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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2002 -00206 DEVELOPMENT SERVICES DATE ISSUED: 5/7/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S101 BC -01000 SITE ADDRESS: 08485 SW HUNZIKER ST SUBDIVISION: KNOLL ACRES ZONING: R -4.5 BLOCK: LOT : 005 JURISDICTION: TIG Project Description: Replacement of original wiring for (3) branch circuits in day care facility. 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: 2 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: CLICKENER, ROBERT R + PATRICIA OWNER 13855 SW PACIFIC HWY TIGARD, OR 97223 Phone: Phone: Reg #: FEES Required Inspections Type By Date Amount Receipt Rough -in PRMT CTR 5/7/02 $60.15 2720020000( Elect'I Final 5PCT CTR 5/7/02 $4.82 2720020000( Total $64.97 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. .1 may o: airtpies of these rules or direct questions to - \ C a � / , Permit Signature: „. G I-sued By: Kln — a 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: S L CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day ji.v, . Electrical Permit Application . i • Date received: 5 7 00 - Permit no.: ea ; A i 4 ,..1 Ji City of Tigard Project/appl. no.: • Expire date: City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: .', 4 ,. .1z , r' F, .T PERMIT .� . - -1 . ,, .. P E,OF . PE T ❑ 1 & 2 family dwelling or accessory iit Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial w' fi h 0 •: P :., . JOB ; SITE INFORMATION ' :. ' �,ka i Job address: .g ' g S F-Ft..,�fQ Z S't«2 Bldg. no.: Suite no.: Tax map /tax lot/account no.:257. p/ Sc _ O /ic0 Lot: Block: Subdivision: , 6“...../..- E c_1?-e" Project name: . • t+-24.0 . - (' P ,:cription and location of work on premises: L ' 0 o e..r7,44 -4. W 6_ Estimated date of completio l . lie t'•n: -7,0 .-02 • l,,rrsbt'is= 0:, u11,,Z-13 .s..+v cL PCS5 loot.- A-t ' . r ''"';`,,,l',';','' , . . E SCHEDULE ` � , t. 'z "° a � GONTRt�,CTOR APPLICATION � , . - � • F E' HE LE f °. i Job no: Fee Max Business name: * Description Qty. (ea.) Total no. insp New residential - single or multi - family per Address: dwellingimit. Includes attached garage. City: State: ZIP: ' Service included: Phone: Fax: E -mail: 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof __ CCB no.: Elec. bus. lic. no: Limited energy, residential ___ 2 City /metro lic. no.: Limited energy, non- residential MIME 2 Each manufactured home or modular dwelling IME Signature of supervising electrician (required) Date Service and/or feeder 2 Sup elect name (print): License no: Services or feeders — installation, alteration or relocation: .... 4 ' :. r . :,..':•` ; ' .. PROPERTY OWNER ,:, t r :y`, , , . 200 amps or less 2 Name rint ' - �J 201 amps to 400 amps EM__ 2 (P ) �c — F�pFZ �LC1C IZ 401 amps to 600 amps ___ 2 Mailing address: • • ,, , 4 ■ e 601 amps to 1000 amps ___ 2 _ _ _� - R State o g... ZIP: ZZ Over 1000 amps or volts ___ 2 Phone: 0,('063 Fax:5D3 57/ Q E- mailCJ .k .e,, -( ao% ,.' econnectonly _ 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, 6 0, 701. (� v 201 amps to 400 amps • ___ 2 �t �- Owner's signatur -� n -c^6: 6)-( 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: State: ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: M! •,`G'C 2 Phone: Fax: E-mail: Each additional branch circuit: ir��_OMMIIIMIll PLAN REVIEW (Please check all that apply) Misc. (Service orfeeder 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 MM. 2 family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, IME ❑ 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 l� Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ Glr1lA ❑ 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 %) $ • 19 ` 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: i 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 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 n Garage Door Opener Dwelling Service or Feeder $90.90 2 Services or Feeders n 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 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 exte per panel n 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 e! g'.-- n Fire Alarm Installation or feeder fee. First branch circuit / $46.85 Each additional branch circuit . $6 /'', 30 n HVAC Miscellaneous n Instrumentation • (Service or feeder not included) Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 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 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 $ ❑ 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 INSPECTI06.,DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Req ested a4 AM PM BUP Location "r .1/4 . mac' Suite MEC Contact Person)" Ph ( ) ?TO c PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC . — 04 Footing ELC Foundation Access: /l- e �/ Ftg Drain ��� ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors \-. 71// Ext Sheath /Shear Ina Sheath /Shear Framing Insulation • Drywall Nailing \ Firewall Fire Sprinkler Fire Alarm ' Pre vit,zi.s 2 t/ 'i- (..))14, /7 v? Susp'd Ceiling Roof ' ■4.,0 aw i Other: Final • PASS PART FAI PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final C c - e (4 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. taigliMPJ PART FAIL T n Please call for reinspection RE: n Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk Date E1 ° © ; Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL