Permit .,� , CtITY OF TIGARD ELECTRICAL PERMIT
... PERMIT #: ELC2000 -00626
DEVELO PMEN Tigard, SO R 2 (503) 639 -4171 CES DATE ISSUED: 11/7/00
13125 SW Hall
PARCEL: 1S135DC-02500
SITE ADDRESS: 11775 SW 91ST AVE
SUBDIVISION: ZONING: R -7
BLOCK: LOT : JURISDICTION: TIG
Project Description: New service and one outlet.
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: 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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JOHNSTON, MARIE WILLAMETTE ELECTRIC INC
11775 SW 91ST PO BOX 230547
TIGARD, OR 97223 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 CTR 11/7/00 $86.95 2720000000( Elect'I Final
5PCT CTR 11/7/00 $6.96 2720000000(
Total $93.91
This Permit is issued subject to the regulations-contained in the Tigard Municipal Code, State of OR. Spedalty 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 7:00pm for an inspection the next business day
•
A E le c trical Permit Application
R EC E I V E D Date received: Permit no.:6(,6, cd( •
tel::.I .. � C lty of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tig ,\pR y22.000 Date issued: 1 p1} B ; eft t/ Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 COMMUNITY DEVELOPMENT Case file no.: Pa type:
Land use approval: . - •
TYPE OF PERMIT •
01 & 2 family dwelling or accessory O Commercial/industrial ❑ Multi - family ❑ Tenant improvement
O New construction O Addition/alteration /replacement ❑ Other: O Partial
- JOB SITE INFORMATION -. .. • - -.
Job address: / / 7 7 S S' J 9 / ST - Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision: •
Project name: A Ave To(-w.ctc rti/ I Description and location of work on premises: N,,,J g c, ft 0vT(„r r
Estimated date of completion/inspection: / / - 3 U - a v •
- - ------CONTRACTOR APPLICATION 'F " � 7 — - — 5L•Y FEE "SC)IIEDUL'E'' J•"""""
Job no: 9 . Fee Max •
5--4..4 /m„.,__ Description Qty. (ea.) Total no. insp
Business name:
W t 11 h .nn r ti C r c.T t c New residential - single or multi- family per
Address: Pd get, 230 S - 7— dwelling unit. Includes attached garage.
City: -7-,5 w A h I State.,` ZIP: ep. K / . Service included:
1000 sq. ft. or less • 4
Phone( fir, b2N .3631 Fax: GZtt 2
Each additional 500 sq. ft. or portion thereof
CCB no.: .5 ) I Elec. bus. lic. no: 3 y - 2 Fs-3 C—
Limited energy, residential 2
City /me lic. no.: 5 �J Limited energy, non - residential 2
�� 4° 3 - 00 Each manufactured home or modular dwelling
Signature of supervisinctrician (required) Date Service and/or feeder 2
Sup. elect. name (print): 0 rt- Ai (, Y e__ License no: /9 6 S—S Services or feeders — installation,
alteration or relocation: gL ,t= -() 2
PROPERTY OWNER • - 200 amps or less /
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: • 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I 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 llation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: - 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 / 6 ( ' s 6 -r 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 -care facility Each pump or irrigation circle 2
O 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 allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection. I 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 $ g‘ �%
❑ 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 %) $
Expires TOTAL $ q 3 i (r
accepted as complete.
Name of cardholder as shown on credit card
. $
Cardholder signature Amount 440 -4615 (6/00 /COM)
Electrical Permit Fees: Limited Energy Fees:
• TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems '
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manuf'd 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 I I Vacuum Systems
201 amps to 400 amps $106.85 2
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
•
200 amps or less $66.85 2 Fee for each system $75.00
201 amps to 400 amps $100.30 2 (SEE OAR 918 - 260 -260)
. 401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above.
ri Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n Boiler Controls
a) The fee for branch circuits
with purchase of service or
feeder fee. n - Clock Systems
Each branch circuit $6.65 2
b) The fee for branch circuits n Data Telecommunication Installation
without purchase of service .
or feeder fee. n Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous
(Service or feeder not included) n Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy
•
panel, alteration or extension $75.00
Minor Labels (10) $125.00 n . Landscape Irrigation Control
Each additional inspection over n Medical
the allowable in any of the above •
Per inspection $62.50 n Nurse Calls
Per hour $62.50
In Plant $73.75 - •
ri 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 $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ Fees:
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 BUILDING INSPECTION DIVISION At
24- Fid6elnspection Line: 639 -4175 Business Line: 639 -4171 MST
BU9'
Date_ Requested // /) AM PM BLD
Location / ) 77) 5 w 9 /3 f 4O-' Suite MEC
Contact Person
/ . / Ph Z 7 - 3 �/ PLM
Contractor 'Vv + ((, -c� �-� . Ph SWR
BUILDING Tenant/Owner ELC -d a 2
Retaining Wall ELR
Footing Access:
Foundation / FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation �� d
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
t £ ECTRICA
ough In
UG /Slab,
Low Voltage
Fire Alarm
Final
PART FAIL
•
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 f
Date Inspector ZidIr — ■ - Ext ■ • Other P
Final
PASS PART FAIL • • DO NOT REMOVE this inspection record from the job site.