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Permit CITY O F TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY Y 111; DEVELOPMENT SERVICES PERMIT #: ELR2001 -00039 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/14/01 SITE ADDRESS: 10980 SW 115TH AVE PARCEL: 1S134AC 02642 SUBDIVISION: ENGLEWOOD NO.3 ZONING: R -4.5 BLOCK: LOT: 208 JURISDICTION: TIG Project Description: Irrigation Controller A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA /TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: :ONTROLLER : X HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: DAVENPORT, KEVIN S AND j) d KATHLEEN V (�(� 10980 SW 115TH TIGARD, OR 97223 Phone: Phone: Reg #: FEES Required Inspections Type By Date Amount Receipt Elect'I Final 5PCT CTR 2/14/01 $6.00 2720010000 PRMT CTR 2/14/01 $75.00 2720010000 Total $81.00 EXPIRED 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) 246 -1987. Issued by 1 ��i' j Permittee Signature �+' /iX'�ti�/ - 1 � 1 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 7:00 P.M. for an inspection needed the next business day Electrical Permit Application Date received: / b/ Permit no.: €62 / _,,,, x) 31 _° 41'1' City of Tigard Project/appl.no.: Expire date: City ojTigard 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 *1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION Job address: l(r:}fp It S /t u Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: I Subdivision: y oe, 0 Project name: I Description and location of work on premises: Estimated date of completion/inspection: CONTRACTOR APPLICATION FEE SCHEDULE Job no: t` Fee Max Business name: D escription Qty. (ea.) Total no. insp New residential - single or multi - family per Address: dwelling unit. Includes attached garage. City: I State: I ZIP: Serviceincluded: Phone: I Fax: I E -mail: 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof CCB no.: [Elec. bus. lic. no: 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 Service and/or feeder 2 Services or feeders — installation, Sup. elect. name (print): License no: alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): t j . (f) )P ,-- 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: l Si......) 1S 601 amps to 1000 amps 2 City: —n ) State: CfL It: 9 -722_3 Over 1000 amps or volts 2 Phone: Ito -vs I Fax: [ E -mail: Reconnect only l 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, 6 0, 70 . � // 201 amps to 400 amps 2 Owner's signature: V / gate: �� D 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 signor 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 I 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 $ ❑ 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 accepted as comp te. TOTAL $ Name of cardholder as shown on credit card ® Q Cardholder signature Amount i �!7 g �� 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 4, Check Type of Work Involved: Residential - per unit � 1000 sq. ft. or less $145.15 4 I 1 Audio and Stereo Systems Each additional 500 sq. ft. or I � I portion thereof $33.40 1 l i 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 n Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less $80.30 2 n 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 rJ 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. Audio and Stereo Systems Branch Circuits Ti Boiler Controls New, alteration or extension per panel a) The fee for branch circuits f � I with purchase of service or l Clock Systems feeder fee. I � Each branch circuit $6.65 2 l i Data Telecommunication Installation b) The fee for branch circuits without purchase of service r7 Fire Alarm Installation or feeder fee. First branch circuit $46.85 �I HVAC Each additional branch circuit $6.65 Miscellaneous I I 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 ❑ Landscape Irrigation Control Minor Labels (10) $125.00 pi Medical Each additional inspection over the allowable in any of the above 1 Nurse Calls Per inspection $62.50 Per hour $62.50 In Plant $73.75 Outdoor Landscape Lighting* Fees: n Protective Signaling Enter total of above fees $ n Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee * No licenses are required. Licenses are required for all other installations See "Plan Review" section on $ front of application. Fees: Total Balance Due $ Enter total of above fees $ 5 i 00 ❑ Trust Account # 8% State Surcharge $ 6, o a Q Total Balance Due $ v i ' i \ forms \elc- fees.doc 10/09/00 Permit #: E a00 / 0 ,3? .F� Address: l o ? V) /Ls- A ---oke--- fir, : �' Issued by: a � - P ate: d 41/a/ /.g9 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 1. I own, reside in, or will reside in the completed structure. ❑ 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. ❑ 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR it. 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. (2 hi/O/ (Signature of pe it applicant) (Date) (White copy to issuing agency permit file, EXPIRED pink copy to applicant) 1,qi CITY OF TIGARD BUILDING INSPECTION DIVISION 22 -Hotir Inspection Line: 639 -4175 Business Line: 639 -4171 MST ' BUP Date Requested 5 -7 AM PM BLD Location / Oc gG -5 4 -✓/ /S ' 4' Suite MEC Contact Person Ph i- 3 y PLM Contractor _ cli2,t119 Ph SWR BUILDING Tenant/Owner ELC "" Retaining Wall ELR tab /- O4) 3 Footing Access: Foundation S � /l 9 ) FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing D ywal on / r l c Drywall Nailing P� r Fire wall / V 1< Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: i tir it Final f��`° /_7-1e._ Q 2J C , A 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 EXPIRED Gas Line Smoke Dampers Final PASS PART FAIL ril Service c fres 4 Rough In UG /Slab X 6� Low Voltage Fire Alarm Final PASS PART 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 Other Date '3 9 ( Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.