Permit CITY OF TI GA R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00006
i DEVELOPMENT SERVICES DATE ISSUED: 1/5/01
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134BD-07300
SITE ADDRESS: 10885 SW 115TH AVE
SUBDIVISION: PENN LAWN ESTATES ZONING: R -4.5
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Bedroom sauna outlet, GFCI outside outlet
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: 1 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:
DONALDSON, BRUCE J TICE ELECTRIC
10885 SW 115TH AVE PO BOX 15009
TIGARD, OR 97223 2139 SE BELMONT ST
PORTLAND, OR 97293 -5009
Phone: Phone: 233 -8801
Reg #: LIC 00000166
SUP 2586S
PLM 2586s
ELE 26 -126C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 1/5/01 $53.50 2720010000( Elect'l Final
5PCT CTR 1/5/01 $4.28 2720010000(
Total $57,78
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.
PERMITTEE'S SIGNATURE CL�eL�C�� ISSUED BY:
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 7:00pm for an inspection the next business day
01/05/2001 08:26 503 - 872 -8290 TICE ELECT.SERV.DEPT PAGE 01
Electrical Permit Application
A . Date received: Penult no 4 . - e 17
":42'.:1'11' .:� City of Tigard Projectiappl. no.: Expire date:
City of Ti gard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By Receipt no.:
Phone: (503) 639 -4171 �� Ole no.: Payment type:
Fax: (503) 598 -1960
Land use approval:
1 1 OF Paoli
CFI I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family Q Tenant improvement
0 New construction 10 Addition/alteration/replacement 0 Other: 0 Partial
JOB SITE IN JORMIA f ION
Job address: 99 ..4576 Bldg. no.: Suite no.: Tax map/tax lot/accountno.:
Lot: Block: Subdivision: M4 i 5
Project name: Jay Donald1 Description and location of work on premises: l .rOOm oa uria atit.1 t, Cl;'CI
Estimated date of completion/ins r - don: -
CON Iis-1('IOR APPLICATION lit SCIILI)I'1.F •
1F'ee Max
lob po: DoteriPtioa Qty. (e.) Total no. Lisp
Business name: Tice F a pe-i c c ,
til1- single or mid-family 1 per
Address: PO $0 e 1 • dtrellingattif- Includes attached cartage.
_ City: Portland State:0R ZIP :97 -Gang SavIcoindwiri
1000 sq. ft. or less 4
1'tlorl 3 -233 -8801 Fax503- 872 - 8 >�t9�'a'I' Each additional 500 sq. t, or portion thereof
CCB no.: [Elec. bus. lic. no: 26 -1260 Urnitedenergy,residential 2
City/ etro lic, no.: 2 0 1 4
Limited energy, 2
Each manufactures home or modular dwelling
Si �upervisipg electrici (required) pate
Se sootier feeder 2
Services orfeeders-installation,
Sup. elect. name (print): John J. Maori]. License no: 25865 alteration or relocation:
200 amps or less 2
201 steps to 300 imps 2
Nye (print): Jay Donaldson ,- 401 amps to 600 amps ' 2
Mailing address: 60 amps to 1000 amps
State: [ZIP: Over 1000 amps or volts 2
city:
Phone: —Lax: , E - mail; Recotracotottly 1
-
deta
Temporary services or feaeders
Owner installation: The installation is being made on property I own installation, alteration, o ion:
which is not intended for sale, lease, rent, or exchange according to 200 > or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps . 2
Owner's signature: _
Date: 401 to 600 amps 2
I N G I N I .F R Branch circuits - mew, alteration,
or exlemaion per panel:
Name: _ A. Fee for branch circuits with purchase of
service or feeder fee each blanch circuit 2
Address; B Fee for branch circuits without putchese
City: $ I ZIP: B. of service or feeder fee, first breach circuit. 1 , - 46 ; - 2
Phone: Fax: E - mail: Each additional branch circuit: -
I'LAN lit:VIEIV(Please check all that apply) Misc. (Service or' feeder not included): 2
Each pump or irrigation circle .
0 Service over 225 amps - commercial O Health - care facility Each sign or outline lighting 2
O Service over 320 amps - rating of 1142 0 Hazardous location —
family dwellings dwellin O Building over 10,000 square feet four or Signal circuits) or a limited energy panel, 2
O System over 600 volts nominal more residential units in one structure alteration. or extension
0 Building over three stones 0 Feeders, 400 amps or more 'I)escnftion:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional ins aver the allowable in any of ire above
0 Other. Per inspection 1 I
O EgressJlightingpian Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ 5 3 50-
'Nat all jurisdictions accept credit clots. please call rudsdielion for loose IMama °m Notice: This permit application Plan review (at %) $
0 Visa 0 MasterCard expires if a permit is not obtained
I I _ within 180 days after it has been State surcharge (8%) .... $ .--4--.24-
Credit card number GIs accep as complete. TOTAL $ _- -57 -r78
Name of cerdbolder as drown on cruet cod
$
/►rttogrst Trust Acct 166 ,o - .iota t¢aoIooM
cardbolda a picture .J
01/05/2001 08:26 503 -872 -8290 TICE ELECT.SERV.DEPT PAGE 02
.. . , , _ 10885 SW 115th
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Number of cltone per perrnitargowd Re(FOR ALL Few.__ _�.._._..,____.. _._ '
Vspe
(FOR ALL SYS fEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential - per unit
1000 sq. It or less 5145.15 4 n Audio and Stereo Systems
Each additional 500 sq- ft. or
portion thereof $33.40 1 n Burglar Alarm
Limes Energy $75.00
Each Manufd Home or Modular Garage boor Opener' Service or Feeder 590.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System'
Installation, alteration, Or relocation .
