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14570 SW MCFARLAND BLVD-1 AAIB aINvidvAoW MS OLM IL J_ m W -o J C . ro u ro U 3 cn 0 N 14570 SW MCFARLAND BLVD /� CITY OF TIGARD rLEr.TRICnL r-,CRr1T"r DEVELOPMENT SERVICES PERMIT #: ELC97 -0950 13125 SW HaH Blvd.,Tigard,OR 97223 (503)6394171 DnTF TM)UEDs 11/06/97 PARCEL..-. 25110BA-02400 tit n,i i� r i-v r; ON ING; P 2 JUR15DICTION. TT- re", !irst alich circuit to an fRisti-,; single family MM, U-('tNE=' UN 00 s, nr, L_r-Gs. . . et f11 2,00 amp. . . . . . . : 0 pjlh /IRRIGATION. . . . : 0 ,-it rlj,Tj* ! 400 rEillip. . . . . . rjlGN/OIJT I.-INE i-ro. . o -17-11 r7N11'ROY. Z, 401, 600 amp. . . . . . , a Q SIGNAL./PANEL. . . . . . . : 0 (;:411 P'..., 10120 1 t 0 MINOR LABEL ( 10) . . . f 0, ...---SRnNC,H INSPECTIONSRV DE-/FETT" CP 0 PLR MG!",MT10N. ER HOUR. . . . . . . . . . . i 1 1; W/ o F3PVC MR rnp, I ODD' ORNM I CIRC: 0 IN PLANT. . . . . . . . . . . . CA REVIEW rjECt 4 RES UhITT!lj. . . . . . . . : ) GOO VOLT NOM,I NAL. . . . . . . AMM . 1X.PSG PRFA/SPEr M' . .. r-1-,En ' T'l '7 t jpc, a m n Wt 1; by ri at,vF,c-p 717, '714 M C'- rll�"T 3 1,5. 00 qE0 11/0C/97 97-.300'f n r T) P 3 1. 771 (3 E7 r) 1. 1/Or-,/97 97 -300747 715 TOTAL REOUTrIrl) TN3PE('TTnNS) R 0 U rj F1 Elect' I 'lti?i-vice T- rlevg rave Elect' I Fi T.Lt is .:;iiedu '.Ject, to the "ejulationi contained in the Tija d �ur:cipal Code, State of Drejon Specialty Codes and all othe k:-i, will be L-e in a:cvdance with app,oved plans. This permit will expire if work is not started within I" sve that 160 days. ATWIM: 0"jor taw requires you to folho the rules adopted L) ,spended fot I erIF . TI-ose ru',f' Vp wl ,,,tl it DAR E2-ffl1-e0t0 thrrugh [AF 952-0A1-,367. You may obtain a copy an S tr OX by ca 11,; '997. T-1 eLl U) J;7nI.1,J)TTON [INL.Y T c)wi wtiic,) i - w,31. intendeEl f(.ii- LU 'r, r T I rIN 0`11-y T)F)Tr . 1 1 4 44 4 +A--1 !'++ 4-f 4++ I f I f ' 4- + I 1 4 f 1,1 f t t"i CITY OF TIGARD Electrical Permit Application Plan Check M 13125 SW HALL BLVD. Rec'd By-_ _ TIGARD OR 97223 Date Rec'd Date to P.E. Phone(503)639-4171, x304 Print or Type Date to DST G Inspection (503) 639-4175 permit M Fax (503)684-7297 Incomplete or illegible will not be accepted called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development_ _ Number of Inspections per permit allov fed Name(or name of business)-pl- lit r4 �j1�- Service included: Iteme Cost Sum Address 14 570 S tti M f-lit i a _ 4a. Residential-per unit 1000 sq.It.or less $110.00 4 City/Slate/Zip ►� �? - Each additional 500 sq.ft.or Commercial❑ Residential portion thereof __ $2500 v_ 1 l_imitod Energy � $25.00 Each Manuf'd Home or Modular 2a. Contractor installation oriy: Dwelling Service or Feeder $68.00 p (Attach copy of all current 1lcenseai 4b.Services or Feeders Electrical Contractor Installs ion,alteration,or relocation -- 200 amps or less $60.00 2 Addres 201 amps to 400 amps _ $80.00 City_ -_, Statem+ Zip 401 amps to 600 amps � $120.00 z Phone No_ (301 amps to 1000 amps $160.00 ^_ 2 Job NO. Over 1000 amps or volts $340.00 2 W 2 Reconnect only $50. Elec. Cont. Lice.No. Exp.Date -- 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 less -_ $50.00 _ 2 Signature u)SU r. Elec'n_ 201 amps to 400 amps w $75.00 2 g p - -- 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License Exp.Date see"b"above. Phone N - 4d.Branch Circuits Now,alteration or extension per panel 2b. For owner installations: n)The fee for branch circuits with of service or Print Owner's Nal1?e� _ feeder fee,lee. Address 70 c W Ka Each L,ranrh circuit Cit ,Sttate Zip i y 1,)iire wit len for branch circuits 0. S7` ��4 p without out purchase of service or feeder lee. First branch circuit $35.00 ✓- 'The installation is being made on property I own which is riot Fach additional branch circuit` $5.00 intended for sale, lease or rent. 4e.Miscellaneous (Service or feeder not Included) Owner's Signature, Each pump or irrigation circle $40.00 _ Each sign or outline lighting $40.00 --- 2 a 3. Plan Review section (if required):* Signal circuits)or a limited energy panel,alteration or extension $40.00 2 Minor Labels(10) $100.00 - N Please check appropriate Item and enter fee in-Action 5B. _4 or more residential units in one structure 4f.E 3ch additional inspection over Service and feeder 225 amps or more the ullowable In any of the above _System over 600 volts nominal Per i,Nspection _- $35.00 - _ Classified area or structure containing special occupancy Per hu... _ $55.00 m as described in N.E.C.Chapter 5 In Plant $55.00 uj *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%Surcharge(.05 X total fees) $ -y NOTICE Subtotal $ 5b.Enter 25%of line 5a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if reauir (Sec.3) $ -NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION Orl WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED, Trust Account M. /(� Total balance Due 1f ,nsts1err%,APP nov ainn Permit#: Address: Issued b _` Date: s4 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, URS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement befoh e a building permit can be issued. This statement is required for residential buildih.tg, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2,and either box 3A or 3B: ,a 1. I own, reside in, or will reside in the completed structure. ig2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. F-1 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contre ctors Board. OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. 0 I hereby certify that the above information is correct and that I have rend and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. rV • -- ------ — (Signature of permit applicant) (Date (White copy to issuing agency permit file, pink copy to applicant) Information Notice to Property Owners About Construction Responsibilities Mot-. Thr.k lnl,,rr,r, won Nom c i( Pioperr.t, Owners (daunt Construction Responsibilities wh.c dcrcloped bt•rhe Constrnrti„n Contractors Board in accordance with ORS 70/.055(5). II \o nr are ak inu&,your utvn contractor to construct a new home or make a substantial improverrtent to an existing structure, �-uu carr i,rcvent man; prohlems by being aware of the (`allowing responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If toll lilt(' pr� cr,nnt I, tiRTi,,tered with the Construction Contractors Board to do labor in con."tnteting or assisting in the. Cow,truchon fir impro%cl-wilt of a re"idrntial onicture, you will, in most instances,he ruled to be an employer and the people y or.r hire will he rmployee,,. Ai,the employer, you must comply with the following: t►r•rg!on'c%t ithholding tax laee: A,v an rntpl iye:r,you must withhold income taxes from employee wages at the lime employees ,IW Imid Y.,11 ;e ill the liahl- (of the tax payments even if Vol]don't actually withhold the tax from your employees. For more inf„rnwho ti. call th,• ()ret:on Held. of Revenue at 945-8091. l oemployment insurance tax: 1- rn •n,,,k,yer, you are rednired to pay a tax for unemployment insurance purposes on the �tia�r�of toll t mplr,y e�. I4,r more infcn - ;ttir n.call the Oregon Employment Division at the Department of Human Resources at 378_1524 11'orker4'corupentiatlion i�tutrance: A (!,11110y you etre subject to the Oregon Workers'Compensation Lata, and most ut,t,rin �t otKrrs' ompcns:mon m,urr,r,u• fui if you fail to obtain workers'compensation insurance,you may F„ ,rrhlc•ct t, h;nalci,.t;md tt ill he ha'tlr•h't all' I,tirn cwsts if rine ol'youremployees is injured on the joh. For more information, call ihr DI i,urrt at the Department of Consumer and Business Services at 945-7888. t'.4. Internal 11(vi cnue Sere ice: A—i au rntployer,y(,'tt rnuA tt ithhold federal income tax front employees'wages. Ynu will be liahlc for II)c tit% l,ay r,rtInr ,•\t•n if \('11 didn't actually withhold the tax. For more. information,call the Internal Revenue Service M 1-8(K) 829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance; 1w ihr prrn,ir holder for Iln,,project,you are respon,,IHe for resolving any failure to meet code requirements that m,ry be hroughl to you attention through inspections. a I