11200 SW 79TH AVENUE 11d'-,t')O SW 79th AVENUE
CITY CSF TIGARD ELECTRICAL P'FRMIT
\ DEVELOPMENT SERVICES PERMIT #: EL.C97-0800
DATE: I SSL IED: 12/05/97
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171
F,ARCEL_: 1 S136CA-03900
SITE ADDRESS. . . ° 1 1:Z-100 SW 791H NVI:.
SUBDIVISION. . . . -.FRIENDL._Y ACRES 70NING: R-4. 5
BLOCK. . . . . . . . . . : LOT. . . . . . . .. . . . .. . :009 JUR1c:n1CTIUN: TIG
Project Description : Installation of one (1) branch circuit to existing SFD.
---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS----- -----MISCELLANEOU9-----
1000 SF OR LE'SS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADD' L 5O09F. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT I._INE _TG. . : 0'
LIMITED ENEPGY. . . . . : 0 401 -- 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
MANE. HM/ S 'C/FDR. . : 0 601+amps-1000 volts. : 0 MINOR LASEi_ (10) . . . : 0
--SERVICE/FEEDER---- -----BRANCH CIRCUITS------ ---•-ADD' L INSPECTIONS----
0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
2201 - 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0
401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
601 - 1000 amp. . . . . : 0 -------------------PLAN REVIEW
1000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR ) = 225 AMPS. . : CLASS AREA/SPEC OCC. :
Owner: ----_______....... _...- ---__._.----------___.___ _.___-_______.__-- FEES
EVERETT ROLES type amount by date recpt
11200 SW 79TH PRMT $ 35. 00 TJH 12/O4/97 97-301454
TIGARD OR 97223 SPCT $ 1. 75 TJH 12/04/97 97-301454
Phone #:
Contractor: ------_-_.--- _----------------.--------_--_---------_-_______----_-
JPr ELECTRICAL SERVICES INC $ 36. 75 TOTAL
4120 SE INTERNATIONAL WY
STE A-107 ----•--- REQUIRED INSPECTIONS -� -
MILWAUNIE OR 97222' Roi.rgh-in Elect' 1 Final
Phone #: 654--3325 Elect' 1 Service
Reg #. . s 093774
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is net started within IAP
days of issuance, or if work is suspended for more than 188 days. ATTENTION: Oregon law requires you tc follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAP 952-AN1-001C. through OAR 9521-MI-1987. You may obtain a copy
of these rules or direct Questions to TW by rallinq (503)246-1987.
,i nat i-ire • - J ss1.ied b
Permittee y �.. >^.a. ..Lk1ac�i/�._ y = - -�
-------- OWNER INSTALLATION
The installation is being made on property I own which is not intended for
sale, lease, or rent.
OWNER' S SIGNATURE: _ DATE: __...
INSTALLPTION ONLY -- -- --------- ---------- --
s T GNATIIRE (IF sllPR. FL rf' N: Q� _G� ['� 112-x. _______— T)ATE s /1 117
........_.. _
LICENSE NO: �(�' S _--- —
4+++++++•t+++•++4•++++++++++++++•+41+++++++++++++++++++++++++++++ F+++++++++++++++++
Call 639-4175 Ly 7:00 p. m. for an inspection needed the next business day I
++++++++++-+••h+++'1-+++++++++•+++++++++++++++++++++++++++++++++++++++++-1-++++++++++++ I
06
�e»r.
CITY OF TIGARD Electrical Permit Application Plan Check ft
13125 SW HALL BLVD. Recd By -T N
( 4 '
TIGARD OR 97223 Date RecdDate to P.E -I J
iA
Phone (503)539-4171, x304 Date to DSI---
Inspection (503) 639-4175 'print or Type ,
Incomple-k'e or illegible will not be accepted Permit".�� �
Fax (503)6`.34-7297 Called YY�;L.t r' !_
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development_ Number of Inspections per nermlt allowed --
Name(or name.of business) 1") -es Service included: Items Cost Sum
Address 1 1,-CG "5c'u 1 Cl 4a. Residential-per unit
City/State/Zip TG G("Ct 1000 sq.ft.or less $110.00
I Each additional 500 sq.ft.or _
Commercial ❑ r^,Qsidential portion thereof $25.00
LArnitod Energy _-_ $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $6800
2a. Contractor installation only: - - -
(Attach copy of all cu en licenses) 4b.Services or Feeders
Electrical Contractor • I �C' �YIC f- �t_�')C Installation,alteration,or relocation
Address',11a0 .QC- II1 iCr rt�rla 1 200 amps or less $80.00 2
1 -- 201 amps to 400 amps $80.00
City ,Iw0.�,J-GA j State 0 Zip 3 401 amps to 500 amps $120.00
Phone No. 601 amps to 1000 amps $110.00
Job N0. Over 1000 ar ps or volts $340.00
Elec.Cont. Lice. No. TZ7 Exp.DateReconnect only $50.00 -v�- -- '
OR State CCR Rec. No. `-r 1U Exp.Date _____ 4c.Tempc;ary Services or Feeders
COT Businr;-s T• )r Metro No.S 1(;v _Exp.Date V_ Installation,alteration,or relocation
200 amps or less $50.00
Signature of Supr. Elec'n 201 amps to 400 amps $75.00
401 amps to 600 amps $100.00
Over 600 amps to 1000 volts,
License No _ ��l C J Exp Date me"b"above.
Phone No.-
-- - - 4d.Drench Circuits
Now,alteration or extension per panel
2b. For owner installations: a)The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee
AddrvL,s Each branch circuit $5,00
b)The foo for branch circuits
city_, State - Zip __. without purchase of
Phone N0.- service or feeder fee.
First branch circuit �_ $35.00 2
The installation is being made on property I own which is not Each additional branch circuit_ $5.00
intended for sale, lease or rent. 4e.fA)svicellaneous
(Service or feedui not Included)
Owner's Signature _ Each pump or irrigation circle $40.00
Each sign or outline lighting - $40.00 2
3. Plan review section (it required):' Signal circutt(s)or a limited energy
panel,alteration or extension $40.00 2
--
Please check appropriate Item and enter fec in section 5131. Minor Labels(10) $100.00
4 or more residential units In one structure 4f.Each additional Inspectlnn 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 orcupa ry Per hour $55.00
as rf4grribed 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. 0.Enter total of above fees $ .--
a%Surcharge(.05 x total fees) $
rNO7JyE Subtotal $ ---
5b.Enter 25%of line Be for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review It really(Sec.3) $
NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRU,:TION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ElTrust Account a .)5
Total balance Due
I 0srs�et.c9n APP nw W" -
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Phone: 639-4171
Date Requested: _,— [ 1 -7 — 7 A.M. P.M• MST:
Location: L /T2G .f� _ BUP:_
Tenant: Suite: Bldg: — NEC: _—
Contractor: Phone: PLM:
Owner:
Phone: ELC:!-L-JZ62c,
ELR:_—_ _
_ SIT:
BUILDING BLDG(con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Z:80W Sewer/Storm
Footing Roof UndFI/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Line Rough-In UG Sprinkler
Foundation Insulation Sewer liood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Beat Pump Low Volt
Approved Approved Approved v Approved
Appr/Sdwlk Not Approved Not Approved Not Approved ved Not Approved
FINAL, FINAL FINAL FINAL
O Call I'or reinspectionReit.spoction fee of S —required before next in tion 0 Unable io iiv pect
O&
/
Date. l0__-t P°g° or —
lnspector —`__� ----- F---�—