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Permit , CITY OF T I GA RD ELECTRICAL PERMIT PERMIT #: ELC2002 -00109 uE:�l�1 DEVELOPMENT SERVICES DATE ISSUED: 3/15/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S115BB-03900 SITE ADDRESS: 16060 SW KING CHARLES MAINT. SUBDIVISION: BUILDING ZONING: BLOCK: LOT : JURISDICTION: KIN Project Description: Installation of 2 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: 1 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: KING CITY NO 4 BROADWAY ELECTRIC - COCHRAN INC OWNERS OF ALL LOTS 626 SE MAIN PORTLAND, OR 97214 Phone: Phone: 234 -6564 Reg #: LIC 00072942 SUP 3447S ELE 37 -546C FEES Required Inspections Type By Date Amount Receipt Wall Cover PRMT CTR 3/15/02 $53.50 2720020000( Rough -in Elect'I Final 5PCT CTR 3/15/02 $4.28 2720020000( Total $57.78 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. ATTENTIO : e - oon-1 wrequires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 'rough OAR 952 -001 -0080. You may obtain copies of these rules or direct questions to Permit Signature..' _ ssued By: • i OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, leas -o: rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: S y C— Call 639 -4175 by 7:00pm for an inspection the next business day n • Electrical Permit Application .4; Date received: Permt no.:� _ City of Tigar R ECEV E D Project/appl. no.: Expire date: • City of Tigard Address: 13125 SW Hall Blvd ard (a 2 j 3 Date issued: By: Receipt no.: Phone: (503) 639 -4171 F t� " � `° Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: BUILDING ION - - oc.`P - 2'pD o� Q ooQ (Q. - . .. TYPE OF PERMIT - - 0 1 & 2 family dwelling or accessory • 0 Commercial/industrial 0 Multi - family 0 Tenant improvement v New construction 0 Addition/alteration /replacement 0 Other: 0 Partial JOB SITE INFORMATION Job address: , ° ""v••• :.►. - IWO Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: (Subdivision: i i AX,o 't4 • Project name:cpt.c- (v■d>stO r e,LJC I Description and location of work on premises: M r..). C-{ >) (_N -- ('\ • r Estimated date of completion/inspection: p \ OA k e 2_ , E_, o IC a G OLF M Ali T ■ L.DC) 't t ' CONTRACTOR APPLICATIO FEE SCHEDULE • Job no: 1 ()( o,c? D — = ? 11 1 4 • .. Fee Max Business name: Lp��,r 1,nc_ , a�c,� Description . Qty. (ea.) Total no. insp New residential - single or multi- family per Address: ( 5 \ C Mo-' ^ dwelling unit Includes attached garage. City: 2 , -A0,3,,,, I State: �. I ZIP: CV4Z.14 Service included: Phone:93 231},4E64 I Fax: 23$ -21S E -mail: 1000 sq. ft. or less • 4 Each additional 500 sq. ft. or portion thereof CCB no.: 7 2. 4'2_ I Elec. bus. lic. no: -37_5(4(4,c q Limited energy, residential 2 City /metr lic. n .: Q/ L energy, non - residential 2 e Each manufactured home or modular dwelling Signature of su rvising electrician (required) Date J / f 0 4 Service and/or feeder 2 Sup. elect.name(print): -,� �� •� Licenseno:3 s Services or feeders — installation, alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): ‘14.1 C' < y c l o I L A- aL 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: 601 amps to 1000 amps 2 City: V.., \tt1 CI, C- ,-- I State:0 (_I ZIP: Over 1000 amps or volts 2 Phone: 'Flax: I 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, or relocation: 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 Address: service or feeder fee, each branch circuit 2 City: I State: - 1 ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: 2 Phone: Fax: E -mail: - Each additional branch circuit: Misc. (Service or feeder not included): - ❑ Service over 225 amps - commercial ❑ Health-care facility Each pump or irrigation circle 2 Cl 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 0 Other. Per inspection 1 - _( • ( . J Submit _ sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other . • Permit fee $ ' 'r 674, Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application / ❑ Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) $ _ - j{ Expires accepted as complete. TOTAL $ ih' 7,7g' ' 7 g' Name of cardholder as shown on credit card $ L b�/ Cardholder signature Amount 440 -4615 (6/00 /COM) � /U 4 1Art:t s 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 4, Check Type of Work Involved: Residential - per unit - 1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33.40 1 ❑ Burglar Alarm Limited Energy , $75.00 Each Manufd Home or Modular G rage 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 n Vacuum Systems' 201 amps to 400 amps $106.85 2 401 amps to 600 amps $160.60 2 601 amps to 1000 amps . $240.60 2 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. r7 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 Fire Alarm Installation • or feeder fee. , Yl / / . ( First branch circuit $46.85 iG D Each additional branch circuit $6.65 . (o -lOb El 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 ❑ Medical Each additional inspection over the allowable in any of the above Calls Per inspection $62.50 Per hour $62.50 In Plant $73.75 LJ Outdoor Landscape Lighting Fees: -�j n Protective Signaling 5 Enter total of above fees $ : i /') 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 $ -59 , 7e Enter total of above fees $ • ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ i:'dsts\forms \elc- fees.doc 10/09/00 03/15/2002 09:40 5036393771 CITY OF KING CITY PAGE 02/2 • • KING CIT • 15200 S.W. 16th Avenue, King City, Oregon 97224 -2693 Phone: (503) 639-4082 • FAX (503) 629-3771 • • • Notice To Contractors Workin In King City • Due to an intergovernmental agreement with the City of Tigard, many building related permits for projects in King City are issued and inspected by the City of Tigard. If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the appropriate application legibly and submit it to the King City staff. The King City staff will • collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create the permit, issue the permit, and perform inspections. Please indicate on the permit application whether you would like the Tigard staff to call you when the permit is ready for issuance or whether you prefer it to be mailed without any notification. Any incomplete or illegible application will be returned to King City staff for correction and no processing will occur until a complete, legible application is received. If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a King City staff person. King City staff will simply sign this form indicating land use approval. • Take this signed form to the City of Tigard Development Services Counter located at 13123 SW • Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are available at 639 -4171 Ext. 304 should you have any questions concerning submittal requirements. All permit fees will be assessed and collected at the City of Tigard. • • The City of King City hereby authorizes applicant to pursue permits at the City of Tigard Building Department for the following project: -'-1. 414 :.,,ii I _� _ % ' I 1i915 I eir-44a4 4min located at: 1.0. \bat • King City Representative 3-- 13 d • DSTS'.tiCUNST DOc • • • • • CITE( OF TIGARD BUILDING INSPECTION DIVISION MST • 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 3 -- AM PM BLD Location /p (0 .SGe, //h / 4 C44,4 Suite MEC Contact Person Ph .5 Z- 7 3 G7 PLM Contractor Ph SWR BUILDING` , . ; ti ; :3 �� Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear - Int Sheath /Shear Framing Insulation Drywall Nailing Firewal I Fire Sprinkler Fire Alarm 1 Susp'd Ceiling Roof (1 I Misc: Final PASS PART FAIL PLUMBING'a Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANIC L Post & Beam Rough In Gas Line Smoke Dampers Final P�►SS —R AS FAIL ELE CTRL� "Alegi K F Service G /Slab Low Voltage Fire Alarm na ‘s+ii! PART FAIL SITE, 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 Date 3 " 1, 2 Inspecto 1 o E Final PASS PART FAIL DO NOT REMOVE this inspection record from the job ite.