Permit CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00594
, l DEVELOPMENT SERVICES DATE ISSUED: 10/19/00
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134CD -01300
SITE ADDRESS: 11955 SW 116TH AVE
SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R -4.5
BLOCK: LOT : 048 JURISDICTION: TIG
Project Description: Installation of one 200 amp or less service or feeder.
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:
SHELTON, JAMES C + JUDY C OWNER
11955 SW 116TH
TIGARD, OR 97223
Phone: Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT CTR 10/19/00 $80.30 2720000000( Elect'l Final
5PCT CTR 10/19/00 $6.42 2720000000(
Total $86.72
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Speaalty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not st, ied within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rul: adopted bythe Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtai copies of these rule- or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE ISSU ■' BY:
• Aral
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or re
OWNER'S SIGNATURE: /X c:=\ e
W4 , l ` DATE: 7
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
A Electrical Permit Application
•
Date received: 09 9 —d0 Permit no.: �GLd�dd _ 5
- 9
4l �:l City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: , -ly-eD U By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
4 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: i t r- 1 SS S , wr • M0 A V fie. Bldg. 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:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: `'` ` Max
Business name: ° t:7 t rJ t..) �r� _ Description I 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
Each additional 500 sq. ft. or portion thereof
CCB no.: I 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
Sup. elect. name (print): License no: Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 1 2
Name (print): 3A Iv% -s C C. - *-t L i , Ps, 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 1 lS SS S.w • \ %to 41 A.Vkf_ 601 amps to 1000 amps 2
City: 't t C-+r4 t2 CS I State: OR I ZIP: 9, Over 1000 amps or volts 2
Phone(),) S 24 -19 Fax: I E -mail: Reconnect only
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, or relocation:
200 amps or less 2
ORS 447, 455, 479 670, 701.
1 i 20 1 amps to 400 amps amps 2
Owner's signatu �A any Date: t 0 t i Si o0 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
❑ 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 I I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ SO. . 3 x>
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ 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 %) .... $ Cp. 47-
Expires accepted as complete. TOTAL $ S fa .1 Z
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/90/COM)
Electrical Permit Fees: Limited Energy Fees: ,
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
(� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ 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 n Garage Door Opener
Dwelling Service or Feeder _ $90.90 2
Services or Feeders Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less { $80.30 $ 0 .'3 0 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
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, cr relocation
200 amps or less $66.85 2 Fee for each system $75.00
201 amps to 400 amps $100.30 2 (SEE OAR 918 - 260 -260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above.
ri 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 �-
feeder fee. l l Clock Systems .
Each branch circuit $6.65 2
b) The fee for branch circuits n Data Telecommunication Installation
without purchase of service
or feeder fee. n Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous
(Service or feeder not included) n Instrumentation
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
Minor Labels (10) $125.00 n Landscape Irrigation Control
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
ri Outdoor Landscape Lighting"
Fees:
❑ Protective Signaling
Enter total of above fees , $ t0.10
8% State Surcharge $
(0.42. F Other
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ g,co.°lZ- Fees:
Enter total of above fees $
El Trust Account #
8% State Surcharge $
Total Balance Due $
i:\dsts \forms \elc- fees.doc 10/09/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 . 'MST
BUP
Date Requestedd/' ` / ` D C) AM P
_ BLD
Location 5 -J I (h Suite MEC
Contact Person l i 9 5I / Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC 2 00 5 y 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 � ‘ 5 , /e) 0 0 1-T9 S•'Ge v /CC GnJCL
Firewall
Fire Sprinkler
Fire Alarm � (I/4 ieQ C /���� 7 5 #040�
Susp'd Ceiling (}-
Roof 41/ ft/ //1/J
Misc: �""� C� /
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 • - T FAIL
ICA
Rough In
UG /Slab
Low Voltage
Fre Alarm
4,0 •ART 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date / ` _ 19 `2 v Inspector Ext
Other
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 Requstecl l/' AM PM BLD
Location it r r 5 5 ) /'/4' e1, Suite MEC
Contact Person Ph ,50°LCZ G 1 � ! PLM
Contractor Ph Sty /9b'/ SWR
BUILDING Tenant/Owner ELC 2-0
Retaining Wall ELR
Footing Access:
Foundation /3 FPS
Ftg Drain �J / SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall /
Fire Sprinkler X() O /� e S lJ 11 / ,OA" [
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING r S 4 —
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
ice v � o c,P
Rough In p
UG /Slab PG n 4 e- ,
Low Voltage
Fire Alarm
Final
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: .i nable to inspect - no access
ADA
Approach /Sidewalk J `
Other Date / / / I — ' n Inspector IC, A Ext
Final
PASS PART FAIL DO NOT 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 / /— / rj''GL
Crawl drain Electrical final // 19 -0C) f
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing 4 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 � 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
PLM - Plumbing Permit
4 Inspection Description Date Passed By
BUP - Fire Protection System Permit Plumbing underslab
J 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
- 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 11 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 #: ELC2000 -00594
iw�l i t , DEVELOPMENT SERVICES DATE ISSUED: 10/1.9/00
� �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S134CD -01300
SITE ADDRESS: 11955 SW 116TH AVE
SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R -4.5
BLOCK: LOT : 048 JURISDICTION: TIG
Project Description: Installation of one 200 amp or less service or feeder.
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:
SHELTON, JAMES C + JUDY C OWNER
11955 SW 116TH
TIGARD, OR 97223
Phone: Phone:
Reg #:
FEES
Required Inspections
q
Type By Date Amount Receipt Elect'I Service
PRMT CTR 10/19/00 $80.30 2720000000( Elect'l Final
5PCT CTR 10/19/00 $6.42 2720000000(
Total $86.72
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 st. ied within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requi you to follow rul: adopted by th.e Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtai copies of these rule- or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE 1 ,\,„ 1/4/f L . , ISSU - ' 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: / • 0. 2 DATE: 7G—/ 9 —DU
CONTRACTOR INSTALLATION ONLY li
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day