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Permit . CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2000 -00707 0y DEVELOPMENT SERVICES DATE ISSUED: 12/21/00 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103CD -07900 SITE ADDRESS: 13695 SW 118TH CT SUBDIVISION: CREEKSIDE PARK ZONING: R -4.5 BLOCK: LOT : 009 JURISDICTION: TIG Proiect Description: Installation of (6) branch circuits. 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: 0 W /SERVICE OR FEEDER: 0 PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 6 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: BRUTCHER, JACK L + MARTI E OWNER 13695 SW 118TH CT TIGARD, OR 97223 Phone: Phone: Reg #: FEES Required Inspections Type By Date Amount Receipt Wall Cover PRMT CTR 12/21/00 $80.10 2720000000( Elect'l Final 5PCT CTR 12/21/00 $6.41 2720000000( Total $86.51 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 ad • • -d by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain •• +ies of thes- ules or direct questions to OUNC at (503) 246 -1987. A Al PERMITTEE'S SIGNATURE y ).\ - 1j, z .— ISS , ED B Y: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: k M ' `, "^ /3c-to'x- DATE: /a "o / 630 CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day . _ . „, ... .- - 44, Electrical Permit Application Date received: /,2 at7,Q0 Permit no.: £G e --cold '. al City of Tigard Projectiappl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.: Phone: (503) 639 - 4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT *541 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial JOB SITE INFORMATION Job address: /3 6 9 5 / - 3 / / '- c `- - ' i 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 SCIIEDL1 E Job no: ) l)-D O € 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: 100o 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 Service and/or feeder 2 Sup. elect. name (print): License no: Services or feeders - installation, alteration or relocation: PROPERTY OWNER 200 amps or less 54 Oirt 2 Name (print): . (-= (< L 34 i I 12 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: ( 3 L, cl 5 Sc..) // ° C' 1--- 601 amps to 1000 amps 2 City: '77 G/} .2 0 I State: 62 I ZIP: Q '72-2-F Over 1000 amps or volts 2 Phone: (n si5/— y "7 fI Fax: — I E -mail: 4).7,4A f F gL, ,,/ i 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, alteration, or relocation: 200 amps or less 2 ORS 447, 455, 479, 670, 701. 201 amps to 400 amps .2 Owner's signature: a -- Date: / - a / "' 401 to 600 am s 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 4' 2 City: I State: I ZIP: B. Fee for branch circuits without purchase ¢� of service or feeder fee, first branch circuit: VG • 2 Phone: Fax: E-mail: Each additional branch circuit: 5 55. PLAN REVIEW (Please check all that appl)) 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 Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other qq 0 Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ VJ ❑ 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%) .... $ 6 4 Expires accepted as complete. TOTAL $ Co . Sr r Name of cardholder as shown on credit card $ Cardholder signature Amount 440.4615 (6A0/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 4, 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 ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular ❑ 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 El 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, 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, r7 see "b" above. Audio and Stereo Systems Branch Circuits n Boiler Controls New, alteration or extension per panel 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 ❑ Fire Alarm Installation or feeder fee. First branch circuit $46.85 n HVAC Each additional branch circuit $6.65 Miscellaneous ❑ 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 ❑ Medical Each additional inspection over the allowable in any of the above n 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 $ ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ i:\dsts \forrns\elc- fees.doc 10/09/00 CITY OF TIGARD Permit Application Plan Check# - _ 13125 SW HALL BLVD. Recd By TIGARD OR 97223 Date Recd Phone (503) 639 -4171, x304 Print of Type Date to P.E. Date to DST Inspection (503) 639 - 4175 Incomplete or illegible will not be accepted Permit # Fax (503) 598 -1960 Called 1. Job Address: 4. Complete Fee Schedule Below: Number of Inspections per permit allowed Name of Development Name (or name of busin 1, Service included: Items Cost Total --- • 4a. Residential - per unit 1,,_, Address / i W2 F7 as 3 1000 sq. ft. or less $147.15 4 City /State /Zip Q Each additional 500 sq. ft. or portion thereof $33.40 1 Commercial ❑ Residential ❑ Limited Energy $75.00 - Each Manufd Home or Modular Dwelling Service or Feeder $90.90 . 2 2a. Contractor installation only: (Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders information for COT data base). Installation, alteration, or relocation . Electrical Contractor 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 Address 401 amps to 600 amps $160.60 2 City State Zip 601 amps to 1000 amps $240.60 2 Phone No. Over 1000 amps or volts $454.65 2 Job No. Reconnect only $66.85 2 Elec. Cont. Lice. No. Exp.Date 4c. Temporary Services or Feeders OR State CCB Reg. No. Exp.Date Installation, alteration, or relocation 200 amps or less $66.85 2 COT Business Tax or Metro No. Exp.Date 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 2 Signature of Supr. Elec'n Over 600 amps to 1000 volts, see "b" above. License No. Exp.Date 4d. Branch Circuits Phone No. New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or p I feeder fee. Print Owner's Name Jl 1 13RUM- lieR Each branch circuit $6.65 2 b) The fee for branch circuits Address f -5 ' r (,Z without purchase of service City a 7 '. I State e ' ip '17 or feeder fee. u Phone No. $ j First branch circuit �_ $46.85 IC- 3 L. •-• Each additional branch circuit S $6.65 33 ?s The installation is being made on property I own which is not 4e. Miscellaneous intended for sale, lease or rent. (Service or feeder not included) i Aii,, Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 Owner's Signature GxC:� f Signal circuit(s) or a limited energy panel, alteration or extension $75.00 3. Plan Review section (if required):* Minor Labels (10) $125.00 Please check appropriate item and enter fee in section 5B. the allowable in any of the above 4 or more residential units in one structure Per inspection $62.50 Service and feeder 225 amps or more Per hour $62.50 System over 600 volts nominal In Plant $73.75 Classified area or structure containing special occupancy as 5. Fees: described in N.E.C. Chapter 5 5a. Enter total of above fees $ , / * Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ t • tfT Not required for temporary construction services. Subtotal $ 5b. Enter 25% of line 5a for NOTICE Plan Review if required (Sec. 3) $ Subtotal $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR ❑ Trust Account # WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ st -.5 I i:\dsts\forms\electric_rev.doc - 8/00 CITY OF TIGARD BUILDING INSPECTION DIVISION - MST- 24 -Hour Inspection Line: 139 -4175 Business Line: 639 -4171 y / BUP Date Requested /--/ frD AM PM BLD Location /1 l78e Suite MEC Contact Person Ph 6 ,Vi1 S PLM Contractor ,Q Ph / // SWR BUILDING Tenant/Owner ' - PG SC_ ( J/ .e 4 C�.2 �n'GuG ELC 0010 7a c7 Retaining Wall c 4 f ELR Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes: SGN Slab - a, tie . 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 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 EcrR�r.._ Service Rough In UG /Slab Low Voltage Fire Alarm Z AS sil c 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 /� /� Other ` Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.