Permit • CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00051
11 DEVELOPMENT SERVICES DATE ISSUED: 1/24/01
A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S112BD 00700
SITE ADDRESS: 14655 SW 76TH AVE 002
SUBDIVISION: MARCIENE II ZONING: R -12
BLOCK: LOT : JURISDICTION: TIG
Proiect Description: This permit is for 1J/2 hours inspection time to inspect electrical wiring for new vent fans that were
installed in 'units 2_through 7.�
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/0 SRVC OR FDR: PER HOUR: 1
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:
BOOTH - HEYDON LLC ELECTRO WIRE INC
PO BOX 1185 18857 SE SUNNYSIDE RD
LAKE OSWEGO, OR 97035 BORING, OR 97009 -9271
Phone: Phone: 658 -8136
Reg #: ELE 26 -667C
LIC 67879
SUP 2717S
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 1/24/01 $93.75 2720010000( Elect'I Final
5PCT CTR 1/24/01 $7.50 2720010000(
Total $101.25
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 o these_r_ules or direct questions to OUNC at (503)
246 -1987. /
PERMITTEE'S SIGNATURE __ I // ISSUE BY: /��%
OWNER STALLATION 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: 1 44_ L DATE:
LICENSE NO: 7/7_5
Call 639 -4175 by 7:OOpm for an inspection the next business day
e
Electrical Permit Application
Datereceived: -,1.44.-o/ Permitno.: 0 ,4-0006 !
,rW City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: 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 ❑ CommerciaUindustrial U J
Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
'' JOB SITE INFORMATION '
Job address: P. 5 kJ 7 • - Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
• ' ^f' ' - '- CONTRACTOR APPLICATION -' ` ' '' ' •:: - ' - ° FEE SCHEDULE
Job no: Fee Max
Description Qty. (ea.) Total no. insp
Business name:
/ ` /// ., - New residential - single or multi- family per
Address: /•C`0% 7 7 5 f _Srn nn ,./47,6k.- / dwelling unit. Includes attached garage.
City: City:/3,,,, I Statol j ZIP: 5 Service included:
Phone: ,1; ; Fax: I E-mail: 1000 sq. ft. or less _ 4
Each additional 500 sq. ft. or portion thereof
CCB no.: , 74 I Elec. bus. lic. no: ,., - , 7 •
Limited energy, residential 2
Cit /metro lic. no.: Limited energy, non- residential 2
• g_ea "t'o'Y ,:jif ZZ % 0, Each manufactured home or modular dwelling
Signature of supervising electrician (required) / Date Service and/or feeder 2
Sup. elect. name (print): 1 j 4. — L - .50 A.I License no:27 7$ Services orfeeders — installation,
alteration or relocation:
,r, 4 PROPERTY OWNER / 2
• 20 0 amps or less
Name (print): `,6 ,j9--� / 201 amps to 400 amps 2
_� j 401 amps to 600 amps 2
Mailing address: 7j �Q r 1 /� 601 amps to 1000 amps 2
City: ‘-�L�n , • State :a/ 7IP:97 2-4' 1 Over 1000 amps or volts _ 2 .
i Phone' /3 7i - f i • x: ,-,-,/ 'E-mail: Reconnect only 1
Owner installation: The installation is beini made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, , 70, 70 . 200 amps or less 2
1 201 amps to 400 amps 2
/
Owner's signatur. / ,e �✓ 41 Date: 401 to 600 amps 2
- • ENGINEER . , 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: 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):
❑ Service over 225 amps- commercial ❑ Health - carefacility Each pump or irrigation circle • 2
❑ Service over 320 amps- rating of 1&2 ❑ 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,
❑ 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:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the all wable in any of the above:
❑ Egress/Iightingplan ❑ Other: Per inspection I/ rle ( 1 0,1 1 1 i
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 $
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at — %) $ i
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 7• 56_ --
Expires accepted as complete. TOTAL $ =/f_D-i 25_
• Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6 /00 /COM)
Electrical Permit Fees: Limited Energy Fees: ' '
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� 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 n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular n Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n 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 n
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. n Audio and Stereo Systems
Branch Circuits n Boiler Controls
New, alteration or extension per panel •
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 n
Each additional branch circuit $6.65 HVAC
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over n M edical
the allowable in any of the above
Per inspection $62.50 n Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting*
Fees: n Protective Signaling •
Enter total of above fees $ n 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