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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2001 -00192 A DE VELOPMENT SERVICES DA TE ISSUED: 4/17/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S116AD -24900 SITE ADDRESS: 16714 SW JORDAN WY SUBDIVISION: BEDFORD GLEN ZONING: BLOCK: LOT : 015 JURISDICTION: KIN Project Description: Installation of 4 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: 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: ETTESTAD, LYLE L + LINDA A TUALATIN ELECTRIC 16714 SW JORDAN WAY PO BOX 655 TIGARD, OR 97224 WILSONVILLE, OR 97070 Phone: Phone: 682 -2955 Reg #: LIC 00065650 SUP 3483S ELE 3 -268C FEES Required Inspections Type By Date Amount Receipt Rough -in PRMT CTR • 4/17/01 $66.80 2720010000( Elect'I Final 5PCT CTR 4/17/01 $5.34 2720010000( Total $72.14 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 - 6699 or 1 -800- 332 -2344. r Permit Signature: _,4/( 1 2t Issued By: da-- 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 P5OS] c , A Electrical Permit Application Date received: y / a / Permitno.:ae /—ii/9,2 . ,11°I.:1 I City of Tigard Project/appl. no Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: B • _.. .• - ceipt no.: 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:] an Bldg. no.: Suite no.: Tax map /tax lot/account no.: .o Lot: Block: u..ivision: ■ 1 • a t 4 Project name: E ■ Description and location of work on premises: ., t v=van . stimated date of completion/inspection: V csk\.., a e.n W M2. • TY CONTRACTOR. APPLICATION _:'. ; : _ FEE SCHEDULE ' - Job no: 1 Fee Max Business flame' — • Description Qty. (ea.) Total no. insp • "` `� a , New residential - single or multi- family per Address: PO i pv( b — dwellingunit. Includes attached garage. 11EIMMEMMIIME State ZIP: q 0 Serviceincluded: Phone: L;�, . sGS MEM= E -mail: 1000 sq. ft. or less 4 CCB no.: t �,�jU Elec. bus. lic. no: �a �� Each additional 500 sq. ft. or portion thereof __ _ Limited energy, residential ___ 2 2 City /metro lic. _ o.: 1- __ Limited energy, non - residential _ 2 ^� 40 _ftigi y -11 Each manufactured home or modular dwelling Signature of supervising el - ctrician (required) Date Service and/or feeder ■■. 2 Sup. elect- name (print): 1A' Q • t , vt C� License no:3 cation: Ilation, Services or feeders install El alteration or relo ' PROPERTY OWNER - - - _ 200 amps or less 2 Name (print): \_ \ 201 amps to 400 amps __ 2 its 401 amps to 600 amps _ 2 Mailing address: Lt�� =� pr __ 601 amps to 1000 amps ___ 2 ISZIERMIIMIIM State: dQ ZIP: ' _ls.,. Over 1000 amps or volts ___ 2 Phone: _. p -143) Fax: 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,orrelocation El ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps __ 2 Owner's signature: Date: 401 to 600 amps ___ 2 x - - --- E NGINEER';- -- - - - - -- - - 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 "E= Phone: Fax: E of service or feeder fee, first branch circuit: Each additional branch circuit: . MEM \°t. ct ,: - „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 IIIIII 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* ME 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Descri .tion: _ ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lightingplan ❑ 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 $ _L ,. a3 ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ _ u Credit card number: / / within 180 days after it has been State surcharge (8 %) $ • 3 \ Expires accepted as complete. TOTAL $ �a . Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00 /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 1, 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 I 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 n Vacuum Systems 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 El 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 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 n Data Telecommunication Installation b) The fee for branch circuits without purchase of service n Fire Alarm Installation or feeder fee. First branch circuit $46.85 Each additional branch circuit $6.65 n HVAC Miscellaneous i I 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) $125.0• Each additional inspection over I Medical the allowable in any of the above n Nurse Calls Per inspection $62.50 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 $ • i:\dsts \forms \elc- fees.doc 10/09/00 I 3rr CITY OF TIGARD BUILDING INSPECTION DIVISION MST - "c* 24-Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 5"- AM PM V BLD Location /67 7/(( 5 w ;; 4 r 'el CL-.■ w y Suite MEC Contact Person Ph 'i Z- 21, - PLM Contractor Ph. 2C ( SWR BUILDING ° F Tenant/Owner 7 GA )1,--C-e-11 /, ELC "W" 0 2-- Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam /1/eV / i , / /l Ext Sheath /Shear ` /� ` 6 Y \ 51 - e . _ Int Sheath /Shear Framing Insulation ,I� Drywall Nailing f C! Y/ Cc Firewall / Fire Sprinkler /k7 < " _ - 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 ,M,EGHA 1:P.AL.:, ° Post & Beam Rough In • Gas Line Smoke Dampers Final PASS PART FAIL _. Service Rough In UG /Slab . Low Voltage PASS P • RT FAIL ' ITE: 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 Agi ADA Approach /Sidewalk Other Date Inspector �, ,� Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.