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Permit CITY OF TI GARD ELECTRICAL PERMIT PERMIT #: ELC2002 -00465 ' 4341 " 13125 Ai f DEVELOPMENT H O PMENT Tigard, SERVICES 639 -4171 DATE ISSUED: 9/12/02 PARCEL: 2S 103AC -06800 SITE ADDRESS: 12911 SW 113TH PL SUBDIVISION: FONNER WOODS ZONING: R -4.5 BLOCK: LOT : 004 JURISDICTION: TIG Project Description: Reconnect. 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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: LEE SELLICK OWNER 12911 SW 113 PLACE TIGARD, OR 97223 Phone: 503 - 957 -0784 Phone: Reg #: FEES Required Inspections Type By Date Amount Receipt Elect'I Final PRMT CTR 9/12/02 $66.85 2720020000( 5PCT CTR 9/12/02 $5.35 2720020000( Total $72.20 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 Permit Signature: • ho, Issued By: e 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: JY\ 9J -- DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day A -Electrical Permit Application _ Date received h /, / Permit no.: aCp _ co i i 5 " :.'i � 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 �/ & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement litX e ❑ New construction Cl Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION Job address: /Z17/ / 1 Pf -e Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: rS ubdivision: Project name: I Description and location of work on premises: e_/‹c (—, -tom > / annex: f Estimated date of completion/inspection: -• / 2)-z_ CONTRACTOR APPLICATION FEE SCHEDULE Job no: n V., \- CL)- 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. 11C. no: Each additional 500 sq. ft. or portion thereof Limited energy, residential 2 City /metro lie. no.: Limited energy, non- residential 2 Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2 Sup. elect. name (print): License no: Services or feeders — installation, alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): t_GL- C., / / / ,L 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: lzg// sr� '1a1 // 3 p/ a 601 amps to 1000 amps 2 City: 7 I Stater I ZIP: ? 3 Over 1000 amps or volts 2 Phone: 9Sl7 �- 7gi-f• I Fax: 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 installation, 447, 455, 479, s t , 7�� 200 amps or less 2 201 amps to 400 amps 2 Owner's signature:' �7 _ • , Date: ? /z e"z 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 -care facility Each pump or irrigation circle 2 ❑ Service over 320 amps- rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2 family dwellings ❑ 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 Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other 1 c____.1,, ,_, / [� Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ CY �O `1S ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: I / within 180 days after it has been State surcharge (8 %) .... $ S • °3 Expires accepted as complete. TOTAL $7-7a-- . a v Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00/COM) . - ,.. ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT 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 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 0 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 El 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 n Vacuum Systems 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 n Other Ov x10 amps or volts $454.65 2 Reconnect only / $66.85 ‘,4. 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. El 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 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 Each additional branch circuit $6.65 0 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 Medical 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 $ ` C6' - 8 S n Other 8% State Surcharge $ 5.-6 G 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 $ All New Commercial Buildings require 2 sets of plans. i:\dsts \forms \elc- fees.doc 08/30/01 CITY OF T3ARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 63§ -4175 Business Line: 639 -4171 BUP Date Requested ) AM PM BLD Location I.1 )) S N(4 ) ) 3 1.-. Suite MEC Contact Person L am ) T Ph ' 9 7 - ( 7'4 8 9 PLM Contractor Ph SWR s1 BUILDING Tenant/Owner ELC a.0 dd I ( 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 Fire wall Fire Sprinkler P 1 c ) 1 � v 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 (WitL , T�RICAL UG /Slab Low Voltage Fire Alarm Fi SS 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 9/ D ate Inspect. , Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from th = ob site.