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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2000 -00671 E. 4, DEVELOPMENT SERVICES DATE ISSUED: 12/6/00 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -417 PARCEL: 2S 102C B -03101 SITE ADDRESS: 12950 SW PACIFIC HWY SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G BLOCK: LOT : 021 JURISDICTION: TIG Project Descriptio . Four signs for Hudson Plaza 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: 4 LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HMI 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: 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: HENDERSON, MARILYN DOROTHEA WILLAMETTE ELECTRIC INC • JENSEN HUDSON TRUSTEE PO BOX 230547 11795 SW KATHERINE ST TIGARD, OR 97281 • TIGARD, OR 97224 Phone: Phone: 624 -3631 Reg #: LIC 000750 SUP 1965S ELE 34 -283C FEES Required Inspections Type By Date Amount Receipt Elect'I Final PRMT CTR 12/6/00 $213.60 2720000000( 5PCT CTR 12/6/00 $17.09 2720000000( Total $230.69 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 1Y1 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 • Electrical Permit Application Date received: / Permit ife�G D - ci7j (, 7 r ; j j:_ .� City of Tigard RECEIVED Proj ect/appl.no.: Expire date: Add 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: B I Recei tno.: City ofTigard � Y� P Phone: (503) 639 -4171 CEO L - 2000 Fax: (503) 598 -1960 Case file no.: Payment type: COC1MUNITY DEVELOPMENT . Land use approval: - TYPE OF PERMIT 0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement 0 New construction 0 Addition/alteration /replacement Other: 0 Partial JOB SITE INFORMATION Job address: l Z9 TO Ski I'w,er C c iiievy Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: I Subdivision: Project name: HJicsa f 14 7-p- I Description and location of work on premises: C c ( kfj c,�S ,.,{. Estimated date of completion/inspection: / 2 - / S - o 0 _ �� CONTRACTOR APPLICATION • FEE SCHEDULE Job no: Fee Max 9 } Description Qty. (ea.) Total no. insp Business name: (,j, I ( A„ a fie F(e c1yt i c /s„ r New residential - single ormulti-family per Address: P box. 230 S Y ?- dwellingunitlncludesattachedgarage. City: - c fr I State:e .. I ZIP: Cj ,7z,s'/ Service included: Phone: Sb3 6dx - ;b 3 t I Fax: `Zy- Z.!/rEs-I E -mail: 1000 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof CCB no.: ? 501 � I Elec. bus. lic. no: 3 4- 2%- 3 Limited energy, residential 2 City /metro lic. no.: Limited energy, non- residential 2 / ���Q�� //. 29-0 0 Each manufactured home or modular dwelling Signature of supervis g electrician (required) Date Service and/or feeder 2 Sup. elect. name (print): 1 .. F License no: / 96 5---.5' 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 I 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 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: 2 Phone: Fax: E-mail: Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not Included): Cl Service over 225 amps- commercial - 0 Health -care facility Each pump or irrigation circle 2 0 Service over 320 amps- rating of 1&2 0 Hazardous location Each sign or outline lighting cf S'3'r!? a13 = 2 family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, 0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2 O Building over three stories 0 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: 0 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 Permit fee $ 21 . Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Plan review (at _ %) $ O Visa 0 MasterCard expires if a permit is not obtained / O r / Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Ex accepted as complete. TOTAL $ ? 36 G9 Name of cardholder as shown on credit card Cardholder signature $ Amount �O . J 440 -4615 (6■0/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 4, 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 Manutd Home or Modular Garage Door Opener Dwelling Service or Feeder $90.90 2 Services or Feeders ❑ Heating, Ventilation and Air Conditioning System' Installation, alteration, or relocation 200 amps or less $80.30 2 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 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 200 amps or less $6 2 Fee for each system $75.00 201 amps to 400 amps $100.30 2 (SEE OAR 918 - 260 -260) 401 amps to 600 amps $133.75 2 Over 600 amps to 1000 volts, Check Type of Work Involved: see "b" above. ri Audio and Stereo Systems Branch Circuits New, alteration or extension per panel n Boiler Controls a) The fee for branch circuits with purchase of service or feeder fee. 17 Clock Systems Each branch circuit $6.65 2 b) The fee for branch circuits n Data Telecommunication Installation without purchase of service or feeder fee. ril Fire Alarm Installation First branch circuit $46.85 Each additional branch circuit $6.65 HVAC Miscellaneous (Service or feeder not included) ❑ Instrumentation Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems Signal circuit(s) or a limited energy panel, alteration or extension $75.00 Minor Labels (10) $125.00 n . Landscape Irrigation Control Each additional inspection over n Medical the allowable in any of the above Per inspection $62.50 Nurse Calls Per hour $62.50 In Plant $73.75 ❑ 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 $ front of application. No licenses are required. Licenses are required for all other installations • Total Balance Due $ Fees: Enter total of above fees $ _ El Trust Account # 8% State Surcharge $ Total Balance Due $ i:\dsts \forms \elc- fees.doc 10/09/00 CITY OF TIGARD BUILDING INSPECTION DIVISION . MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 r - BUP Date Requested / a - 1 3 AM PM BLD Location / 2-9) 5G.- 73 C((i c u 7 Suite MEC Contact Person Ph 4 Z / PLM Contractor Ph SWR BUILDING Tenant/Owner ELC i -d -tic 6 7 ( 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 / Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: ' I 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 r mice Rough In `f A- UG/Slab ` Low Voltage `�� / •d Fire Alarm F. SS RT 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 ,fdle Date /2/2 --� Inspecto Other Approach /Sidewalk D / E x t Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.