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Permit • CITY TIGARD ELECTRICAL PERMIT �. �. °-• PERMIT #: ELC2000 -00333 - Z VI DEVELOPMENT ig r SERVICES DATE ISSUED: 06/16/2000 (503) 639 -4171 PARCEL: 1S125CD-05800 SITE ADDRESS: 09950 SW LANDAU PL SUBDIVISION: PP1990 -051 ZONING: R-4.5 BLOCK: LOT : 002 JURISDICTION: TIG Project Description: Install one branch circuit in SF dwelling 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: DALE GREENBLATT EVERGREEN ELECTRICAL CONTRACTO 9950 SW LANDAU PLACE 23861 SE 442ND TIGARD, 0 97223 SANDY, OR 97055 Phone: Phone: 503 - 668 - 4608 Reg #: LIC 136311 ELE 3 -472C SUP 4581S FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT SS 06/16/200 $37.50 00030 Elect'I Final 5PCT SS 06/16/200 $3.00 00030 � Total $40.50 O'C\G\IS‘ 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. PERMITTEE'S SIGNATURE \ ( ( ISSUED BY Y \N c l e cr __� «<1]] / Lail t n a. • /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: C3V\.. (J , c ft �J DATE: 6 - IG - o LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day • CITY OF TIGARD Plan Check # 13125 SW HALL BLVD. RE CE9@� Electrical Permit Application Recd By se c TIGARD OR 97223 Date Recd (e a - r � � � Phone (503) 639.4171, x304 2000 Date to F.E. Date to DST inspection (503) 639 -41'COM ;N l' DE �� :.Ni Print of Type Permit* 61-c, - 2.03Q , - © (:�Z,3 Fax (503) 598 - 1960 In or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development . Number of Inspections per permit allowed Name (or name of business) 00.1e C-i reer, Vila..-1 Service included: Items Cost Sum 1 Address 1 � 5 0 SI ,0 l_1�.1\(1 11 . (A 1" ,r� t • 4a. Residential - per unit Ci /State /Zi \ yk cl 0 r(L Each ad ti or less $ 117.75 4 tY p T ) Each additional 500 sq. it or it portion thereof $ 26.75 1 Commercial ❑ Residential limited Energy $ 60.00 Each Manufd Home or Modular i 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). Installation, alteration. or relocation Electrical Contractor O P ^ � ELe Tvv-ic, t- 200 amps or less $ 64.25 2 Address ',3$101 E 1- c4 - 201 amps to 400 amps $ 85.50 2 G _ • 401 amps to 600 amps $ 128.50 2 City Y � State r)i�l Zip 0 1 - 11 J 601 amps to 1000 amps $ 192.50 2 Phone No. i 10 g - 1 - 14.0 Ug - Over 1000 amps or volts $ 363.75 2 Job No. ( - ) „ ) - I I g . Reconnect only $ 53.50 2 Elec. Cont. Lice. No. 3 - 4"1 a. C Exp.Date 101 rr- C 4c. Temporary Services or Feeders OR State GCB Reg. No.13t0?)1 I Exp.Date _ Installation, alteration, or relocation COT Business Tax or Metro No - Exp.Date (olryi jr)D 200 amps or less 5 53.50 2 201 amps to 400 amps $ 80.25 2 Signature of Supr. Et 401 amps to 600 amps $ 100.00 2 Over 600 amps to 1000 volts, see "b" above. License No. 1 4 5S1 S Exp.Date %C> fm 101 4d. Branch Circuits Phone No. t o 1D SS -l.lt r,0 New, alteration or extension per panel a) The fee for branch circuits G V t 2b. For owner installations: with purchase of service or C C lli"1" 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. Phone No. First branch circuit t $ 37.50 5 Each additional branch circuit $ 5.35 _ 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 circuits) ore limited energy panel, alteration or extension $ 60.00 3. Plan Review section (if required): * Minor Labels (10) $ 100.00 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. Enter total of above fees $ J 1.50 * Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ '3 • n0 Not required for temporary construction services. Subtotal $ 4 0.5 0 Sb. Enter 25% of line 5a for NOTICE Plan Review if required (Sec. 3) 5 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 #f- - AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 40 i :\dsts\formsle lectrie. doc CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639 - 413x-' Business Line: 639 -4171 BUP Date Requested V0.400 AM X PM BLD Location `7-1' 0 C a Ad , e- ( Suite eia)/, Contact Person \ sfec, Ph 1--- -7 006 PLM Contractor Ph SWR Tenant/Owner e ' 1 Retaining Wall ELR Footing Access, Foundation ( to - / ` � FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab Ay C. SIT Post & Beam g9-2_ ( Ext Sheath /Shear Int Sheath /Shear Framing Insulation / r, �--� Drywall Nailing Na F/C 2_/Cc� ��' /��� Gde, ld l / 6_4 -/ � 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 Post & Team Rough In Gas Line Smoke Dampers . �� PART FAIL • CTRIC Service' Rough In UG /Slab Low Voltage Fire 4 larm 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 Date 64/ / l 0 ( Inspector Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.