Permit A - CITY OF TIGARD , ELECTRICAL PERMIT
PERMIT #: ELC2002 -00569
DEVELOPMENT SERVICES DATE ISSUED: 10/25/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S112BD -00100
SITE ADDRESS: 07560 SW BONITA RD 034
ZONING: R -12
SUBDIVISION:
BLOCK: LOT : 065 JURISDICTION: TIG
Project Description: Alteration of (5) 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: 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: 4 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:
WASHINGTON CO. HOUSING AUTHORITY SYLVANIA ELECTRIC CO
111 NE LINCOLN ST 5328 SE 109
#200 -L, MS63 PORTLAND, OR 97266
HILLSBORO, OR 97124 -3082
Phone: 503 - 8464794 Phone: 503 - 762 -2714
Reg #: ELE 26 - 1086C
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/25/02 $73.25
[TAX] 8% State Tax 10/25/02 $5.86 Rough -
Elect'! Final
Total $79.11
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 far -more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules ar�set forth in OAR 952 -.001 -0010 throe h • 'R 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246-6 /6 99 or 1 ed t 10- 332 - 2344. Q�� / 1 _
Issu By: , - / r�� Permit Signature: V / --ZS '0
OWNER INSTALLATION ONLY
The installalllowis - tieing made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUP'. EC'N: I DATE: G6
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
•
a
Electrical Permit Application
Date received: /O 50 — Permit no.: Fe_e_pio,t,, X5
4 '.,,l,l City of Tigard Project/appl.no.: A e date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: , B ri Receiptno.:
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
. . . - . • . JOB SITE INFORMATION ... :, , . ,
Job address: 5 O - `; O i ' • Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: Description and location of work on premises: ;i Nffl
Estimated date of completion/inspection:
, 'rCONTRACTOR'- APPLICATION ' . ., " •, , FEE. SCHEDULE ^ ..
Job no: / Fee Max
Business name: • . C. Q Description Qty. (ea.) Total no. insp
'�''� New residential - single or multi- family per
Address: ` C (� dwelling unit. Includes attached garage.
INEIWICIIIMIMIEL N.t.afC" ZIP: Wall Service included:
Phon Ej ( — • i i t . 01 VI !L� • 1000 s q. ft. or less 4
Each additional 500 sq. ft. or portion thereof __
CCB •.: (O 00 Elec. bus. lic. no: — 0 `C
Limited energy, residential ___ 2
City /metro lic. no.: Limited energy, non - residential ___ 2
Each manufactured home or modular dwelling ■■■
Signature of supervising elect n re' / Date :f W' Service and/or feeder 2
Sup. elect name (print): = y� License no: Q Services orfeeders— installation
alteration or relocation:
K PROPERTY OWNER , . 200 amps or less 2
Name (print): j, O#4� _,s, �/ , rt u A?, r p,t, r 201 amps to 400 amps ___ 2
401 amps to 600 amps ___ 2
Wain:. . ddress: ft 4.10 - 21 ,o — A_ AMI 601 amps to 1000 amps ___ 2
EIDEMMI Stater ZIP: • 71, Over 1000 amps or volts ___ 2
Phone: Fax: E -mail: Reconnect only 1711 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,orrelocation:
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 CO ess: service or feeder fee, each branch circuit ' `P 2
City: State: ZIP: B. Fee for branch circuits without purchase ,; `c�/
of service or feeder fee, first branch circuit: A 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/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 $x ,14.5--
❑ 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 %) $ f �'
Expires accepted as complete. TOTAL $ =�� 9, �'
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00 /COM)
.
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT 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 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n 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 Garage Door Opener
Dwelling Service or Feeder $90.90 2 El
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 I I 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 - 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. n Audio and. Stereo Systems • .
Branch Circuits '
New, alteration or extension per panel Boiler Controls
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
Each additional branch circuit $6.65 n HVAC
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 Ti ach additional inspection over I I Medical
the allowable in any of the above
Per inspection $62.50 n Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: n Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25 %Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application.
• Fees:
Total Balance Due $
Enter total of above fees $
E l Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
•
i:\dsts \forms \elc- fees.doc 08/30/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / a — a v AM PM BUP
Location 7 d Suit 3 MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 4 — e S6
Footing
Foundation ELC
Access:
Ftg Drain 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
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
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
Fire Alarm
PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date c o � � Inspector . Ext
4 AP
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL