Permit C ITY OF TIGARD ELECTRICAL PERMIT
('' PERMIT #: ELC2004 -00302
JAI DEVELOPMENT SERVICES DATE ISSUED: 6/1/2004
-`" 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2 S 105 D D -07100
SITE ADDRESS: 14665 SW KLIPSAN CT
SUBDIVISION: PACIFIC CREST ZONING. R -7
BLOCK: LOT : 047 JURISDICTION: TIG
Project Description: Adding (1) branch circuit for new a /c.
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: 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:
AMY MAUSS (GARY) COOPER ELECTRIC
14665 SW KLIPSAN CT 11845 SE 34TH ST
TIGARD, OR 97223 MILWAUKIE, OR 97222
Phone: 503 - 579 -6963 Phone: MOM #654 -1100
Reg #: 'it 8 -8803 2965S
LIC 42918
FEES ELE 3 -191C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/1/2004 $46.85
[TAX] 8% State Surcharge 6/1/2004 $3.75 Rough -
Elect'I Final
Total $50.60
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 - • 9 R 952 - 001 - 0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6• :• or 1 -800- 332 -2'4;
Issu • By: 0 / 04, 1 e Permit Signature: cam /' 1
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: ,' � �' r��'t -� DATE:
LICENSE NO: p0 s
Call 639 -4175 by 7:00pm for an inspection the next business day
' - 'l. Electrical P ermit Application
� /+ �+ Date received: 5, lq Permit no.: iG ...60 g
. s� .1 City of 1 i = 3'.i.t l poll Projecdappl. no Expire date:
Address: 13125 S { x611•11 ., 97223
City of Tigard Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 MAY 2 8 2004 Case file no.: Payment type:
Land use approv i1: (ATV OF Tf
,TYPE OF PERMIT
L & 2 family dwelling or accessory Commercial/industrial Multi- family Tenant improvement
❑ 1:1 Cl New construction ❑ Addition/alteration/replacement LI Other: Cl Partial
JOB SITE INFORMATION
Job address: • . 5 4 J filiTAWSWA111111 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: ' Subdivision:
Project name: V idnIEMI Description and location of work on premises: _5:- N '
Estimated date of completion/inspection:
_ CONTRACT 1 R ; : ,t . • ":1 l .: FEE SCHEDULE
k
• Job no: Fee ' Max
Business name: C. 10 ® pe R 6 L k c://R (t, Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Address: I ■ 'rh i e... dwelling tmit. Includes attached garage.
City: 0 L G,.) - i e State:O R ZIP: V.722 Service included:
Phone:6 6, 3- ngi)'3 I F ax:&„5 -// E- mail: 1000 sq. ft. or less 4
' 0 � CCB no.: 42 ? / g , I Elec. bus. lie. no: 3_1 g`� ` Each additional 500 sq. ft. or portion thereof
/ ..- Limited energy, residential 2
1 `�1 City /metro lie no.: QQ G+ 1i 9 >'�` 1 �Oy Limited energy, non - residential 2
'_� — -....C./ Each manufactured home or modular dwelling
Signa ure o supervising electrician (required) Date Z Service and/or feeder 2
Sup. elect. name (print): G -, / C dO 4. License no: Services or feeders - installation,
alteration or relocation:
• ' ' PROPERTY OWNER • 200 amps or less - 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: • 601 ampsto 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only t
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:
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
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: I ZIP: B. Fee for branch circuits without purchase ` "
of service or feeder fee, first branch circuit: 't (0 t �, 2
Phone: Fax: E -mail: -
Each additional branch circuit:
Misc. (Service or feeder not included):
0 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 O 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/lightingplan ❑ Other: Per inspection I 1
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 $
❑ 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 %) :. - $ -3,
Expires accepted as complete. • TOTAL $ ,5?) . 6 0 '
Name of cardholder as shown on credit card
$ `
Cardholder signature Amount • t 440 - 4615 (6/00 /COM)
•
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT F•ES
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
P 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 n
Dwelling Service or Feeder $90.90 2 Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 n
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 ❑ 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. ❑ 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 n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 ❑
Each additional branch circuit $6.65 HVAC
Miscellaneous .
n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over n Medical
the allowable in any of the above f � I
Per inspection $62.50 l l Nurse Calls
Per hour $62.50
In Plant $73.75 1-1 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 $ -
ID Trust Account # 8% State Surcharge $ .
Total Balance Due $
is \dsts\forms \elc- fees.doc 06/07/01
CITY OF TIGARD 24 -Hour
BUILDING Inspection 'Line (503) 639 -4175
INSPECTION DIVISION Business Lin: (503)=639 -4171 MST
BUP
Received Date Reque t -d AM AM PM BUP
Location CS u i te
a CO'j – Ooh ?
Contact Person ♦ -r �1 ' h ( ) • � o ' O °� ( PLM
Contractor / Ph ( ) SWR
BUILDING Tenant/Owner 0/M E v00 If — 06 3d k.
Footing
Foundation ELC
S c 1)v
Access: /A:ntb ,v
Ftg Drain
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam - - - --
Shear Anchors f d
d_k x
Ext Sheath/Shear Ci -�. /l� a `o
Int Sheath/Shear "
Framing
Insulation �- C� X �T7 jrt
Drywall Nailing TA a
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING 1
Post &Beam Mgr
Under Slab
Rough-In -
Water Service
Sanitary Sewer -
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
:MECHANICAL:d
Post & Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
- ECTRICAL
Service
Rough -ln
UG /Slab
Low Voltage
Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI �E� �� .'� �".,° �..` ° °,' - 0 Please call for reinspection RE: ' Ei Unable to inspect - no access
Fire Supply Line _
ADA D /0.//,67. Inspector Ext
Approach/Sidewalk iP
Other:
Final DO NOT REMOVE this inspection reco ' rom the job site.
PASS PART FAIL