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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2001 -00047 "Ai DEVELOPMENT SERVICES DATE ISSUED: 1/23/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: ISI25DA -06800 SITE ADDRESS: 09585 SW 69TH AVE SUBDIVISION: KINGS VIEW ZONING: R -4.5 BLOCK: LOT : 054 JURISDICTION: TIG Project Description: Installation of service and 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 HMI SVCI FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 2 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 NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: MICHELLE HAACK PORTLAND STATE ELECTRIC 9585 SW 69TH PO BOX 230933 TIGARD, OR 97223 TIGARD, OR 97281 Phone: Phone: 233 -8030 Reg #: LIC 96644 SUP 4125s ELE 26 -854C FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT CTR 1/23/01 $173.90 2720010000( Elect'l Final 5PCT CTR 1/23/01 $13.91 2720010000( Total $187.81 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 OUNC at (503) 246 -1987. PERMITTEE'S SIGNATURE ISSUED BY: 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: DATE: LICENSE NO: Call 639 -4175 by 7:OOpm for an inspection the next business day A Electrical Permit Application t Date received: /,23 / , Permit no.: ,9_,C /00/ — DOOM 4 ,Vi City of Tigard . Project/appl.no.: Expire date: City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: Byb ff'Receiptno.: 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 0 Commercial/industrial 0 Multi- family 0 Tenant improvement 0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial JOB SITE INFORMATION Job address: q ,19S ,5 ,W. (pt ) ^ Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: (Subdivision: _ Project name: I Description and location of work on premises: J », • / , - .t , Estimated date of completion/inspection: _ _ 1 ' CONTRACTOR APPLICATION FEE SCI II DULE Job no: Fee Max Business name: � j , �, a „„b . a Description Qty. (ea.) Total , no. insp New residential - single or multi - family per Address: P , n , et) - 4 .,, a30 9 3.3 dwelling mtit . Includes attached garage. City: I State:OL I ZIP: C3 1 Z8 / Serriceincluded: Phone:2, 33 0 I Fax: Z33 -43 E -mail: _ 1000 sq. ft. or less 4 CCB no.: q !n In 1 ' I Elec. bus. lic. no: 2/ 654G _ Each additional 500 sq. ft. or portion thereof Limited energy, residential 2 City /metro lic. no.: Limited energy, non - residential 2 SEE g77 eH-E7 ) j .O .Si6A1i / - 20 -0/ Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2 Sup. elect. name (print): >l� i 402.2> i * t+ f r License no: 25 Services or feeders— installation, alteration or relocation: 30 (D ) PROPERTY OWNER 200 amps or less 2..rST.'?«' 2 Name (print): / /efyG Lc,C /49-,}`c, 201 amps to 400 amps 2 address: 401 amps to 600 amps 2 Mailing 7s-s S uJ 6 9 4," 601 amps to 1000 amps 2 City: 7-764 /L0- I State: I ZIP: 97,„2 2 3 Over 1000 amps or volts • 2 Phone: I Fax: (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, al tl n,orrelocatioa: 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 65' 3 Address: service or feeder fee, each branch circuit 1p . 13. 2 City: I State: I ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 2 Phone: Fax: E -mail: Each additional branch circuit: 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 320 amps -rating of 1 &2 0 Hazardous location Each sign or outline lighting 2 family dwellings 0 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 O Building over three stories ❑ Feeders, 400 amps or more *Description: 0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable to any of the above: 0 Egress/Iightingplan ❑ Other Per inspection 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 $ 73 . Cl Visa ❑ MasterCard expires if a permit is not obtained' Plan review (at _ %) $ Credit card number. / / _ within 180 days after it has been State surcharge (8 %) .... $ /3 , 9 / Expires TOTAL as complete. TOTAL $ �'? • / Name of cardholder as shown on credit card Cardholder signature Amount 440-4615 (6/00✓COM) Electrical Permit Fees: Limited Energy Fees: •s, Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY p Restricted Energy Fee. $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total y 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 ❑ + 201 amps to 400 amps $106.85 2 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 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 ❑ 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 ofservlce ❑ Fire Alarm Installation or feeder fee. - First branch circuit $46.85 Each additional branch circuit $6.65 ❑ HVAC • Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 ❑ 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 $ ❑ 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 CITY OF TIGARD Electrical Permit Application Plan Check # 13125 S_W HALL BLVD. Rec'd By i TtGARD OR 97223 Date Recd Date to P.E. Phone (503) 639 -4171, x304 Date to DST Inspection (503) 639 -4175 Print of Type Permit # Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called 1; Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections per permit allowed Name (or name of business) M I C - 4Et_L.,E 14A'cr-• Service included: Items Cost Sum 4' Address q511. S . 1N • • 4a. Residential - per unit City/State/Zip i2.. 17 2 73 1000 sq. ft.' or less $ 117.75 4 ty P / ) QT . J Each additional 500 sq. ft. or portion thereof $ 26.75 1 Commercial ❑ Residential Er Limited Energy $ 60.00 Each Manufd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2 (Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders information for COT da ase). Installation, alteration, or relocation 66 Electrical C nttrac • ` I r T EL . • nee. Co Z o C. 200 amps or less $ 64.25 /,Z 8. 2 Add, r. 0 r ► • k x )g3 201 amps to 400 amps $ 85.50 2 401 amps to 600 amps $ 128.50 2 City / l GA-Pb State Zip _e'7_5_1_ 601 amps to 1000 amps $ 192.50 2 Phone No. Z 5 - 0 Over 1000 amps or volts $ 363.75 2 Job No. Reconnect only $ 53.50 2 Elec. Cont. Lice. No. ;11,0 -.C-'Exp.Date /d - / - / 4c. Temporary Services or Feeders OR State CCB Reg. No. Exp.Date 2-8-o I Installation, alteration, or relocation COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2 201 amps to 400 amps $ 80.25 2 Signature of Supr. Elec'n ri. 401 amps to 600 amps $ 100.00 2 �- - Exp.Date Over 600 amps to 1000 volts, 4/ .Z S see "b" above. License No. p.Date ' /�� � - - .)7-0.5 4d. Branch Circuits Phone No. New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or feeder fee. Print Owner's Name Each branch circuit 2J $ 5.35 10.70 2 Address b) The fee for branch circuits without purchase of service City State Zip or feeder fee. Phone No. First branch circuit $ 37.50 Each additional branch circuit $ 5.35 The installation is being made on property I own which is not 4e. Miscellaneous intended for sale, lease or rent. (Service or feeder not included) Each pump or irrigation circle $ 42.75 Owner's Signature Each sign or outline lighting $ 42.75 Signal circuit(s) or a limited energy if required):* panL alteration or extension $ 60.00 3. Plan Review section ( Minor Labels (10) $ 100.00 Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over 4 or more residential units in one structure the allowable in any of the above Per inspection $ 50.00 Service and feeder 225 amps or more Per hour $ 50.00 System over 600 volts nominal In Plant $ 59.00 Classified area or structure containing special occupancy as described in N.E.C. Chapter 5 5. Fees: 20 • 5a. Enter total of above fees $ * Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ / 1 ---.-7-1 Not required for temporary construction services. Subtotal $ 5b. Enter 25% of line 5a for _ NOTICE Plan Review if required (Sec. 3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ ...--- IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # ZZ11 AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ /50.34 is \dsts \forms \electric.doc CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested Z 7 AM PM BLD Location VI s w G f 6t 4"-( Suite MEC Contact Perso / Ph Z3) - y0 3 U PLM Contractor P r+ C 11, � rT14-r _ f (,ee . Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear -S �—r✓l � C_ c 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 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 ervi ough In UG /Slab Low Voltage Fi ASS P T. FAIL Backfill /Grading Sanitary Sewer Storm Drain [ 1 Reinspection fee of $ required before n- o -ction. Pa at City Hall, 13125 SW Hall Blvd Catch Basin [ ] Please call for reinspection RE: ] Unable to inspect - no access Fire Supply Line ADA �) Approach /Sidewalk Date 7 7 D/ Inspector `I� A Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.