Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00316
. ...41 ' DEVELOPMENT SERVICES DATE ISSUED: 6/18/01
._� �) 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 103AA - 03900
SITE ADDRESS: 12285 SW 106TH DR
SUBDIVISION: CLYDESDALE ZONING: R - 4.5
BLOCK: LOT : 019 JURISDICTION: TIG
Proiect Description: Replacement of service panel.
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:
LANG, DEREK J + OWNER
TAYLOR, JENNIFER A
12285 SW 106TH DR
TIGARD, OR 97223
Phone: Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT CTR 6/18/01 $80.30 2720010000( Elect'I Final
5PCT CTR 6/18/01 $6.42 2720010000(
Total $86,72
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rul- —.opted opted by • - •regon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 throu h OAR 952 - 001 -0080. You may obta copies of these rules o direct qu�ns to OUNC at (503)
246 - 6699 or 1 -800- 332 -2344.
Permit Signature: I - ued By: ��I% // / '
i&fi OWNER INSTALLATION ONLY
The installation is being made o / erty I o , hich is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: /1�✓�' DATE: 6 4/ 3 7
/ f
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
4 1 y Electrical Permit Application
11 Ii■ Date received: G 0e f e/ Permit no.: eGesa p /..pp3/
4“,./ City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
)g 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: \22$S SW \0 %.‘ .i f B ldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: I Description and location of work on premises:
Estimated date of completion/inspection: - a ( - 0
CONTRACTOR APPLICATION FEE SCIIEDELE
Job no: Fee Max
Business name: Description Qty. (ea.) Total no. insp
New residential - single or multi- family per
Address: dwelling unit. Includes attached garage.
City: I State: I ZIP: Service included:
Phone: I Fax: I E -mail: 1000 sq. ft. or less 4
CCB no.: I Elec. bus. lic. no: Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic. no.: Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date ce r or feeder 2
Sup. elect. name (print): License no: Services o seders — installation
\ relocation: , 84)
PROPERTY OWNER 200 amps or less 2
Name (print): — . Z.EQEK L.P■(.;c 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: ZZSZ)$ 5U.) kOCoTk Dr 601 amps to 1000 amps 2
City: T\ (cete.4 I State: (:),Kj ZIP: co 2, a3 Over 1000 amps or volts 2
Phone - qb 8 - 3t>17 I Fax: I E - mail:
Reconnect only I
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 installation, alteration,orrelocation:
200 amps or less 2
ORS 447, 455, 479, 0, 7 1.
201 amps to 400 amps 2
Owner's signature: Date: 0 401 to 600 amps 2
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 -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 O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O 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:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan ❑ Other. Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other 7
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 00 J
0 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 %) $ • `/ a
Expires accepted as complete. TOTAL $ (/. 7 `
Name of cardholder as shown on credit card
Cardholder signature Amount 440-4615 (6/00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, 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 n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Ti Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation G�r-�
200 amps or less $80.30 •3C) 2 ❑
201 amps to 400 amps $106.85 2 Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n 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
New, alteration or extension per panel n Boiler Controls
a) The fee for branch circuits
with purchase of service or Ti Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
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 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
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 ❑ Outdoor Landscape Lighting
Fees : ❑ Protective Signaling
Enter total of above fees $ epzo Ti 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 06 /07/01
JUN -19 -2001 14:56 P.01/01
CITY OF TICGAKu
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OREGON ELECTRIC CONST /GROUP
1010 SE 11TH AVE
PORTLAND, OR 97214
Electrical Signature. Form
Permit #: ELC2001 -00316
Date Issued: 6/18/01
Parcel: 2S103AA -03900
Site Address: 12285 SW 106TH DR
Subdivision: CLYDESDALE
9lock: Lot: 019
Jurisdiction: TIG
Zoning: R-4.5