iahilit;and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for tY nc,:udcnt; Ind omissions .uch as falling tools,paint overgpray, water damage from pipe punctures, fire,or work that must he r n re-clone. Time to supervise employees: Make: sure you have sufficient time to supervise your employees. tO LU Expertise: Make sure you have the expertise to act as your own general contractor,to coordinate the work of rough-in and finish �r trades• rand to notify building officials at the appropriate times so they can perform the required inspections. If you have additional question%, write or call the Construction Contractors Board(PO Box 14140,Salem,OR 97309-5052, 5(1,1/378-462 1), The Board is located at 700 Summer St. NE Suite 30), in Salem. prup-own.pm4 1194 I I I � I 8 L 01 � ' P , , V ' 4 v— a 00 E W O � p G�II �U! , w � ca -00 oa� .� ... ..... cx "ACL w MUM cn 0.0 CL CL 0 , , , W ?� V N Q CC Li J p C; LL C N O co Q ` CL U LL Q (n ' U mLZ �- M y � J Q r F-• 4 p 1{a. ___A 133HIS Q U LL -� m-_ -- a .. STREET I ' , , Oa V , 0* , M , O ' , V N m z ISO � ' , CL a o ' O ' a , U ' , cr a M m ' < cn" ; I'll ' U ; L =W'p AN ' , CL a ' Q , c;a m V 4\. y 0' , O © ai > � ; aD N N ; CL M r- m , , m ' , m , W ; a; V I 't1 � O ; O ' —1 Notes on the installation of a natural gas compressor Owner: Robert R. Hale 14570 SW McFarland Tigard, Oregon 97224 Installa location: same Gas compai.X contact: Smokey Stover Northwest Natural Gas 721-2454 Compressor type: Fuelmaker FMQ-2 Installat.i.on work summary: A concrete slab adjacent to the garage will mount the comp.rec!jor. A 240 volt 20 amp circuit to power the compressor will be fed from an electrical shutoff switch mounted on the garage wall more than 5 feet from the compressor and visible from it. A natural gas pipe will be run above ground from the gas meter to the compressor inlet, and will incorporate a shutoff valve near the meter and visible from the compressor, more than 5 feet from the compressor. 4 a W J e CITY OF TIGARD BUILDING INSPECTION DIVISION 2441our Inspection Line: 6394175 Business Phone: 6394171 Date Requested: --��� _ M. / P.M. MST: /_ _ Location: ! J 70 � J BUP: _ Tenant: _ _ Suite: ` —Bldg NFC: Contractor: Q Phone: Owncr _ —Phone: ELC: ELR: SLIT: _ BUILDING BLDG(con't) PLUMBING MECHANICAL Q�.I.�,�„ r_ SITE Site Post/Beam Post/Beam Post/Beam Coverr-mince Sewer/Storm Footing Roof UndFl/Slab Rough-In Ceiling Water Line Slab Framing Top out Oas Line Rough-In UG Sprinkler Foundation Insulation Sewer Hood/Duct Reconnect Vault Bsmt Damp Drywall Storm Furnace Temp Service MISC. Masonry Ceiling Rain Thain A/C UG Slab Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Heat Pump opt Approved Approved Approved Approved Approved LAppr/-S,d%%,Ik Not Approved Not Approved Not Approved vol Not Approved FINAL FINAL FINAL. FINAL FINAL __.Che 4 G os z Lam__ - ,. Cil Y — M - 6 P7 _�i'�t� C1 Call for reinspection 0 Reinspection fee of S required before next inspection O Unable to inspect Inspector Date: �� Page of (HERMIT CITY OF TIGARD DnTCII0SUED: . 10/033/96 03c7 COMMUNITY DEVELOPMENT DEPA►RTMENI 13125 SW Hall Blvd.Tigard.Oregon 97223x0199 (503)539-4171 PARCEL- 2-31 1 0BnA 121"400 BLVD !21AWOW I IILLS ZONING: P- LOT. . . . . . . . . . . . . :40 I`LOC3R F'URN, 0 FVAF'�COOLERS:�Oj______w...__ _ `- . !-'=!'. . , . ;rF UNIT HEATERS. . : 0 VENT FANS. . . : 0 1.1,.71ANCI'' f.:-f'c' :r- VCNTS W/O APDL- 0 VENT SYSTEMS: 0 1, .0• • . • . , ' POILERS/COMPRESSORS HOLD?r. . . . . . . : 0 0. 2, HP. . . . : 1 POMC^. INCIN; rr 3-15 HP. . . . : 0 COMML. INCIN: 0 Yr' T- 0 DTU 15-30 HP. . . . : 0 REPnIR UNITS: 0 L'f lr1!_1FF?''^. , 30--50 HFA. . . . : 0 WOODSTOVES. . t 0 50+ HP. . . . 17� CLQ DRYERS. . : 0 n I R HANDLING UNITS OTHER UNITS. r 1 141000 c:f m : 0 GAg OUTLETS. : 1 Addition of a yas furnace, comp. , other-, and gas piping. FEES -V 110i r type amount by date rec.-Pt "._ 51•1 MCF-AMLAND 1'}I.JCI PRMT o 28. 50 JDA 10/03/96 96--2847 '_ PCT 7; 1. 43 ,JDA 10/03/70, '3C, a:1i, � c.� F rI i»_L U/. _ . ... _. "•'W E Til f1';E n_Nn OR i, !� 1 . ? '7. 