Permit •
• CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00443
l DEVELOPMENT SERVICES DATE ISSUED: 9/4/01
,.� I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 101 AD -02400
SITE ADDRESS: 12753 SW 68TH AVE. 200
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT : 032 JURISDICTION: TIG
Protect Description: Installation of (2) branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER 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:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor: 0 W &I2)
GEORGE FOX UNIVERSITY
414 N. MERIDIAN
NEWBERG„ OR 97137
Phone: 503 -554 -2082 Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 9/4/01 $53.49 2720010000( Wall Cover
Elect'I Final
5PCT CTR 9/4/01 $4.28 2720010000(
Total $57.77
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 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 -0080. You may obtain copies of these rules or direct questions to
Permit Signature: 7\ M �Z / �� ? " Issued By: c a_e ,
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: t77 c2 MI -t- p15...vl" DATE:
LICENSE NO:
73
Call 639 -4175 by 7:OOpm for an inspection the next business day
Electrical Permit Application
Date received: Permit no.: _ _� ,,p
.
6. «t.� > :a n i , City of T
•
�, Tigard Project/appl.no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
•
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory /Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
•
Job address: I ) - 7 5 (-r/ ( f Bldg. no.: Suite no. A0 Tax map /tax lot/account no.:
Lot: (Block: (Subdivision: n l •
Project name: (r._0o r0A Porgy /a 0 Description and location of work on premises: Moot , P i t• q / 'a 4 Cirr u � �S
Estimated date of completion/inspection: 1-44. � , , C9'/-5
CONTRACTOR APPLICATION FIE SCI IEDILG
Job no: n ov 9 / Fee Max
Business name: 6- ..0,7 ..0,7 v > Fox L1 h / ✓-o re,/ 7 P r Description Qty. (ea.) Total no. insp
New residential - single or mull- family per
Address: dwelling milt. Includes attached garage.
City: 1 1 t! of bd1 I State: OR I ZIP: , , . Serviceincluded:
Phone: 9 I Fax: I E -mail: 1000 sq. ft. or less 4
CCB no.: 'Elec. bus. lic. no: 3 6 - 7 S Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
?2,ro lic. n0.: Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature o supervising electrician ui ) Date Service and/or feeder 2
i Services or feeders – installation,
Sup. elect. name (print);/��/� �O�P�/'T— �dela¢ icense no: alteration or relocation:
PROPERTY OIVNER 200 amps or less 2
Name (print): y4-. n RDA Uh 1 ✓-PA'S , 201 ampsto400amps 2
401 amps to 600 amps 2
Mailing address: Li / t-1 ll/ M9 v ,d,, , 601 amps to 1000 amps 2
City: AA-P b I State:O k I ZIP: 4' 7 / � , Over 1000 amps or volts 2
Phone: S 5 y 7 O c).._ 'Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: 'ZIP: B. Fee for branch circuits without purchase I (.4
of service or feeder fee, first branch circuit: 0 4 / 2
Phone: Fax: E -mail: Each additional branch circuit: I L. b ✓
PLAN REVIEW (Please check all that apply) - Misc. (Service or feeder not included):
O Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
O Service over 320amps-rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other Per inspection i i 1
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. _ Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ J //
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number / / within 180 days after it has been State surcharge (8 %) .... $ .y
Expires accepted as complete. TOTAL $ .5 7. 7 7
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 (6/00/COM)
I A
Electrical Permit Fees: Limited Energy 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 `, 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 Home or Modular El Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 [El Vacuum Systems
201 amps to 400 amps $106.85 2
' 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 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 0 Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service f r ❑ Fire Alarm Installation
or feeder fee.
First branch circuit 1 $46.85 C/ t;--
1- 1 6 • d ❑ HVAC
Each additional branch circuit 1 $6.65 G, , ( L
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 El Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ 3.5-o ❑ Other
8% State Surcharge $ 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 $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
•
Total Balance Due $
i: \dsts \forms \elc- fees.doc 10/09/00
•
v oft
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24,Hour Line: 639-4175 Business Line: 639 -4171
BUP
i Date Requested 5 AM PM BLD
Location / 1 . 3 54, C tc ,‘t., Suite ZA ]7 MEC
Contact Person Ph . -J3sy PLM
Contractor Ph SWR
BUILDING Tenant/Owner , See U (Gi / ELC 2e.p/-106' V y 3
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation L
Drywall Nailing MS �? Q VO !� U - e / YZ b 1 ! / ✓t5
Firewall /� /� -
Fire Sprinkler Y" /'! D /l Y/ l> 144 CIS Y / s
Fire Alarm A / � r � S J
' Susp'd Ceiling �V 40
Roof
Misc:
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
ELECTRI
Service
Rough In
UG /Slab
�I ow ysItagr
Fire Alarm
Final
PASS PART FAIL .� AN. • .
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date — ( � 1 Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.