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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC1999 -00641 I ; DEVELOPMENT SERVICES DATE ISSUED: 10/27/1999 -A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 25111 BA -09300 SITE ADDRESS: 14440 SW 97TH AVE SUBDIVISION: PP1994 -052 ZONING: R -4.5 BLOCK: LOT : 003 JURISDICTION: TIG Project Description: Installation of a new 200 AMP service /feeder for an existing single family dwelling. 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: 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: HARLEY, ROBERT A OWNER 14440 SW 97TH AVE TIGARD, OR 97224 Phone: Phone: Reg #: FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT DST 10/27/199c. $64.25 99- 319370 Elect'l Final 5PCT DST 10/27/199`✓ $5.14 99- 319370 Total $69.39 A1G1NAL 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 of these rules or direct questions to OUNC at (503) 2461987. / PERMITTEE'S SIGNATURE �� ��;�� ISSUED BY: OWNER INSTALLATION ONLY The installation is being made on .y lo r whi h is of intended for sale, lease, or rent. OWNER'S SIGNATURE: �_ DATE: / CONTRACTOR IN TALLATION ONLY SIGNATURE OF SUPR. ELEC'N: 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 TIGARD OR 97223 Date Rec'd Date to P.E. Phone (503) 639-4171, x304 Date to DST Inspection (503) 639 -4175 Print of Type Permit # C of - °e q/ Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development r 0 D2 r n- - H.602, LEv Number of Inspections per permit allowed Name (or name business) Service included: Items Cost Sum � Address �4 603 11 +1J 4 U L' 4a. Residential - per unit City /State /Zip r 1000 sq. ft. or less $ 117.75 4 ���! 2_ ` 1 Z Each additional 500 sq. ft. or rr��PP portion thereof $ 26.75 1 Commercial ❑ Residential 1�'- Limited Energy $ 60.00 Each Manufd 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 200 amps or less / $ 64.25 4 a$ 2 Address 201 amps to 400 amps $ 85.50 2 City State Zip 401 amps to 600 amps $ 128.50 2 tY p 601 amps to 1000 amps $ 192.50 2 Phone No. Over 1000 amps or volts $ 363.75 2 Job No. Reconnect only $ 53.50 2 Elec. Cont. Lice. No. Exp.Date 4c. Temporary Services or Feeders OR State CCB Reg. No. Exp.Date Installation, alteration, or relocation COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2 201 amps to 400 amps $ 80.25 2 401 amps to 600 Signature of Supr. Elec'n Over 600 ampsto 1000 $ 100.00 2 0 volts, • see "b" above. License No. Exp.Date Phone No. 4d. Branch Circuits New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or 1 feeder fee. Print Owner's 4-4-4-47 Name ' wPjF0 -1 (~ �� L'O� Each bran circuit $ 5.35 2 Address I �°✓ W ell t d UG b) The fee for branch circuits without purchase of service City 'T1 r24) State (71 2_ Zip 6 \ 1221- or feeder fee. Phone No. (p 3 f 9j'2,694t First branch circuit $ 37.50 Each additional branch circuit $ 5.35 The installation is being made on property I own which is not 4e. Miscellaneous intended for sale, lease or ren . \ (Service or feeder not included) Each pump or irrigation circle $ 42.75 Owner's Signature - . � �,,i - Each sign or outline lighting $ 42.75 Signal circuit(s) or a limited energy 3. Plan Review section (if require. * panel, alteration or extension $ 60.00 q Minor Labels bels (10) $ 100.00 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 Per inspection $ 50.00 Service and feeder 225 amps or more 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: 6, y a J r- 5a. Enter total of above fees $ * Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ 5, /C 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 $ ` i 7 i:\dsts\forms\electric.doc CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 � 2C) BUP Date Requested 7�1 Z AM PM BLD Location /44 5 Suite MEC Contact Person — Ph S 5 ' 7 C PLM Contractor Ph SWR BUILDING Tenant/Owner ELC / 9 f % - c c C 1/ Retaining Wall ELR Footing Access: Foundation �1 — FPS Ftg Drain (� l %/, / / ;2_L/ / `� Crawl Drain Inspection Notes: / SGN Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler 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 < EECTRJCAL) Service Rough In UG /Slab Low Voltage Fire Alarm PART FAIL SITE 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 n n Other Date ,� t-v Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 7' ' AM PM BLD Location /44 4 1 51-v 9 Suite MEC Contact Person fiv-i Ph C3 cf S2 P PLM Contractor f c..c%)..r t- Ph 6 b - 7 'L SWR BUILDING Tenant/Owner ELC /f70 q(( Retaining Wall ELR Footing Access: P Foundation . O F �f•� FPS Ftg Drain SGN Slab Crawl Drain Inspection Notes: Ctcc� ! ~f SIT Post & Beam r Ext Sheath /Shear s . S ei - t,q. c:.r Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire A m G Fire A � y lar 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 P FAIL ELECTRICAL ' In UG /Slab Low Voltage Fire Al AP ART 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 7/ 0 Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested sted AM PM BLD / Location J L / � pp 0 / q7 9.l --(-€_ suite MEC Contact Person & & TI ph I9 6 - r2-6 PLM Contractor Ph 6 �S - C 76,6 SWR BUILDING Tenant/ wne C ) ELC f /� 9' ')C 6 «1 Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain y SGN Crawl Drain Inspection Notes: C c / „ Slab ,�,� `` /�, ..d am SIT Post & Beam 4 Ext Sheath/Shear ` { Z-Y�2_r2- - L- - 1� e_ � Ax. Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam vv 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 ELECTRICAL ervice Rough In UG /Slab Low Voltage Fire Alarm Final PASS PA FA IL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before n- 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 Other Date Inspector ,r iri Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.