Permit CITY OF TI CARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00003
� I�l DEVELOPMENT SERVICES - . ty DATE ISSUED: 1/15/02
�` -° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136DD-01400
SITE ADDRESS: 06855 SW BAYLOR ST
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT : 002 JURISDICTION: TIG
Proiect Description: Electrical work associated with construction of new office building.
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: 21 PER INSPECTION:
201 - 400 amp: 1 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:
ESLINGER BUILDERS DAVID JEROME ELECTRIC
11575 SW PACIFIC HWY PO BOX 751
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: 503 - 620 -9515 Phone:
Reg #: -5
SUP 2877S
ELE 34 -119C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT CTR 1/15/02 $246.50 2720020000( Elect'I Final
PLCK CTR 1/15/02 $61.63 2720020000(
5PCT CTR 1/15/02 $19.72 2720020000(
Total $327.85
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 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
Permit Signature: /1 Issued By: 0 ,47 , 3 47 2 /
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
A
Electrical Permit Appl
Alk
Date received: / 2 0 2-- Permit no.:
ti1.:6 "• City of Tigard Proj Expire date: „ o�'
City of Tigard Addr 13125 SW Hall Blvd Tigard OR 97223 Date issued: By: Receipt no.: 5`
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT ' , ' '
❑ 1 & 2 family dwelling or accessory Commercial /industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
. . - JO SITE INFORMATION •
Job address: ' pis •+, Bldg. no.: Suite no.: Tax ma /tax lot/account no.: so , A
Lot: 13 —/i. � Block: - Z Subdiv• ion: (.Jje5 ' '{��' --� g J -
Project name: fl or 'y a , am Description and location of work on pr mises: 46, , Z. '5 i : �y f_... >!7 -
Estimated date of completion/inspection: _ t92 . •
..ate,_.._... 4;r : CONTftAtTOR-APPL-IE-• / ‘:_- - __,:.' *,.....,.. ...Y . - .___ . :. -... -: ' , 1 -
Job no: Fee Max _
Business name: D.A. escription Qty. (ea.) Total no. insp
.A. Jerome Electric
n' Address: P O Box 751 New residential -single ormulti- [amity per
dwelling unit Includes attached garage.
City: Hillsboro I State() R I ZIP: 97123 Service included:
i Phone: 648-5144 I Fax: 648 - 9 7 2 -mail: 1000 sq. ft. or less 4
C CCB no.: 36051 I Elec. bus. lie. no: 34 -119 Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
U) City /metro lie. no.: 106 Limited energy, non- residential 2
/• / 4 /� Each manufactured home or modular dwelling
c_ c_. Signature of supervising electrician (required) ate ( Service and/or feeder 2
Sup. elect. name (print): D 2 V i d i a II - License no:
Services or feeders — installation, •
• alteration or relocation:
PROPERTY OWNER , • 200 amps or less 2
Name (print): immi,ji, 201 amps to 400 amps 2
_ 401 amps to 600 amps 2
Mailing address: _ „ '
Mgr' ' ' r 1� �
601 a mps to 1000 amps 2
City: L 4 L�' State ., ZI :472 2.3 Over 1000 amps or volts 2
Phone: f 1,4" —f�ZE I Fax -' -mail: Reconnect only l
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,orrelocatio .'
ORS 447, 455, 479, 670, 701. 200 amps or less 2 t
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
r ENGINEER Branch circuits - new alteration,
”
' ' ^ ,. or extension per panel:
Name j PieV" } l t,C
C�72 A. Fee for branch circuits with purchase of
Address: �2� _ ' 1.4'.. i, ; - ry service or feeder fee, each branch circuit 2
_ ; ,� _ B. Fee for branch circuits without purchase
r" 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 signor 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 I F I
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 $
❑ 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 %) .... $
Expires accepted as complete. TOTAL $ •
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6R)0 /COM)
0
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p 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 I Audio and Stereo Systems
Each additional 500 sq. ft or
portion thereof $33.40 1 I I Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2 n Garage Door Opener
Services or Feeders n Heating, Ventilation and Air Conditioning System`
Installation, alteration, or relocation .
200 amps or less $80.30 2 I
201 amps to 400 amps / $106.85 / Q 6.85 Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders
TYPE OF WORK INVOLVED - COQ IMERCIAL 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. n Audio and Stereo Systems
Branch Circuits n
New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or n C lock Systems
•
feeder fee.
Each branch circuit 2/ $6.65 /3 q , 6 5 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 ri HVAC
Miscellaneous f-I
(Service or feeder not included) I 1 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 . n Landscape Irrigation Control
Minor Labels (10) • $125.00
Each additional inspection over n M edical
the allowable in any of the above
Per inspection __ $62.50 n Nurse Calls
Per hour $62.50 -
In Plant $73.75 n O utdoor Landscape Lighting
Fees: n t1� n Protective Signaling
Enter total of above fees $ .b
f to ` n Other
8% State Surcharge $ / 9 7 2
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ / c * No licenses are required. Licenses are required for all other installations
front of application. 6 /, 6 3
IC
Total Balance Due $ Sg
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
•
• Total Balance Due $
i:\dsts \forms \elc- fccs.doc 06/07/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7 -/ AM PM BUP
Location • : �% �: Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC avd - 4 9A 23
Footing
Foundation ELC
Access:
Ftg Drain 6 ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm 5— ,p
5 '—' � �! ' e-/TX / 2A [� /;7.-/O ` 7 `� /" /� 1
Susp'd Ceiling
Roof
Other:
Final �h �/ 5
PASS PART FAIL /� �f /✓�
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL,
Service
Rough -In
UG /Slab
Low Voltage
Alarm
F Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date - Inspector ` Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING 6 , Inspection Line: (503) 639 -4175
MST
INSPECTION DIVISION Business' Line: (503) 639 -4171
BUP
Received Date Requested /0 / AM PM _ BUP
Location 5 S Suite MEC -02-7(
Contact Person Ph ( ) PLM
Contractor i - Ph ( ) 6 la - 57 ` at SWR
BUILDING Tenant/Owner ELC ° 70 3
Footing
Foundation ELC
Ftg Drain A ccess: ,
Crawl Drain _ Lj -2J2 / ?
Slab Inspection Notes: L I , ' SIT
Post & Beam eyi (l/ ,, e___'
Ext • Sr ea Anchrs � e- �_ J _ ` ,
\./
Ext Sheath /Shear � � /�
Int Sheath/Shear
Framing
Insulation ��/1
Drywall Nailing
Firewal
Fire SpI rinkler L )p-7L, C , c
Sp
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING COdc --
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain _
C - r
Shower Pan
Other: _,
Final
_ PASS PART FAIL
MECHANICAL P-7/2/0 3
Post & Beam
Rough -In
Gas Line
/4 7
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
'Hough -In
U ab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS PART FAIL
S fl Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date l D -- 62 Inspector �-'l c7�1 { ,�n.' ► Est
Other: 1 7
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL