Permit •
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00111
` ' ° COMMUNITY DEVELOPMENT DATE ISSUED: 3/16/2000
:El c A R D 13125 SW Hall Blvd Tigard, OR 97223 503.639.4171
ewe `' PARCEL: 1 S136DD -01200
SITE ADDRESS: 11600 SW 69TH AVE ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 002 JURISDICTION: TIG
Project Description: Installation of 1 service of 200 amps or less and 1 branch circuit. Job No. 8863
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: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 1 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+ ampNolt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
MATHEWS, SEAN A WILLAMETTE ELECTRIC INC
3855 SW LAKE GROVE #17 PO BOX 230547
LAKE OSWEGO, OR 97035 TIGARD, OR 97281
Phone: Contact #: PRI 503 - 624 -3631
FAX 503 - 624 -2938
FEES
Description Date Amount Reg #: ELE 34 -283C
[ELPRMT] ELC Permit 3/16/2000 $69.60 LIC 75059
[TAX] 8% State Tax 3/16/2000 $5.57 SUP 19655
Total $75.17 REQUIRED ITEMS AND REPORTS
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 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature:
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 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
,. CITY OF T I G A R D/� ELECTRICAL PERMIT
DEVELOPMENT SERVICES! PERMIT #: ELC2000 -00111
44 DATE ISSUED: 3/16/00
I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 6
,� PARCEL: 1 S 136DD -01200
SITE ADDRESS: 11600 SW 69TH AVE
SUBDIVISION: WEST PORTLAND HEIGHTS ` ZONING: MUE
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Installation of 1 service of 200 amps or Tess and 1 branch circuit. Job No. 8863
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 -1'000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 1 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: SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
MATHEWS, SEAN A WILLAMETTE ELECTRIC INC
3855 SW LAKE GROVE #17 PO BOX 230547
LAKE OSWEGO, OR 97035 TIGARD, OR 97281
Phone: Phone: 624 -3631
Reg #: LIC 000750
SUP 1965S
ELE 34 -283C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT DEB 3/16/00 $69.60 0000715 Elect'I Final
5PCT DEB 3/16/00 $5.57 0000715
Total $75.17
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`/1..j,4�OQ ISSUED CY: ; / -�� ( •
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: -4del DATE:
LICENSE NO: /965
CaII 639 -4175 by 7:OOpm for an inspection the next business day
CITY OF TIGARD Plan Che ----
13125 $AN HALL BLVD. RECEIVED Electrical Permit Application ��7 W,
Dat B
Date Recd 3- '00
TIbARD OR 97223
Date to P.E. �--'
Phone (503) 639 -4171, x304 MAR 1 6 2000 Date to DST
Inspection (503) 639 -4175 Print of Tv e UNITY Permit # GLC - ^yj ///
Fax (503) 598 -1960 Incomplete or illegibl will no b e accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) New Tc e. h S'a P7`'wor.t A Service included: Items Cost Sum
Address '// lr o0 Sii 6 7
4a. Residential - per unit
Q � C Z r i "� 1000 sq. ft: or less $ 117.75 4
City /State /Zip 'I . 5 IqX Y) `7 y j Each additional 500 sq. ft. or
J portion thereof $ 26.75 1
Commercial_ Residential ❑ 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 contracto •ir 4b. Services or Feeders
information for COT data base). (,`„ille0 Installation, alteration, or relocation ? j
Electrical Contractor ld, //a .N r 6'. r5 7`4, - w 200 amps or less ( $ 64.25 (0 Y - 2
Address h f v.c 3 3 (~ 201 amps to 400 amps $ 85.50 2
c� 401 amps to 600 amps $ 128.50 2
r. City .G a AD State (J/` Zip ! 7 Z4'/ 601 amps to 1000 amps $ 192.50 2
Phone No. G 2'. - 34,g' i Over 1000 amps or volts $ 363.75 2
Job No. g-X 6, 3 Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 3 9 • Zir3 L Exp.Date 10 / -d 0 4c. Temporary Services or Feeders .
OR State CCB Reg. No. 15 c i Exp.Date g - / Installation, alteration, or relocation
COT Business Tax or Metro No. / s G xp.Date 1' -( '60 200 amps or less $ 53.50 2
�/)) $ 80.25 2
Signature of Supr. Elec'n A0t-., 401 201 am amps ps to to 600 400 am amps p $ 100.00 2
g ,, Over 600 amps to 1000 volts,
• see "b" above.
License No. /96 S -S Exp.Date /0 ( /
y - 3 ( 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. 3 5
Print Owner's Name Each branch circuit A t $ 5.35 s -- 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: / p & C
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) $ S
..
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 # / '7-
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 7S
i:\dsts\forms\electric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 3 2D/00 AM PM BLD
Location 1 (9 0 d lA9 Suite MEC
Contact Person w 1 1 Ole_S_. Ph D2)--/-.0/ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC 20700 - 00/ l l
Retaining Wall ELR
Footing Access:
Foundation 4 Qa � FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing �'J•r
Firewatl
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
= re-Ar-
Rough In
UG /Slab
Low Voltage
Fire Alarm
PAS PART FAIL
�ti'fE
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 3 Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.