Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT PERMIT #: ELC97-0614
~="��"�"�~~" "°""�"�" SERVICES DATE ISSUED: 09/16/97
'nL 13125 SW Hall 8Nd Tigard, 099720(503) 639-4171
PARCEL: 2S103BD-00900
SITE ADDRESS...:12540 SW 121ST AVE
SUBDIVISION • ZONING:R-4.5
BLOCK • LOT • JURISDICTION: URB
Project Description: Replace existing elect. serivce with a new 200 amp service
and four (4) branch circuits for an existing single family dwelling.
---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP/IRRIGATION • 0
EACH ADD'L 500SF...: 0 201 — 400 amp . 0 SIGN/OUT LINE LTG..: 0
LIMITED ENERGY : 0 401 — 600 amp • 0 SIGNAL/PANEL • 0
MANF. HM/ SVC/FDR..: 0 601+amps-1000 volts.: 0 MINOR LABEL (10)...: 0
----SERVICE/FEEDER---- ----BRANCH CIRCUITS ---ADD'L INSPECTIONS---
0 — 200 amp • 1 W/SERVICE OR FEEDER: 4 PER INSPECTION • 0
201 — 400 amp : 0 1st W/O SRVC OR FDR.: 0 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 — 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp/volt • 0 >=4 RES UNITS • > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC/FDR >= 225 AMPS..: CLASS AREA/SPEC OCC.:
Owner: — FEES
STEVEN P ALLEN type amount by date recpt
12540 SW. 121ST AVENUE PRMT $ 80.00 GEO 09/16/97 97-299283
TIGARD OR 97223 5PCT $ 4.00 GEO 09/16/97 97-299283
Phone #: 590-3671
Contractor:
OWNER $ 84.00 TOTAL
REQUIRED INSPECTIONS
Rough—in Elect'l Service
Phone #: Underground Cove Elect'l Final
Reg #..: 999999
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-N10 through OAR 952-001-1'; . You ay obtain a copy
of these rules or direct questions to (1UNC by calling )246-1987.
Permittee Signature: , �� Issued By: P �~
OWNER INSTALLATION ONLY —
The installation is being d on property I own which is not intended for
sale, lease, or rent
OWNER' S SIGNATURE : ATE: 67 - �'� -�� ~�
� x +~ v u� �
CONTRACTOR INSTALLATION ONLY ---
SIGNATURE OF SUPR.
ELEC'N: DATE: ��
, `- ��' -x ^r—
� /
LICENSE NO:
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Recd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DSI
Print or Type
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # tC C o � l 'O� /�f
Fax (503) 684 -7297 Called
1. Job Address: �1 4. Complete Fee Schedule Below:
Name of Development 5 �O Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum
I
Address / 25 O 5ci, / ZI 5 4a. Residential - per unit
q
1000 sq. ft. or less $110.00 4
i
City /State /Zip , tt -d Or 3 Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial ❑ Residential Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor Installation, alteration, or relocation OIL
Address 200 amps or less _L. $60.00 ((ft) 2
201 amps to 400 amps $80.00 2
City State Zip 401 amps to 600 amps $120.00 2
Phone No. 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. Exp.Date
OR State CCB Reg. No. Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less _Silie $50.00 2
Signature of Supr. Elec'n 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No.
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name S'4Cc 1e 1 en feeder fee.
Address 1 2.S 1 /Q Su.) 121 3 Each branch circuit i $5.00 20 2
Tl ` a r State are. Zip b) The fee for branch circuits
City Q d p without purchase of
Phone Ne. 5 'jO -- 47 I service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
/ (Service or feeder not included)
Owner's Signature l'. ■G� Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
g am
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: g _ j
Not required for temporary construction services. 5a. Enter total of above fees $ ■ ��_
5% Surcharge (.05 X total fees) $ 9
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location ZS Lk) 1 7/ Si AVE E Suite MEC
Contact Person Ph / PLM
Contractor. `loll o / l Ph S1 1) _3 - t SWR �1
BUILDING Tenant/Owner ELC 9 d -00tP
Retaining Wall ELR
Footing Access: n
Foundation FPS
Ftg Drain IIICCC...eee
Crawl Drain Inspection Notes: (l ,' SGT
Slab Je �'� /
SIT
Post & Beam
Ext Sheath /Shear ( ViVE
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm "s�
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 1 FAIL
. 5ECTRICA
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
ART FAIL
SITE- -
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next i section. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: J Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date �� Inspector A.._ ,i �h�jl Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.