Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00089
DEVELOPMENT SERVICES DATE ISSUED: 2/12/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S10300 04400
SITE ADDRESS: 13815 SW 124TH AVE
SUBDIVISION: EAGLE POINTE ZONING: R -4.5
BLOCK: LOT : 019 JURISDICTION: TIG
Project Description: Job #8450 - Add (2) GFI's outside and (1) outlet at fountain area.
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: 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:
TERRY GIBSON ATLAS ELECTRICAL CONTRACTORS
13815 SW 124TH AVE 4403 SE ROETHE RD
TIGARD, OR 97223 MILWAUKIE, OR 97267
Phone: Phone: 659 -2212
Reg #: SUP 2581S
LIC 1532
ELE 3 -2C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 2/12/01 $46.85 2720010000( Elect'l Final
5PCT CTR 2/12/01 $3.75 2720010000(
Total $50.60
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 f 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
Electrical Perm App
G � ry , Date received: Permit no -a � / -, ..; .
A. ,,. .J i ;,
- .J i; City of Tigard Re Project/appl. no.: Expire date:
Address: 13125 SW Hall Blvd, Tigard, OR 9722 „ ��'
City of Tigard g 40 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 c ,..?, � (y}
Fax: (503) 598 -1960 r p E\''° Case file no.: Payment type:
Land use approval: 0,00
TYPE OF PERMIT
12i 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 13815 SW 124th Avenue Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: Terry Gibson I Description and location of work on premises: Add (2) GFI' s outside and (1)
Estimated date of completion/inspection: outlet at fountain area.
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: 8450 Yee Max
Description Qty. (ea) Total no. insp
Business name: Atlas Electrical Contractors, Inc.
New residential - single or multi- family per
Address: 4403 SE Roethe Road dwelling wit. Includes attached garage.
City:Milwaukie I State: OR I ZIP: 97267 Service included:
Phone: 659 -2212 I Fax: 659 -4944 E -mail: 1000 sq. ft. or less 4
CCB no.: 1532 I 3 -2C Each additional 500 sq. ft. or portion thereof
EIeC. bus. 11C. no: Limited energy, residential 2
City /metro lic. no.: X 432 Limited energy, non- residential 2
A r ` : , i 2/5/01 Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): Lenny Warnke License no: 25815 Services or feeders - installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: FFax: I E -mail: 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: Date: 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
Phone: Fax: E -mail:
of service or feeder fee, first branch circuit: 1 46. F 5 46.85
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc .(Serviceorfeedernotincluded):
❑ 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/lighting plan ❑ Other: Per inspection
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 $ 46.85
❑ 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 %) .... $ 3.75
Expires accepted as complete. TOTAL $ 50.6
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6p0/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 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 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular n G arage 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 2 n V acuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2 t�I Other
601 amps to 1000 amps $240.60 2 I I
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 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 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 pi HVAC
Each additional branch circuit $6.65 I 1
Miscellaneous n 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 N urse Calls
Per inspection $62.50
Per hour $62.50 U O 1 - - d — " Liyr
Fees: ❑ 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\forms\elc- fees.doc 10/09/00
r y Z .
CITY OF TIGARD BUILDING INSPECTION DIVISION MST �• •
24 :kIourspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 2 ' _) AM PM BLD
Location /11/1 5 /Z /IA"? Suite MEC
Contact Person ) _ / Ph 4f/ -26 / v PLM
Contractor a 5 E (�� Y� - . Ph SWR
BUILDING Tenant/Owner 77 /1G$,r Ca--0 � `j,�� 1� 7 ,,/ /A ELC Ztr / - 'ice ) , �f
Retaining Wall ELR
Footing Access:
Foundation �/ FPS
Ftg Drain ( ��� _ /2_ 7 1-- o^1 1 2-3 SGN
Crawl Drain Inspection Notes: �L
Slab Zft 1 / 2 SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof /] Q
Misc: l
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
ervice
Roug In
UG /Slab
Low Voltage
Fir- Alarm
PAS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ J 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: [ J Unable to inspect - no access
ADA
Approach/Sidewalk
Other Date l Inspector / 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
Crawl dram Electrical final l_ /o / a
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing � 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 -
Concrete Lab Final Fire damper -
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
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 4 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 -00089
} , IA DEVELOPMENT SERVICES DATE ISSUED: 2/12/01
1 ! 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 103CC -04400
SITE ADDRESS: 13815 SW 124TH AVE
SUBDIVISION: EAGLE POINTE ZONING: R -4.5
BLOCK: LOT : 019 JURISDICTION: TIG
Project Description: Job #8450 - Add (2) GFI's outside and (1) outlet at fountain area.
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: 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:
TERRY GIBSON ATLAS ELECTRICAL CONTRACTORS
13815 SW 124TH AVE 4403 SE ROETHE RD
TIGARD, OR 97223 MILWAUKIE, OR 97267
Phone: Phone: 659 -2212
Reg #: SUP 2581S
LIC 1532
ELE 3 -2C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 2/12/01 $46.85 2720010000( Elect'l Final
5PCT CTR 2/12/01 $3.75 2720010000(
Total $50.60
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. Thos.
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 ati ISSUED BY: i
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: 1
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day 1."14