Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00232
i. ��; DEVELOPMENT SERVICES DATE ISSUED: 4/16/99
. 044 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111 BA -00109
SITE ADDRESS: 14110 SW 97TH AVE
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -4.5
BLOCK: LOT : 028 JURISDICTION: TIG
Project Description: Residential 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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 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:
THOMAS D. PARKER BENTLEY ELECTRIC
14110 SW 97TH 41547 SW WITHYCOMBE RD
TIGARD, OR 97224 GASTON, OR 97119
Phone: 620 -7674 Phone: 503 - 985 -9500
Reg #: LIC 44467
SUP 1382S
ELE 2 -20C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT BON 4/16/99 $45.00 99- 314596 Elect'I Service
Elect'I Final
5PCT BON 4/16/99 $2.25 99- 314596
Total $47.25
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This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty Codes and all other applicable laves.
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 throe• ■AR 9 b 11- '1180. You may obtain copies of these rules ordirect questions to OUNC at (503)
246-1987.
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Permit Signature: Issued By: e ��
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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: A f k( DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By 60,.)
TIGARD OR 97223 Date Rec'd q.- /b -14
Date to P.E.
Phone (503) 639 -4171, x304 Print or Type Date to DST
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit# 1.0 ( - - 0,UT��
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) - i�.SR.14. - 2 Service included: Items Cost Sum
Address l 41 1. e ll •c\le. 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip \G- -p. .t Z. � 1ZZ4 Each additional 500 sq. ft. or
Commercial El Residential portion thereof $25.00 1
Li mited 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 licenses) 4b. Services or Feeders
Electrical Contractor 1 r=sE - _.a' Fli-- . Installation, alteration, or relocation
200 amps or less $60.00 2
Address 4154 - 1 W I rt-CC ol--A "'t. 201 amps to 400 amps $80.00 2
City (- Ste .f State Ctg, Zip "r11.1 401 amps to 600 amps $120.00 2
Phone No. • 11 ,5 - '=It_ 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. Z -79 c- Exp.Date Ib i-
OR State CCB Reg. No. 4‘.. Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.D. Installation, alteration, or relocation
f 200 amps or less $50.00 2
- ` 201 amps to 400 amp $75.00 2
Aim of Supr. Elec 'n . IIILWroid_ 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 135Z.s Exp.Date see "b" above.
Phone No. `185 - • IoC=D
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit 1 $35.00 = 2
The installation is being made on property I own which is not Each additional branch circuit - 'a -- $5.00 10 , on 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 $40.00 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: � �D
Not required for temporary construction services. 5a. Enter total of above fees $ -
5% Surcharge (.05 X total fees) $ i • Z
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 # $ L f �� Z5
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 63,9 -4171
� 'l 4 � BUP
Date Requested l.Y r _I - C c7 AM q ' PM BLD
Location 1 Z I 1 IJ 1 +' ^ \ Suite MEC
Contact Person 0e(,U Ph i -To PLM
Contractor Ph SWR G��p
BUILDING Tenant/Owner ELC / - I / / Oo 2 2
Retaining Wall ELR 3
Footing Access:
Foundation FPS
Ftg Drain SGN
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
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
JAW ART FAIL
tLECTROt
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
fir ■
S 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
Other Date (> 9 9 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.