Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00640
� DEVELOPMENT SERVICES DATE ISSUED: 12/16/02
� 13125 SW Hall Blvd.. Tisrard, OR 97223 (503) 639 -4171
PARCEL: 2 S 110 D C -02200
SITE ADDRESS: 15570 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: WILLOW BROOK FARM
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Install 7 branch circuits to coolers and freezer.
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:
TIGARD CENTER ELECTRICAL DIMENSIONS INC
9777 WILSHIRE BLVD. PO BOX 12146
#609 • 3961 N WILLAMS AVE
BEVERLY HILLS, CA 90212 PORTLAND, OR 97212
Phone: Phone: 282 -7255
Reg #: LIC 44008
SUP 2964S
FEES ELE 26 -432C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/16/02 $86.75
[ELPLCK] ELC PIn Rev 12/16/02 $6.94 Rough -in
Elect'I Final
Total $93.69
•
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 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246-6699 or 1 -800-3, -2344.
Issued By: _/' J Permit Signature: d)'j JAL 4'
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: C�� . /1e(XJDATE:
LICENSE NO: P-/ (M 5
Call 639 -4175 by 7:00pm for an inspection the next business day
•
IA Electrical Permit Application
a Date received:/ j -/ , — '� - on. -Permit no.: �= V - O d OLIO
fi'' 4,..'ll'I� City of Tigard ject/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Ti E'v issued: By:i�) I Receipt no.:
Phone: (503) 639 -4171 ��11 E
ate
Fax: (503) 598 -1960 Case file no.: Payment type:
DEC 11 200
Land use approval: RD
O 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
O New construction *Addition/alteration/replacement 0 Other. 0 Partial
•
JOB SITE INFORMATION
Job address: 15'510. Sw PAGtr-IC- 1.-11AN Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: I Description and location of work on premises: ) NSr'ow -(7.1 an.4. ()) :0
Estimated date of completion/inspection: l O
CONTRACTOR APPLICATION FEE SCIIEDU.E
Job no:) -5250 . Fee Mau
Business name: /l � Description Qty. (ea.) Total no. insp
�JedG�b1� vi nvl E= lnl� �.�Y/ ) New residential -single or multi- family per
Address: j p, IZI4, - dwelling wit. Includes attached garage.
City: - I State: ZIP: .:1-7-7. &nice included:
Phone: I Fa x: I E -mail: 1000 sq. ft. or less • . 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 4 1 4 .1 0043 I Elec. bus. lic. no: Zee. - 432G Limited energy, residential 2
City /me s ic. no I ir 4 • Limited energy, non- residential 2
..,, d , Z Q i Each manufactured home or modular dwelling •
S' : ature of supervising electrician (required) D Service and/or feeder 2
Sup. elect name (print): a 6 (3 i - 3 r c!' License no: lc/ 6 — L1 — Services or feeders - installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 4p ,( / i N 201 amps to 400 amps 2 - 401 amps to 600 amps 2
Mailing address: l(o' (3CJ go ITV /K 4 601 amps to 1000 amps 2
J
City GLA� State: c'e ZIP: x!' 0 Ove 1000 amps or volts 2
Phone: 6i1.. GI 4.14, . 1 Fax: S4 i(zg2I E- mail: -- _ Reconnect only 1
Owner installation: The installation is being made on property I own Temporary seniors or feeders - .
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, orrelocatioo: 2
ORS 447, 455, 479, 670, 701. 200 amps or less
201 amps to 400 amps 2.
Owner's signature: Date: 401 to 600 am s 2
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 ' 1 2
Phone: Fax: E -mail: Each additional branch circuit
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps-commercial . O Health-care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 182 O Hazardous location Each sign or outline lighting 2
family dwellings O 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 extension* 2
O Building over three stories O Faders. 400 amps or more 'Description:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O 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 adapt credit cards, please call Jurisdiction to more information. Notice: This permit application Permit fee $ ��rO
O 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%) .... $ C • l 9
Expire' accepted as complete. TOTAL $ ' 3
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440-4615 (6i001COM)
Electrical Permit Fees: Limited Energy Fees: ' ° 4 -s
r
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 `, Check Type of Work Involved:
•
Residential - per unit 4 Audio and Stereo Systems
1000 sq. ft. or less $145.15
Each additional 500 sq. ft. or •
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular 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 Other
601 amps to 1000 amps _ $240.60 2 El
Over 1000 amps or volts $454.65 2 •
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY 75.00
Fee for each system
Installation, aoerr less $66. alteration, or relocation (SEE OAR 918 -260 -260)
200 amps oe _ •
201 amps to 400 amps $100.30 2 Check Type of Work Involved:
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts. Audio and Stereo Systems
see "b" above.
Branch Circuits • ❑ Boiler Controls
New. alteration or extension per panel
a) The fee for branch circuits Clock Systems
with purchase of service or
feeder fee.
Each branch circuit $6.65 2 li=l Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service 0 Fire Alarm Installation •
or feeder fee.
First branch circuit I $ 46 . 85 El HVAC
Each additional branch circuit L $6.65 9h
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $ 53 . 40 Intercom and Paging Systems •
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy Landscape Irrigation Control'
panel, alteration or extension . $75.00 El
Minor Labels (10) $125.00
El Medical
Each additional Inspection over .
the allowable In any of the above El Nurse •Calls.
Per inspection $62.50
Per hour $62.50• .
In Plant $73.75 ❑ Outdoor Landscape Lighting'
•
Fees: El Protective Signaling
R63 .
Enter total of above fees $ ❑ Other
8% State Surcharge $ f e) 4 4 Number of Systems
25% Plan Review Fee No licenses are required. Licenses are required for all other installations
See 'Plan Review' section on $
front of application. - . F •
Total Balance Due $ 13. •
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
• Total Balance Due $
•
•
i:\dsts\fonns\elc- fees.doc 10/09/00 . - - - _
CITY OF TIGARD 24 -Hour
BUILDING_ Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ,rg AM PM BUP
Location / SOU 5 Z(J Ale#z Suite MEC
Contact Person /31- Ph (a. PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner c3 et,0ej.+1A'v ELC "0 90
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain •
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam ^
Under Slab / 1
Rough -In
Water Service
Sanitary Sewer -
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
P PART FAIL
LEtTRIC
Serve
Rough -In
UG /Slab
Low Voltage
Fire Alarm
a 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
is PART FAIL
❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Date IF? O � Inspector � ,, _ Ext
Approach/Sidewalk P ! v
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL