Permit C
CITY ELECTRICAL PERMIT
O F TIGARD G A R D
PERMIT #: ELC2000 -00581
�r DEVELOPMENT SERVICES DATE ISSUED: 10/6/00
r�l I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135AD-04400
SITE ADDRESS: 08516 SW LUCILLE CT
SUBDIVISION: LUCILLE ESTATES ZONING: R -12
BLOCK: LOT : 006 JURISDICTION: TIG
Project Description: Installation of 7 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: 6 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:
NATHAN, ERWIN J VANDER STOEP ELECTRIC
8516 SW LUCILLE CT 23765 THIRD ST NE
TIGARD, OR 97223 AURORA, OR 97002
Phone: Phone:
Reg #: LIC 89417
SUP 4360S
ELE 24 -304C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 10/6/00 $86.75 2720000000( Wall Cover
5PCT CTR 10/6/00 $6.94 2720000000( Elect'l Final
Total $93.69
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 SIGNATUR % / �+1 /r+: ISSUED BY:
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
r
. ,.
Electrical Permit Application
A.
Date received: /(j /eVer Permit no.: 6GC ego oO -DO /
-•11, ;•f i City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
i 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction O Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: S576. S, (J 1,1 ).4....e. C7' Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: • I Block: I Subdivision:
Project name: 17(f . frkc'{.4 )'J I Description and location of work on premises: 8 R 7:)a/446I= "* •1
Estimated date of completion/inspection: I — 0
CONTRACTOR APPLICATION FEE SCIIEDU.E
Job no: Fee Max
Business name: ['h./pg./Q._ SEEP &1.-.EC - Description Qty. (ea.) Total no. insp
�
1^ New residential - single or multi - family per
Address:
Z37�� / /�(RD ��- • G dwelling unit Includes attached garage.
City: 1) I Stater ZIP: €772,c.2"7.._-- Service included: •
Phone: 'e57 j !1 I Fax:�'Z$- 17 (` 'E -mail: }�t/�,11D siv� t• or less 4
CCB no.: : I Elec. bus. lic. no: 21.-30 2 /
Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
Cit I Limited energy, non- residential 2
/ __ �„„+ %1/ 1O _e.i... DU Each manufactured home or modular dwelling
ignature of supervising el- . ician (required) Date Service and/or feeder 2
Sup. elect. name (print):•L bE12 .S a-0� License no: 43 C OS 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 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: 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, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am . s 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
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: (� 2 2
Each additional branch circuit: O
PLAN REVIEW' (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1 &2 0 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,
O System over 600 volts nominal more residential units in one structure alteration, or extensions` _ 2
O Building over three stories Cl Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan 0 Other: Per inspection I I I I
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 Penult fee $ k - 7 j
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ 4=agb
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ G .9Y.
Expires accepted as complete. TOTAL $ _ ?'.3 . eo 9
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00/COM)
•
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Electrical Permit Fees: Limited Energy Permit Fees:
Number of Inspections per permit allowed
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Service included: • Items Cost Total
4a. Residential - per unit Restricted Energy Fee $75.00
1000 sq. ft. or less $147.15 4 (FOR ALL SYSTEMS)
•
Each additional 500 sq. ft. or
portion thereof $33.40 1 Check Type of Work Involved:
Umited Energy $75.00
•
Each Manufd Home or Modular - ❑ Audio and Stereo Systems
Dwelling Service or Feeder $90.90 2
Burglar Alarm
4b. Services or Feeders
•
Installation, alteration, or relocation Garage Door Opener'
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2 0 Heating, Ventilation and Air Conditioning System'
601 amps to 1000 amps $240.60 2
Over 1000 amps or volts $454.65 2 ❑ Vacuum Systems'
Reconnect only $66.85 2
4c. Temporary Services or Feeders ❑ Other
Installation, alteration, or relocation
200 amps or less .$66.85 2 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
201 amps to 400 amps r $100.30 2
401 amps to 600 amps . $133.75 2 Fee for each system $75.00
Over 600 amps to 1000 volts.. (SEE OAR 918 - 260 -260)
see "b" above.
4d. Branch Circuits Check Type of Work Involved:
New alteration or extension per. panel Audio and Stereo Systems
a) The fee for branch circuits
with purchase of service or ❑
feeder fee. Boiler Controls •
Each branch circuit $6.65 2
b) The fee for branch circuits ❑ Clock Systems
without purchase of service . ,
or feeder fee. Data Telecommunication Installation
First branch circuit $46.85 �� • 3
Each additional branch circuit co $6.65 ,, .g n Fire Alarm Installation
4e. Miscellaneous
(Service or feeder not Included) ❑ HVAC
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Instrumentation
Signal circuit(s) or a limited energy .
panel, alteration or extension $75.00 _ ❑ Intercom and Paging Systems
Minor Labels (10) $125.00
4f. Each additional Inspection over : ❑ Landscape Irrigation Control'
the allowable In any of the above
Per Inspection $62.50 ❑ Medical
Per hour $ 62.50 •
In Plant - $73.75 _ ❑ Nurse Calls •
5. Fees: LC. , 75 El Outdoor Landscape Lighting' 6a. Enter total of above fees $ o
8% Surcharge (.08 X total fees) $ O
Subtotal Protective Signaling
6b. Enter 25% of line 6a for ❑
Plan Review if required (Sec. 3) $ Other
Subtotal $
Number of Systems
❑ Trust Account a / 9 • No licenses are required. Licenses are required for all other installations Tota! balance Due $ J rG
• FEES:
ENTER FEES $
•
•
8% SURCHARGE (.08 X TOTAL ABOVE) $
•
• TOTAL $
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CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
;• BUP
Date Requested /1- Le/ AM PM BLD
cv
Location �i S ( Stv G i /Aa CA Suite MEC
Contact Person Ph VlO 7 -57 / Z PLM -
Contractor :ir cif-r- 6 • ; Ph SWR
BUILDING Tenant/ wner ELC, vj/ -ric) 5
Retaining Wall Gr! f( VCI ,S 6.6 ELR
Footing Access: 1 &9 f "
Foundation OH f G _ v FPS
Ftg Drain / / 0 SGN
Crawl Drain Inspection Notes:
Slab 7- c( R SIT
Post & Beam
Ext Sheath /Shear Uf L f S i fl (2- S cl (e, 4- rQ,_ ), r / 0 / iluip
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler "�/ tit 4.-4•4!
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
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
Cf LEM:RIG
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
P T FAIL
BackfillGrading
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 p D Inspector t Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.