Permit CITY OF TIGARD ELECTRICAL PERMIT
y� „N, DEVELOPMENT SERVICES ELECTRICAL
PERMIT #: E
! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/08 /97
PARCEL: 2S112DC -01500
SITE ADDRESS...:15615 SW 74TH AVE #BLD
SUBDIVISION :FANNO CREEK ACRE TRACTS ZONING:I —P
BLOCK LOT °004 JURISDICTION: TIG
Project Description:
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp ° 0 PUMP /IRRIGATION : 0
EACH ADD'L 500SF...: 0 201 — 400 amp 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY - 0 401 — 600 amp 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp - 5 W /SERVICE OR FEEDER: 50 PER INSPECTION - 0
201 — 400 amp ° 0 1st W/0 SRVC OR FDR.: 0 PER HOUR....• ...... : 0
401 — 600 amp - 0 EA ADD'L BRNCH CIRC: 0 IN PLANT : 0
601 — 1000 amp 0 PLAN REVIEW SECTION
1000+ amp /volt - 0 ) =4 RES UNITS ) 600 VOLT NOMINAL..:
Reconnect only ° 0 SVC /FDR 1= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
JIM CASTILE type amount by date recpt
8100 SW DURHAM ROAD PRMT $ 550.00 JSD 10/08/97 97- 299880
TIGARD OR 97224 SPCT $ 27.50 JSD 10/08/97 97- 299880
Phone #:
Contractor:
DICKINSONS ELECTRIC $ 577.50 TOTAL
8449 SW BARBUR BLVD
REQUIRED INSPECTIONS
PORTLAND OR 97217 Ceiling Cover Elect'l Service
Phone #: 246 -3550 Wall Cover Elect'l Final
Reg #..: 000006
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 thules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952- 001 - 1987.- - 7 Ymu may obtain a copy
of these rules or direct questions to OUNC by calling (503)24 1987.
o- Grp \ A I e H . � �'.
Permittee Szgnat_ire t F Issued y•
r
OWNER INSTALLATION ONLY
The installation is being made on property I on 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 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
.1
CJTY OF TIGARD Electrical Permit Application Plan Check # �7 7
13125 SW HALL BLVD. Rec'd By Y ,' Z `-
TIGARD OR 97223 Date Rec'd 0 -61 ' f f
Date to P.E.
Phone (503) 639 -4171, x304 Print or Type Date to DST
Inspection (503) 639 -4175 Permit# LCg - 10�� C�
Fax (503) 684 7297 Incomplete or illegible will not be accepted Called /T �L-
1. Job Address: 4/ `� d Fee Schedule Below:
Name of Development / % `� .�t�2 " R /CompIete
--- Number of Inspections per permit allowed '
Name (or name of business) �/ /ate Service included: Items Cost Sum
Address > 5� S�.J "L �" (� 1 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip Each additional 500 sq. ft. or
Commercial • Residential ❑ portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current censes) 4b. Services or Feeders
r ,' 4
Electrical Contracto C-2 S T' G /� /�D fti Installation, alteration, or relocation a�
Address 7 «4 S-:,J /,�r�.r l,, 200 „L_ 201 1 amps less $80.00 2
amps t to o 400 amps $80.00 2
City k. State 012 Zip df '7 2 / • 401 amps to 600 amps $120.00 2
Phone No. 2, C/ -' ��s"'O 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. a6/_ G Exp.Date /C)7. - -,/ -q-
OR State CCB Reg. No. )� ? '/.3 � Exp.Date / i j
!% 4c . Temporary Services or Feeders
COT Business Tax or Metro No. r !S. 4. p. Pate Installation, alteration, or relocation
i 200 amps or less $50.00 2
Si Signature of Sur. Elec' _ „ t 201 am to 400 amps $5.00 2
9 P 401 amps to 600 amps $100.00 2
'I Over 600 amps to 1000 volts,
License No.,. S /Exp.Date see "b" above.
Phone No. :_rf S' 3 Syc 4d. Branch Circuits
New, alteration or extension per panel
2b. For ow installations: a) The fee for branch circuits with
j purchase of service or Cad
Print Owner's Name feeder fee. �/
Address Each branch circuit $5.00 O 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is bei made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting 840.00 2
3. Plan Review section (if required): * Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: A d a/
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ ✓ 7;.
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # S 7 t r -
Total balance Due 7
I: \DSTS \ELC96.APP Rev 9/96
•
CITY OF TIGARID BUILDING INSPECTION DIVISION
24 -Hour Inspection. Line: 639 -4175 Business Phone: 639 -4171
I
Date Requested: c.I.A., pa,r1 , o� l / <I A.M. P.M. MST:
Location: /5 // �/5" S-6( J � 7-/-791....,_ BUP:
Tenant: /J&JDas devil_ PK- Suite: Bldg: MEC:
Contractor: o) /(Z'ML2 ar7 PY12 Ct Phone: 5/.5=3 5
PLM:
Owner: sje477 . ( 44 9 - rL k, Phone: ELC: 9 7 0660
� / . � l l .i",..0 ` tI . i r_ / 4 &La •.� // , f ELR:
J , .'L`. ,/ _ r.. I 4.
// I Y / Wt /_ SIT:
BUILDING BLDG (con't) PLUMBING MECHANIC • ' ' SITE
Site Post/Beam *Post/Beam Post/Beam Cover ervice Sewer /Storm
Footing Roof UndFUSlab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinlder
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL INAL) FINAL
4 / A/7s OA- /YEZ S C L OUI ,E /A/ . /'i AA/ . /r /Nk a R
/3ox S L 7i /NG . O ?/) - 1)47 v /CES /I-A c SEC vAilt=
tl /y /1-- - P/9-. s S
, 1/, - Co ill, /e_ /-e — PQ S'S - J6
0 Call for reinspection 0 Reinspection fee of $ required before next inspection 0 Unable to inspect
Inspector: 6 176 Date: / — Z 3 9 / Page of
_ . Y OF TIGARD
PERMIT #:
' " BUILDING DIVISION DATE ISSUED:
13125 SW Hall Blvd., Tigard, OR 97223
Phone: (503) 639 -4171 /i %rr: iµ
Inspection Requests (24 Hrs.): (503) 639 -4175 ,. '_� ' --� -
INSPECTION WORKSHEET FOR DATE: TIME: Ant—) PAGE:
SITE ADDRESS: 15(p15 . 'LO / 2 -1 1-31 irigD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
LO i rel ess 'i ftsi 1
OWNER: r -�.P yk d i V �• I YLdt S PHONE #: 563 �O 0 CONTRACTOR: �1' " PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR REINSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0442-'4 Date: 7-0 - Phone #: (503) 718 -
i :\Buil di ng\IVR\IVR- InspWorksheet- BlankForm.doc 03/02/2005