9u TnTAL --_.._-.._._. REQUIRED INSPE"CTIONc _ F issued subject t. t''e eq.lations :ortained in the Ga i-, Line Insp - -:Fa: Code, Ctate cf 0,e. v3pecialty Cedes and all other Methanical. InSp All work will be done it accordarce Kith _ Mi �c. Inspect an This pent rill enpire if work is not starte-1 r-i nal Inspection ^_r if wort is -.spended for /Ore 6., m W f , :- spect i on 6:39--4175 _J City of Tigard MECHANICAL PERMIT Planck/Rec. # 13125 SO Hall Blvd APPLICATION Permit # 01K- 9&03x7 Tigard, OR 97223 (503) 639-4171 • Description�� ', P _ Table 3A Mechanical Code _ OTY PRICE AMT Job M,k 1) Permit Fee �— -0- 0- 1000 Address - •• 2) Supplemental Permit 300 urnace o 100,000 BTU I)V c • 1) incl, ducts 8 vents l 6.00 i +•*a •• •^• Furnace 100,000 BTU Owner 2) incl ducts h vents 7.50 • Floor Furnance ') incl vent 600 •m• •m•. •-••• SuspendedHeater, wall heater— — •'• �• — 4) or floor mounted heater _ 600 • 9Vent not inr,, in Occupant 5) appliance permit 3.00 .,.... oRepair of heating, re ng. 61 cooling, absorption unit 6.00 Boiler or comp, heat pump, air con . 7) to 3 HP; absorp unit to 100K BTU 6.00 • Boiler or comp, heat pump, air con _ �• 6) 3-15 HP, ebsorp unit to 500K BTU 1100 Contractor �� __ T5",-7r comp, heat pump, air con . 9) HP; absorp unit .5-1 mil BTU 1500 • of er or comp,Meat pump, air con � k QA �• 10) 30-50 HP; absorp unit 1-1 75 mil BTU 22.50 here ac now edge that l lave read this app ica io , that the Boiler or comp, heat pump, air con . information given is correct, that I am the owner or authorized 11) > 50 HP; absorp unit 1.75 mil BTU 37.50 agent of the owner, that plans submitted are in compliance with it an ing .jnit to State laws, that I am registered with the Construction Contractor's 12) 10,000 CFM 4.50 Board, that the number given is correct. (If exempt from State Air an ,ng uni reg strNion, please give reason below.) 13) 10,000 CTM + 7.50 portable - -- 14) evaporate cooler 4.50 Vent fan connecte — 15) to a single duct 3.00 Ventilation system not 11 L o) included in appliance permit 450 o�. M11 Z.W —oo served by — i-) mechanical exhaust 450 escnoe worK new ition alteration l repair Commercial or industrial to be done residential non-residential O 18) type incinerator 3000 Existing use of Other ie., woo s ove. water budding or property _ 19) heater, solar, clothes dryers. etc. 4.50 Pr000sed use of 20) Gas piping one to four outlets 2.00 building or property 21) Mcre than 4-ber outlet (each) 200 Type of fuel -oil Q natural gas PG Q electric () -- Minimum Fee 525.00 SUBTOTAL a. •SU PERMITS BECOME VOID IF WORK OR CONSTRUCTION — AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 5% SURCHARGE ty3 IF CONSTRUCTION OR WORK IS SUSPENDED OR -�—� ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 250% OF SUBTOTAL AFTER WCRK IS COMMENCED TOTAL Special Conditions Date issued �^by Lca,Mos*sdaec HPGIT 1m'e 14 M dgo,-99 - Home Layout 0 ................................................. .............. ...................................................... ............................. ............................. ......................................... ..... ............ ............................................I. ...... ......................... * .. .............I........... .... ........................................................ ........................... ......... ............. ....... .............. ......... ................................ ....... .................... ... ...........- . ................................................................................ .......... -.-......... ...................... ...... ....... ........................................................................... ....... ........ .... ............. ............................. .. ................*............ .................... ..................—............................ ...... ....... ....... ............. ............../........... .... ..................................................................... ................... ....... ................. ...................... ...... ............................ A ... .............................................................................................. ........................ ......................... .... ........ ............. 0 ... ...... ............................. ..... ........... .......... ......... ..... ....... .... ....*........ ..... ..... ...... . .................. ....... ----.. .................................. .........-.1....... .. .... ..... ................. .............................. .... ...................... ....... ...... .........11........................-............ . . .... ..................... ............... ............ ........................ ..................1.11......... ...... ...... ....................................... .................. ................................................ ...................................... ..................................... .. . .... ... ........................... ............... ........... .......... .......... ...... ...... .... ....... ............................ .......... ....... CF � ........ .\............................. . ............................. .... .. ......I............................ —A........................ ....... ...... ...... ............. ....................... .........T............. .. ....I.-.................................................. ............................. ...............A-=.................... ......... ........................I... ......... ....... ................................................... ........... ............................--...............................-.... ...... ...... ................. ... .............................. ....... ................ ....................................I................................................................. ........ ...................... ....... .................................... .................................................. ......................................................... ............................. ................................................................................................................................. ...................I......................... L.......J .......J Windows Windows —Door t— Wa Ils Roof Floors pERMIT #: F_L - 575 CITY OF TIGARD DATE ISSUED: 09/04/96 COM LAITY DEV PARCEL: 2S 1 1OBA-02400 fP E(VT PAA T I T[312-' 'n Blvd.no�►d, , 7,fl a ' ( d b l LCL V G SUBDI V 151ON. . , . ,H DOW HILL.; ZONING:R-2 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :40 Project Description : Installation of 2 branch circuits without purchase of servr re or feeders. a /l ---RE IDEIVIIAI_-UIVI1'------__---TEMP SRVC/FEEDERS-,--- -----MISCELLANEOUS----- -- 1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 EACH ADD' L 5O05F. . . : 0 2,01 400 amp. . . . . . . : 0 SIGN/OUTLINE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0 M(ANF. HM/ SVC/FDR. . : 0 601 +Amps--1OOO volts. : 0 MINOR LABEL ( 10) . . . : 0 ------SERVICE/FEEDCR----- ----BRANCH CIRCUITS----- ---ADD' L INSPECTIONS--- 0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0 201 - 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0 401 - 600 amp. . . . . . : 0 EA ADD' l_ HRNCH CIRC: 1 I N PI__AN1 . . . . . . . . . . . : 0 601 _ 1000 amp. . . . . : 0 -------------------PLAN REVIEW SECTION----------------- 1000+ amp/Volt. . . . . : 0 ) =4 RE, UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . : Reconnect only. . . . . : (A SVC/FDR )= 225 AMPS. . : CLASS AREA/SPE: OCC. : Owner,: -__---------------_---_----------------------------•--- FEES ------------------ BOB HALE type -%mount by date recpt 14570 SW MCFARI_AND BLVD PRMT $ 40. 00 D*A 09/04/96 9628.3560 SPC' $ 2. 00 D*A 09/04/96 96283560 TIGARD OR 97224 Phone #: Contractor: --------------_-------_--------------------------------- TUALATIN LLECTRIC f 42. 00 TOTAL PU DOX 655 ------- REQUIRED INSPECTIONS ---- WIL.L-;ONVILLE OR 97010 Phnne #: 503-682-2955 Req #. . : 65650 This permit is issued subject to the regulations contained in the 4 ` Tigard Municipal Code, State of Ore. Specialty Codes and all other / r1mi ee Signati.