200 amps or less $80.30 2 I l Vacuum Systems'
201 amps to 400 amps $106.85 2
$160.60 »" _..._..___... 2
401 amps to 600 amps n Other
601 amps to 1000 amps $240.60 2
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 S75AQ
200 amps or less 566.85 2 y
?,p1 amps to 400 amps -,---____ $100.30 2 (SEE OAR 91s- 260 -260)
401 amps to 690 amps — $133.75 2 Check Type of Work Involved:
over 600 amps to 1000 volts,
see "b" above. a
Audio and Stereo Systems
Branch Circuits
New, alteration or ertanslon per panel I 1 Boiler Controls
a) The fee for branch circuits
with purchase of service or Li feeder fee. Clock Systems
Each branch circuit $8.65 2
5) The fee (or branch circuits Cl Data TelecommunIcation Installation
without purchase of service
or feeder lee. Fire Alarm Installation_
First branch drtatit 1 $46,85 4 11 . $5
Each additional branch circuit _ 1 $6.65 6.65 n HVAC
Miscellaneous
(Service or feeder not Included) n Instrumentation
Each pump or irrigation drcle $53.40
Each sign or outline lighting $53.40 _ n Intercom and Paging Systerns
Signal eArcuit(s) or a limited energy
panel. alteration or extension $75.00
Minor Labels (10) 5125,00 Landscape Irrigation Control'
Each additional inspection over Medical
the allowable In any of the above
Per inspection $62, ❑ Nurse Calls
Per hour 562.50
In Plant $73.76 ❑
Outdoor Landscape Lighting'
Fees:
Protective Signaling
Enter total of above fees s 53.50
8% State Surcharge $
4.28 ❑ Other
• Number of Systems
25% Plan Review Fee
See Plan Review' section on $ ' No licenses are reoulred. Licenses are required fur all other Installations
front of application -
Total Balance Due $ 57.78 Fees`
Enter total of above fees $ -
® Trust Account tt 166
8% State Surcharge S
Total Balance Due s
•
i Ms's \forms\elc- fees.doc 1 0/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspectiontine: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested ' / AM PM BLD
Location / U 0 jw / /5 rt Suite MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner drOVevi-e) C'
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection i � SGN
ection Notes:
P
Slab G D 1 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
Pos Beam
Top
d Out b ls1� �,• ! Ln /-
Water - rvice - 774`
San' : ry Sewer
n Drains
- SS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PA FAIL
ELEGTRICAT2
S
Rough In
UG /Slab
Low Voltage
Fire Alarm
PAS 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 Date � //1 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION y
MST
24 -Hour Inspection 639 -4175 Business Line: 639 -4171
BUP •
• & Date- Requested - 5 ° t AM PM BLD
Location �® ~ v ' 5641 //) G ` Suite MEC
Contact Person Ph .C.3 s 3 PLM
Contractor - Ph SWR
BUILDING Tenant/Owner ELC (>20/./-1) uU £ �o
Retaining Wall ELR
I Footing Access: (�
Foundation n -S CIL- -` (4' / — -> / Lt/6190 — / / FPS
Ftg SGN
Crawl Drain Inspection Notes:
Slab / -c e-k^-i Sil-u hl /} Ol/> SIT
Post & Beam f t��
Ext Sheath /Shear - 6 �.---
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler '
Fire Alarm /
,
� ,_/ / /
Susp'd Ceiling -I __i_" _ !1. - �.� !_ -
Roof
7 ......
F
Final
inal
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
I Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
P FAIL
bervice
Rough In
UG /Slab
Low Voltage
Fire e A
PASS 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
0 Ext
Other Date C 0 ( Inspector
Final
PASS PART FAIL DO N T REMOVE this inspection record from the job site.
BUP - Building Permit ELC - Electrical Permit
4 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
Crawl drain Electrical final Z _ / Z,-o a,e®
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing I 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
Post/beam mechanical
Suspended ceiling Gas line
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper
Concrete Lab Final Duct work
Bolting Lab Final Smoke detector
Fireproofing Lab Final Mechanical final
Structural observation
Final inspection
PL M - Plumbing Permit
Inspection Description Date Passed By
BUP — Fire Protection System Permit Plumbing underslab
4 Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
J 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
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00006
041a DEVELOPMENT SERVICES DATE ISSUED: 1/5/01
AU. , - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 t
PARCEL: 1S134BD-07300
SITE ADDRESS: 10885 SW 115TH AVE
SUBDIVISION: PENN LAWN ESTATES ZONING: R -4.5
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Bedroom sauna outlet, GFCI outside outlet
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: 1 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:
DONALDSON, BRUCE J TICE ELECTRIC
10885 SW 115TH AVE PO BOX 15009
TIGARD, OR 97223 2139 SE BELMONT ST
PORTLAND, OR 97293 -5009
Phone: Phone: 233 -8801
Reg #: LIC 00000166
SUP 2586S
PLM 2586s
ELE 26 -126C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 1/5/01 $53.50 2720010000( Elect'l Final
5PCT CTR 1/5/01 $4.28 2720010000(
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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.
PERMITTEE'S SIGNATURE I CC&& ISSUED BY: YYV
I Sk rib
OWNER INSTALLATION ONLY ` t
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:
6
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day