Permit CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00613
, DEVELOPMENT SERVICES DATE ISSUED: 12/4/01
13125 SW Hall Blvd.. Tioard, OR 97223 (503) 639 -4171 PARCEL: 2S110DC -02200
SITE ADDRESS: 15660 SW PACIFIC HWY A -5
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Installation of (6) 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: 5 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 LP HIGHLAND ELECTRIC COMPANY INC
9777 WILSHIRE BLVD #609 PO BOX 655
BEVERLY HILL, CA 90212 TROUTDALE, OR 97060
Phone: Phone:
Reg #: 121W
SUP 2431S
ELE 26 -962C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 12/4/01 $80.10 2720010000( Wall Cover
Elect'I Final
5PCT CTR 12/4/01 $6.41 2720010000(
Total $86.51
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Specialty Codes and all other applicable
laws. All work will be done in accordance with approved plans. This permit will expi of started within 180 days of issuance, or if
work is suspended for more than 180 days. ATTENTION: Oregon law requires ou to follow rules adppted by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -00 -0080. You may obtain c•pies of these rules or direct questions to •
Permit Signature: / 2, sued By: ,� ; �/ / 0624,4121
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: t PO DATES
LICENSE NO: 0`
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Date received: / V Q/ Permit no.: ii4ap0 / •-GtSbe
A t� +, • • F ,1,,.�, City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PEIU%IIT
❑ 1 & 2 family dwelling or accessory 0 CommerciaUindustrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: / G ( S L.) p.....1 ; c ,.,v 1--- Bldg. no.:A. Suite no.: S — Tax map /tax lot/account no.:
Lot: Block: ISubdivision: /
Project name: 'Description and location of work on premises:
Estimated date of completion/inspection: )2 - 01
CONTRACTOR APPLICATION FEE SCII
Job no: Fee Max
Description — Qty. (ea.) Total no. insp
Business name: � �
, �l ti�c-r,', New residential- single or multi - family per
Address: )6 o - 6SS dwelling mtit . Includes attached garage.
City: - r 4e I State: 3? I ZIP: 9?060 . Service included: 4
Phone: y0 — 1135 I Fax: I E -mail: 1000 sq. ft. or less
Each additional 500 sq. ft. or portion thereof
CCB no.: 26 qz2 c I Elec. bus. lic. no: I04 8SO Limited energy, residential 2
City /metro lic. n0.' Limited energy, non- residential 2
, j - - j Q
Each manufactured home or modular dwelling Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License nom Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 1' a^c ?ro v, I•
. t-... e P.... ✓1 is 201 amps to 400 amps 2
9 401 amps to 600 amps 2
Mailing address: 5 77 7 4), i5l,, , 13 /u /O09 601 amps to 1000 amps 2
City: 2 . J ,2c ( V, 1/ s I State: C/4 I ZIP: Spa / a. Over 1000 amps or volts 2
Phone:SB i /C-- 3/ 1 IFax: IE-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, or relocation:
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 /OS 2
B Fee for branch circuits without purchase
City: I State: I ZIP: of service or feeder fee, first branch circuit: ,3 .P 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 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 0 Hazardous location Each sign or outline lighting 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
0 Building over three stories O Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV pads Each additional inspection over the allowable in any of the above:
0 Egress/lightingplan 0 Other. Per inspection 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 Permit fee $ (J
ns
❑ 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 %) .... $ 6. y/
Expires accepted as complete. TOTAL $ • 8 Co • S
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT 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 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders 17 Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑
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 • ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit I $46.85 4t: • $S
Each additional branch circuit 5 $6.65 13 .2. 5 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each signor outline lighting $53.40
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 ❑ 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: ❑ Protective Signaling
•
Enter total of above fees $ Q, fl .10 ❑ 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 $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i :\dsts\forms\elc- fees.doc 08/30/01
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CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. - Rec'd By
TIGARD OR 97223 Date Recd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit #
Fax (503) 684 -7297 Called
1. Job Address: k 4. Complete Fee Schedule Below:
�7
Name of Development I 1 = R v S k Number of Inspections per permit allowed
Name (or name of business) p ( J Service included: Items Cost Sum
Address I5 4 6 S 1.4_, F �t c ,T i< /4 7 � 4a. Residential - per unit
/ 1000 sq. ft. or less $110.00 4
City /State/Zip 7 -----4. Each additional 500 sq. ft. or
Commercial Residential El Limited thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) -� 4b. Services or Feeders
Electrical C t raitor / ogh. / .---e ' /CG fv \ , Installation, alteration, or relocation
Address !- 0 55 / 4 r c- 200 amps or less $60.00 2
)< 201 amps to 400 amps $80.00 2 -
City L State 89A_ /L Zips ?0 G J 401 amps to 600 amps $120.00 2
Phone No. aO - /9 3 T 601 amps to 1000 amps - $180.00 2
Job No. Over 1000 amps or volts - $340.00 2
Elec. Cont. Lice. No. JO 9 gS0 Exp.Date /0 /-0.'2% Reconnect onl $50.00 2
OR State CCB Reg. No. 2 69(0 AC. Exp.Date /a 4c. Temporary Services or Feeders
COT Business Tax or Metro No. S 0a. Exp.Date /0- / -0? Installation, alteration, or relocation
200 amps or less $50.00 2
-
'/�(1 ��' 201 amps to 400 amps $75.00 2
Signature of Supr. Elec'n
£ O_t& � � 401 amps to 6 00 amps $100.00 2
� 43' s Over 600 amps to 1000 volts,
License No E xp.Date i b - 1 - 0 3 see "b" above.
Phone No f5,0.�' $1S 3> L/0 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit / $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection • $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees:
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due $
I:\DSTS \ELC96.APP Rev 9/96
CITY OF TWARD 24 -Hour
BUILDING Inspection Lire: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
j BUP
Received Date Requested , T3 AM PM BUP
Location S(o Suite MEC
Contact Person Ph ( ) 7 �° 61 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner V ff a J U b 1 3
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 9 k(4---„^ SIT
Post & Beam ‘
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear fa S
Framing
Insulation , 1� (91i �,`
Drywall Nailing - i
Firewall 1� L
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
S PART FAIL D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE E Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector �" Ext
Other:
Final DO NOT REMOVE this Inspection recor from t e job site.
PASS PART FAIL