%re applicable laws. All 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 a. than 180 days. (—Issued By -- OWNF R INSTALLATION ONLY------ -------------------------- NThe installation-is�being made on property I own which is not intended for sale, lease, or rent. OWNER' S S I vNATURI:::: DATE: - -----COhITRC1C7[?R INSTALLATION ONLY----------_ w -� SIGNATURE OF SUF'R. ELECT' N: QQ_ 1 � -� DATE: LICENSE NO: Call for inspection - 639-4175 Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. '/� Tigard, OR 97223 Permit #� Of 25 Date Issued Phone (503) 639-4171 FAX (503) 684-7297 CITY OF TIOARD TDD No. (503) 684-2772 Inspection (503) 639-4175 1. Job Address: 4. Complete Fee Schedule Below: Name of Development � �11�L.� Number of Inspections per permit allowed AddreSs��_ ��t_1_� , mG r ��1 1^» service included Items Cost(ea) Sum Y� t vT ��O Residential -per unit City/State/Zip 10 `- 1000 sq. fl or lase $110.0(1 4 ' O Each additional 500 sq ft or Name (or name of business) portion thereof $2500 _.—. :25,00 1 Residential I/J Limned Energy — — Commercial �. � / Each Manurd Horne or Module' Dwelling Service or Feeder $6800 2a. Contractor installation only: 4b. Services or Feeders ��-+�-"`' installation, or 105bn.or reloretion 2 Electrical Contractor 200 amps or ba2 $60 00 $so 00 2 A.- 201 amps to 400 amps 2 Address 401 amps to 800 amps $17000 City ► State =iP� 601 amps l0 1000 amps steo 00 2 X340 00 2 Phone No. C over 11000 amps or volls 350 00 2 ,lob NO. Reconnect only contractor's license O. 4c. Temporary Services or Feeders Contractor's Board Reg. o. Instpileflon,alteration,or relocation 2 Signature of Supr. Elec'n 2txi amps or lose 2 201 ar-,1e to 400 arnps $5000 2 License No.��0 tie No. 401 amps to 600 amps s75.00 — over 800 amps to 1000 volts $100.00 ace 2b. For owner installations: above 4d. Branch Circuits Print Owner's Name New,alteration or extension per pane Address a)The fee for branch circuits with 2 Purchase of service or feeder Fee. City State ZIP -- Each branch circult $500 Phone No. b)The fee for branch circuits without 2 . The installation is being made on property I own which is purchase of service or leader fee 2First branch ci cull $35.00 _ not intended for sale, lease or rent. Each addlthnal branch circuit 3500 _ Owner's Signature _ 4e. Miscellaneous 2 (Service or feeder not Included) 2 Each pumo or Irrigation circle 34000 _. 3. Plan Review section (if required): Each sign or outline lighting —� 340 Or � 2 Signal chcult(s)or a limited energy Itl Please check appropriate Item and enter fee In section 5B Miner Labels tion o or extension $ 340000 4 or more residential units in one structure f- Service and feeder 225 amps or more 4f.Each additional Inspection over U) System over 600 volts nominal - the allowable In any of the above- —��- Classified area or structure containing special occupancy per Inspection $35.00 J as described in N.E.C. Chapter 5 Per hour :55.00 In Plant _ $5500 _ m Submit 2 sets of plans with application where any of the above apply. Not required for temporary construction services. 5. Fees: W 5a. Enter total of above fees $ NOTICE 5%Surc (05 X total fees) $ Subtots, PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 25%of Tina A for AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Plan Review If required (Sec.3) $ CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal S A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS r, Trust Account COMMENCED. wmToomeene4- r #t S nm.rM Balance Due $ I ^ CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639-4175 Business Phone: 639-4171 Footing Rain Drain Cover/Service _1� FINAL: ,a Foundaiion Water Line Ceiling Plum: Post/Beam Mech. Shear/Sheath Framing -Mech. Plbg.Und/Flr/Slab Plbg. Top Out Insulation -Elect. Post/Beam Struct_ <�:�—Rucigh-ice-_, GYP. Bd. 9 San. SewerL rlsas-j4po_-- Appr/Sdwlk Reins. Other: . Date: ! Ci A.M. _-- Address: lt� Tenant _- _ _ Ste:-_-- MST: _--- -- MF Con/Own: C: —�1 -- —. _ PLM: — ELC: THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: a I - - oc 0 Inspector _ --_ Date: �s LU – –t � ED DISAPPROVED/CALL FOR REINSP. CF CO