- Remarks: Replacement of service panel.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form Is received
OWNER: ELECTRICAL CONTRACTOR:
LANG, DEREK J + OREGON ELECTRIC CONST /GROUP
TAYLOR, JENNIFER A 1010 SE 11TH AVE
12285 SW 106TH DR PORTLAND, OR 97214
Phone #: OR 97223 Phon #:
Req #: LIC 203
SUP 1302S
ELE 26 -95C
AN INK SIGNATURE IS REQUIRED 13N THIS FORM
X & JLi jft L
SignEtture of Supervising Electrician
If you have any questions, please call (503) 639 -4171, ext. # 310
F60v
5P 3 s g g— I IC°°
TOTAL P.01
,) -0Y
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ l BUP
2
Date Requested `�' -/ AM PM BLD
Location / Z Z ,5 DY Suite J MEC
Contact Person Ph 57 Z) / 7 PLM
Contractor O)-e arr EA /`// r /C 6;0 4)/0 Ph SWR
BUILDING Tenant/Owner /- Crys — /3 Ye k ELC
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
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL 1 lift
PLUMBING I -
Post & Beam (},/
Under Slab
Top Out
Water Service
Sanitary Sewer I
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PA RT FAIL
ED
ough In
UG /Slab
Low Voltage
Fire Alarm
,6 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 / i Ext
Approach /Sidewalk Date C 2 / — Q 7 InS ector ■ i
Other P /L -i
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
BUP - Building Permit ELC - Electrical Permit
A/ Inspection Description Date Passed By 4 Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service ■ 8
Crawl drain Electrical final ,7y/ ?J r ,Q
Underfloor insulation nQ
Post/beam structural (o e/8/2/'
Shear walls /anchors ELR - Restricted Energy Permi
Roof nailing ' Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry /Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
Drywall nailing - 4 Inspection Description Date Passed By
Suspended ceiling _ Post/beam mechanical
Gas line
Engineered soils
Welding Lab Final Mechanical rough -in
Concrete Lab Final Fire damper
Bolting Lab Final Duct work
Structural observation Smoke detector
Fireproofing Lab Final Mechanical final
Final inspection
PLM - Plumbing Permit
BUP — Fire Protection System Permit Inspection Description Date Passed By
Plumbing underslab
J Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler fmal RP /backflow preventer
Fire alarm fmal Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
4 Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin /Manhole SWR - Sewer Permit
Engineered soils Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits
is \dsts\ forms \InspRecordBUP.doc 04 /17/01
A _ CITY OF TI GARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00316
.4,0 %" - _,,y DEVELOPMENT SERVICES DATE ISSUED: 6/18/01
---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S1 03AA -03900
SITE ADDRESS: 12285 SW 106TH DR
SUBDIVISION: CLYDESDALE ZONING: R -4.5
BLOCK: LOT : 019 JURISDICTION: TIG
Project Description: Replacement of service panel.
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 VO NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS E SPEC OCC:
Owner: Contractor:
LANG, DEREK J + OWNER
TAYLOR, JENNIFER A
12285 SW 106TH DR D,
TIGARD, OR 97223 0(_
Phone: Phone:
5
Le
- - 3o / Reg #:
/
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT CTR 6/18/01 $80.30 2720010000( Elect'l Final
5PCT CTR 6/18/01 $6.42 2720010000(
Total $86.72
■
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. I
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 rul opted by • - •regon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 throw h OAR 952 - 001 -0080. You may obta copies of the rules o direct qu •ns to OUNC at (503) a
246 -6699 or 1-800- 332 -2344.
../
k)e I wed B ,,�
Permit Signature: �( y: 1 , �m , /
OWNER INSTALLATION ONLY e
The installation is being made on • erty I o , hich is not intended for sale, lease, or rent.
0
OWNER'S SIGNATURE:
.zei DATE: 6 / ' aV
r
C
tA
ONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
P
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
7/2/01 Activities for Case #: ELC2001 -00316
9:54:47 AM
Assigned Hold Updated
' Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 6/18/01 DEB DONE No Hold BLD 6/18/01
ELCA003 Permit created 6/18/01 DEB DONE No Hold BLD 6/18/01
ELCA730 Elect'I Service 6/21/01 BRP PASS No Hold 777 6/22/01
ELCA799 Elect'I Final 6/21/01 BRP PASS No Hold ZZZ 6/22/01
ELCA500 (F) Issue permit 6/18/01 DEB DONE No Hold BLD 6/18/01
ELCA520 (F) Print ELC signature form 6/19/01 JMT RECD No Hold JMT 6/19/01
ELCA800 Case Finaled 6/21/01 BRP DONE No Hold 777 6/22/01
r
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