Permit Q CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00337
�,�i�t DEVELOPMENT SERVICES DATE ISSUED: 6/19/00
"" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S101 BC 02800
SITE ADDRESS: 08250 SW HUNZIKER ST
• SUBDIVISION: ZONING: I -
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of 4 branch circuits. Job No. 20379
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: 3 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:
SEVERSON, JAMES A + ROBIN 0 PAGEL ELECTRIC
29404 SW HEATER RD • 1927 21ST AVE
SHERWOOD, OR 97140 FOREST GROVE, OR 97116
Phone: Phone: 357 - 4013
Reg #: LIC 00021574
SUP 4549S
ELE 34 -52C
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT DEB 6/19/00 $53.55 0003080 Elect'l Final
5PCT DEB 6/19/00 $4.28 0003080 Total $57.83 `
•
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. '� A
PERMITTEE'S SIGNATURE _ / /�'a ..� ISSUED = /
,'`� 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.'f S`,ELEC''N: . /t—�� DATE:
`
LICENSE NO: 1 15 -1 /7..5
Call 639 -4175 by 7:00pm for an inspection the next business day
0_ TIGARD Elect ' I Permit Applicati • : Plan Chec >#J
13125 SW HALL BLVD. �5 Rec'd By ��Pi j/j'►6t:t',�
TIGARD OR 97223 /i76 � Date Rec'd 0 /y�
Phone (503) 639 -4171, x304 '� - . .-\ �� � Date to DST
Inspection (503) 639 -4175 ,� o twrint of Type s $ � o �ti�� Permit # /,C - Da337
Fax (503) 598 -1960
. , - Inc ,, - e or illegible will not be Oted Called
0 �O�
1. Job Address: 4. Complete Fee Schedule Below: •
Name of Development Number of Inspections per permit allowed
Name (or name of business) r/ori z onr Service included: Items Cost Sum 4
Address 3.2.50 S u3 I tkvt z i k � r' 6td1 C-." 4a. Residential - per unit
J 1000 sq. ft. or less $ 117.75 4
City /State /Zip 1 q t" 7 a�o2 Each additional 500 sq. ft. or
portion thereof $ 26."35 1
r �� 1
Commercial 6Ed Residential ❑ Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). I Installation, alteration, or relocation
Electrical Contractor 0.9 e .\ Ele.art U 200 amps or less $ 64.25 2
Address l q ( 2 1 1 a.l A v .e_ 201 amps to 400 amps $ 85.50 2
City 'For State .. . c} �( 1 t l0 401 amps to 600 amps $ 128.50 2
ry 'F t a & Zip 601 amps to 1000 amps $ 192.50 2
Phone No. 5 03 - 3 57 - `- 0 ► 3 Over 1000 amps or volts $ 363.75 2
Job No. 2.. 0319 Reconnect only $ 53.50 2
Elec. Cont. Lice. No. .34- 5.2_ C_ Exp.Date /0 - 0 O 4c. Temporary Services or Feeders
OR State CCB Reg. No. 15 7 Exp.Date l o - 40 Installation, alteration, or relocation
COT Business Tax or Metro No. 3 7la 7 Exp.Date A/- 0 I 200 amps or less $ 53.50 2
nn o� e 201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'r 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
License No. 1 45 - 4 C( S Exp.Date / 6 - B see "b" above.
Phone No. S 0 351-40 1 3 4d. Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee. ,5
Phone No. First branch circuit / $ 37.50 37 _
Each additional branch circuit 3 $ 5.35 few 05
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)
Each pump or irrigation circle $ 42.75 _
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
(if required):* panL alteration or extension $ 60.00
3. Plan Review section
( Minor Labels (10) $ 46fi99
!Gef B d
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 • 5. Fees:
5a. nter total of above fees $ 53.6 -5-
5 ,3 .6 5
* Submit 2 sets of plans with application where any of the above apply. g % Surcharge (.c(X total fees) $ 1 1.0 2 g
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # g 3
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ E ( -
i:\dsts\forms\electric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 1 ' . ' I,� ( 0/21 , k-0 AM PM BLD
Location U 2-5 0 Lk ' 1 ro_r Suite C, MEC
Contact Person &yeL 14 CPh gS ?- f 3 PLM
Contractor �'�� Ph SWR
BUILDING .. �`_° ? 3�: ; `
Tenant/Owner ELC L -OO R ?7
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: ,
Slab f 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
j eASS—X_ART__ FAIL CTRICAlL)
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
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
Other Inspector
D `� ,C/ Itor Ext
Other �-.—�
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.