. Subtotal
NOTICE 5b.Enter 25%of fine 6a to,
Plan Review ff required(Sec 1)
PERMITS BECOME VOIU IF WORK OR CONSTRUCTION AUTHORIZED Subtotal S`
IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account P ( 1
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ iii r
i:ldsts%fomnsktnctric.duc
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24-Hou- .nspection Line: 639-4175 Business Line: 639-4171 --
. BUIL
Uate Requested z Z_-- _AM— PM _- BLD —
Location 'r ���' r✓7 Z1i!( Ci� Suite MEC —
Contact Person — — Ph %,j� 7G _ PLM
Contractor _ _ — Ph --_ — SWR —
BUILDING Tenant!OH nerELC
Retaining Wall - ELR
Footing Access: —
Foundation FPS
Ftg Drain
Craw! Drain Inspection Notes: SGN _—
Slab -— - ---- ------ --- ---- SIT
Post& Beam -
Ext Sheath/Shear
Int Sheath/Shear
Framing - -.._-.- --- -- --- - _- - --
Insulation
Drywall Nailing ------- -------- ------ -----
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling - ------- ---- --- -- --------
Roof �'� L
Misc - --- ���1- �- - - � -- - - - -_---.
Final -
PASS PART FAIL. ----- - --- - -- - --
PLUMBING
Post& Beam - - --
Under Slab
Top Out ------ -- -- - -- ---
Water Service
Sanitary Sewer - —
Rain Drains
Final - --------- -- - ----- -- -�
PASS PART FAIL - - -- - - ---- - - ---
MECHANICAL
Post& Beam --- --- - -------- - -- -
Rough In
Gas Line - - ------ --
Smoke Dampers
Final - ------ -- ----
PASS PART FAIL
Service — •' ---LI� `S — L .�-- e yr-p r " 1
Ro`ugfiT6 �( /�
UG/Slab Alt -
Low Voltage ��✓J
Fire Alarn, _
ASS ART FAIL
f
Backfill/Grading -------- - - ---- ----
Sanitary Sewer
Storm Drain ] ] Reinspection fee of$ - _ required before next inspection. Pay at City Ball, 1312!,SW Hall Bled
Catch Basin PIS ase call for reinspection RE
Fire Supply Line ] ] p ___-___-__-�� ___ j Unable to inspect- no access
i
ADA /
Approach/S.dewalk )�
Other
Final Date Ext
f - L� — Inspector�__ -- _
- -
PASS PART FAIL 00 NOT RE E40VE this inspection re=e 16 from the job site.
CITY OF T'IGARD ELE17TRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: EL-C96-0779
�"I-jnaft 13125 SW Hall Blvd, Tigard,OR 97223 t_73)6394171 DATE ISSUED: 121/11/96
PARCEL: 2S103DA01901
SITE ADDRESS. . . : 10825 SW DERRY DELL. CT
SURD I V I S I CIN. . . . : DERRY DELI- PLAT 2 ZON ING: R--i.. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 19
Project Description: Install five branch circi-tits
UNIT---- ---TEMP' SRVC/FEEDERS----- - ----MISCELLANEOUS-----
1000 SF OR LESS. . . . : 0 0 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADDIL 500SF. . . . 0 201 400 amp. . . . . . . : 0 SIG)N/OUT LINE LTG. . : 0
LIMITED ENERGY. . . . . : 0 401. 600 amp. . . . . . . : 0 SIGNAL/PANEL.. . . . . . . : 0
MANF. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : 0
.1,-----SERV ICE/FEEDER--.-- CIRCUITS- --ADDIL- INSPECTIONS— -
0
NSPECTIONS— -0 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
201 400 L-Amp. . . . . . : 0 1st W/O SRVC OR FDR. : I PER HOUR. . . . . . . . . . . : 0
401 600 amp. . . . . . : 0 EA ADDIL BRNCH CIRC: 4 IN PLANT. . . . . . . . . . . : V,
601 1000 amp. . . . . : 0 -------------...----PLAN REVIEW SECTION----------------
1000+ ampi'volt. . . . . : 0 >=4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR ) - 225 AMPS_ : CLASS AREA/SPEC OCC. :
Ownev-: ------------------------------------------------------ FEES --____--_------_.
