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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC1999 -00724 1" DEVELOPMENT SERVICES DATE ISSUED: 12/03/1999 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S 101 AA -02301 SITE ADDRESS: 12170 SW 69TH AVE SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT : 019 JURISDICTION: TIG Project Description: Electrical alteration 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: 1 W /SERVICE OR FEEDER: 10 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: SNYDER, ELLA OPDAL AND FRAHLER ELECTRIC CO JOHN MILTON 11860 SW GREENBURG RD 12170 SW 69TH AVE TIGARD, OR 97223 TIGARD, OR 97223 Phone: Phone: 639 -4627 Reg #: LIC 00037410 SUP 1816S ELE 34 -13C FEES Required Inspections Type By Date Amount Receipt Elect'l Service PRMT BON 12/03/199£ $117.75 99- 320163 Elect'l Final 5PCT BON 12/03/199E $9.42 99- 320163 Total $127.17 ORIGI 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 N otification 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 a y\ f ry ISSUED BY: 8, , 'L � 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: BV t (0 DATE: LICENSE NO: Call 639 -4175 by 7:OOpm for an inspection the next business day CITY OF TIGARD Plan Check # .x31 SW HALL BLVD. Electrical Permit Application Rec'd By MI AGARD OR 97223 Date Rec'd 1 a - 3 = 1 " 1 Date to P.E. Phone (503) 639 -4171, x304 Date to DST Inspection (503) 639 -4175 Print of Type Permit# f l-Crtgg -0 O'3 4 . Fax (503) 598 - 1960 • Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: • Name of Development 69th STREET I11PROVEMENTS Number of Inspections per permit allowed Name (or name of business) J. SNYDER Service included: Items Cost Sum 4 Address 12170 SW 69th 4a. Residential - per unit City/State/Zip TIGARD, OR 97224 • loon sq. ft. or less $ 117.75 4 ry p Each additional 500 sq. ft. or portion thereof $ 26.25 1 Commercial ® Residential ❑ Limited Energy $ 60.00 Each Manuf'd 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 data base). Installation, alteration, or relocation Electrical Contractor FRNHLER ELECTRIC COMPANY 200 amps or less 1 $ 64.25 $64.25 2 Address 11860 SW GREENBURG ROAD 201 amps to 400 amps $ 85.50 2 401 amps to 600 amps $ 128.50 2 City TIGARD State OR Zip 97223 601 amps to 1000 amps $ 192.50 2 Phone No. (503) 639 -4627 Over 1000 amps or volts $ 363.75 2 Job No. 59678 Reconnect only $ 53.50 2 Elec. Cont. Lice. No. 34 -13C Exp.Date 10/01 /00 4c. Temporary Services or Feeders OR State CCB Reg. No. 37410 Exp.Date 07/02/01 Installation, alteration, or relocation COT Business Tax or Metro No. 1987 Exp.Date 12/01 /00 200 amps or less $ 53.50 2 �� 1 aeGQi�` 1�t.y� 401 amps to 400 amps $ 80.25 2 Signature of Supr. Elec'n 401 amps to 600 amps $ 107.00 2 Over 600 amps to 1000 volts, License No. 1816S Exp.Date 10 /01 /01 see "b " above. Phone No. (503) 639 -4627 4d. Branch Circuits 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 10 $ 5.35 $5l SO 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 r 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 3. Plan Review section (if required):* panel, a alteration or extension $ 60.00 Minor Labels (10) $ 107.00 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 Service and feeder 225 amps or more Per inspection $ 50.00 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: 5a. Enter total of above fees $117 * Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.l1$X total fees) $ 9.42 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 # AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $127.17 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 /0)-1 I D-c)' 19 c ) AM PM BLD Location / -i - 70 (pR Suite MEC Contact Person Vviidi- 0461---ph Co PLM Contractor Ph SWR 1 C/ BUILDING Tenant/Owner ELC / °/ Retaining Wall ELR Footing Access: , 1 Foundation FPS i Ftg Drain SGN MAW Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear 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 r l Yl 1 - / cj S Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fir arm SS PART FAIL tin Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay 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 / ? f � ` Ins _ __ 4 / A � � Ext Other ` — - Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.