DON 8 RI TA BABLIEN type amount by date recpt
10825 SW DERRY DELL CT PIRMT $ 55. 00 -'ri;T) .12/11/96 96-287560
5PCT 3 2. 75 JSD 12/11/96 96-287560
TIGARD OR 97223
Phone #: 503-639-4291
Contractors -----------------------------------------------------------------------------
OWNER $ 57. 75 TOTAL
REQUIRED INSPECTIONS
Ceili.ng COVF?t' Electl Final
gone #: Wall Coyer
og
This persit is iss--ed subject to the regulations coitained it the
-
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permit --Rlgnat ui^e
applicable laws. (111 work will be done in accordance with
approved plans. This persit will expire if work is not started
within 180 days of issuanc2, or if work is suspended for eore
than 189 days.
INSTALLATION
The installation is being made on property I own which is not intended for
sal.t-1, lease, or rent.
OWNER' S SIGNATURE: DATE-
____..-._._.__-_-.------____-._--CONTRACTOR INSTALLATIVN
SIGNATURE OF SUPR. ELECIN: DATE
[..ICENSE NO:
Call for inspvctiori
CITY OF TIGARD Electrical Permit Application Plan Check N
13125 SW HALL BLVD. Recd By_ I'L'(1Ci -
TIGARD OR 97223 Date Rec'd_ 1
Date to P.E.-
--Phone(:503)639-4171,x304 r> Dale to DST
rent or Type
lospection (503) 639-4175 Incomlplete or illegible will not be accepted Permit N rL-C --L-? -7 J
Fax(503) 684-7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Nanie Of Development _ _ _ �--- Number of Inspections per permit allowed
Name(or name of business)._,oK M. 13n G-L-.I i. NSi ervice included: items Cost Sum
Address L U &'A 15 `r-1 D c-:N&V .17r_' LL 4a. Residential-per unit
_ _ _
City/State/Zip 1-1 C Ll rt 1� _ 7;1 1000 sq.n.or less $110.00 4
Each additional 500 sq.ft.or -^
Commercial Residential ® Limitedportion thereof $25.00 1
Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00
2a. Contractor installation only: -- '
(Attach copy of all current licenses) 4b.Services or Feeders
Electrical Contractor Installaton,alteration,or relocaticn
----- -- - 200 amps or less __ $60.00 _
Address----- 201 amps to 400 amps _ $80.00
City _ State Zlp _ 401 amps to 600 amps $12000 __ 2
Phone No. 601 amps to 1000 amps $!80.00 2
Job No. Over 1000 amps or volts $340.00
Elec.Cont. Lice. No. Exp.Uate Reconnect only $50.00 -�
OR State CCB Reg. No. Exp.Date_ 4c.Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date ,_ Installation,alteration,or relocation
200 amps or loss $50.00 -
Signature of Supr. Elec'n 201 amps to 400 amps $7500
401 amps to 600 amps $100.00
Over 600 amps to 1000 volts,
License NO._ _-Exp.Date __ see^b"above.
Phone No._______
-- -- - 4d.Branch Circuits
2b. For owner installations: New,alteration or aiper panel
a)The lee for branch nch circuits with
purchase of service or
Print Owner's Name Dcry 6-A-D Al- .BI-/r'/✓ feeder fee.
Address /U e-�L s S LLI• J) /,g I., is (L Each branch circuit $5.00
City-[ Ax D State. 1 _ I y J 2 b)The fee for branch circuits
p - without purchase of
Phone No. 46:3 9 - k.2 y i service or feeder fee.
First branch circuit / $35.00 5• 0 U 2
The installation is being made on property I own which is riot Each additional branch circuit $5.00 2
Intended for sale,lease or rent. 4e.Miscellaneous
.� (Service or feeder not included)
Owner's Signature � Each pump or irrigation circle $4000 - 2
t- - Each sign or outline lighting $4000 - ?
3. Plan Review sectlon (if required):' Signal circuits)or a limited energy'
panel,alteration or extension $40.00 - 2
Please check appropriate Item and enter fee In section 5B. Minor Labels(10) $100.00
`-
___4 or more residential units in one structure 4f.Each additional Inspection over
Service and feeder 225 amps or more the allowable In any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C.Chapter 5 In Plant $55.00 _^
°Submit 2 sets of plans with application where any of the above apply. 5. Fees;:
Not required for temporary construction services. 5a.Enter total of above fees $
5°e Surcharge(.05 X total fees) $ 7
NOTICE Subtotal $ 7-'
5b. Enter 2511G of line Se for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review it r9guiro(Sec.3) $ --NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY El
TIME AFTER WORK IS COMMENCED. Trust Account
Total balance Due
ITISMELC96 APP Rev 9/98