Permit A, (' ELECTRICAL PERMIT
CITY OF TIGARD PERMIT #: ELC2003 -00262
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lr* DEVELOPMENT SERVICES DATE ISSUED: 5/9/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 • PARCEL: 2S102C6 - 01600
SITE ADDRESS: 10395 SW PARK ST
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R-4.5
BLOCK: LOT : 032 JURISDICTION: TIG
Project Description: Service change. 200 amp.
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: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 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:
JOE MCNEIL WILLAMETTE ELECTRIC INC
10395 SW PARK ST PO BOX 230547 •
TIGARD, OR 97223 TIGARD, OR 97281•
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Phone: 503 - 639 -2258 • Phone: 624 -2938 FAX
Reg #: 1624-3631 75059
SUP 1965S
FEES • ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/9/03 $80.30
[TAX] 8% State Tax 5/9/03 $6.42 Rough -
Elect'l Service
Total $86.72 Elect'l Final
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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 -80 3 -2 _
Issued By: J )J &) �� (A J JU Permit Signature: 0 a1
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: ,) 9' �a 5
Call 639 -4175 by 7:00pm for an inspection the next business day
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• 1
Electrical Fermat _
. Date received: .C14 Permit no.: ll i / / M „.._
•� � � i "� . City of Tigard ecUappl. no.: Expire date:
�� c (� 1( � p ro )
C ity of Tigard Address: 13125 SW Ilall Blvd, Tig , OR 97223 Date issued: By It i Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598 -1960 M o ri fl 2003 Case file no.: Payment type:
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Land use approval: C:i i s vr 1 luNciD
cal 1 if I .n: ..IKIFL -
TYPE OF 1'LIt11IT
I & 2 family dwelling or accessory ❑ Commerciauindustrial ❑ Multi - family ❑ Tenant improvement
New construction • 0 Addition/alteration /replacement ❑ Other: CI Pattial
JOII SITL INLOIt11ATION
Job address: id X5 r cu./ pa„r 4 Sr Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: h illock: (Subdivision:
Project name:.. e Me /Uo. / 'Description and location of work on premises: C a cp.... AI ,r k
Estimated date of completion/inspection:
CONTRACTOR APPLICATION I'LL SC11E:DUCE
Fee Max •
Job no: v f Description Qty. (ea.) Total no. Insp
Business name: (O. II ft Atc Ile 41 re y A r Aw C — NewresldenU*I aMgle ormulti- family per
Address: / ° d /3 v ^ 7- TO S'i T dwelling emit. Includes attachdgarage.
T r S A �z o
City: I Statc:O,t I ZIP:. 97z4-1 Service included:
E -mail: I000 iq. ft. or less 4
Phone: t, �s1- 3 t: -I. r I Fax: (. Zr(- 2Q ?kJ Each additional i ) sq. ft. or portion thereof
CCU no.: 7 Tv fci "Elec. bus. tic. no: "3q - Zs 3 ° ` Limited energy, residential 2
City/ elm tic no / s ', L Limited energy, non- residential , 2
5—'19 _ Each manufactured home or modular dwelling
F•-^ Service and/or feeder 2
Signature of supery g electrician (required) Date Services orfeedem— Installation,
Sop. elect name (p n0: 0.‘ „ F. License no: f 96 t -s. attention or relocation: •
PIROPEItTYO11'NI.IU 200 amps or less (_ al= eack 2
.� . fj 201 amps to 400 amps 2
Name (print): / 21 C r t 401 amps to 600 amps 2
Mailing address: , 601 amps to 1000 amps 2
City: State: ZIP: Over 1000 amps or volts _ 2
Phone: 6, 3�' ,9 a5 X 'Fax: I E -mail: Reconnect only I
Owner installation: The installation is being made on property I own Temporary services or feeders -
installation, alteration, or relocation:
which is not intended for sale, lease, rent, or exchange according to 200 amps or Tess 2
ORS 447, 455, 479, 670, 701, 201 amps to 400 amps 2
Owner's signature: • Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel: •
NamC: A. Fee for branch circuits with purchase of • Address: service or feeder fee, each branch circuit 2
City: ( 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 RGVIL,1VI1'lense- ClieCh nlTilt nppll) - - Mtse , (Service or feeder not Included):
Each pump or Irrigation circle 2
OSen m
Service •0 11eallhm
- care outline sign ig or lighting 2
O Service over 320 amps - rating of I&2 O hazardous location Signal Each ss g or o ut or a limited energy panel,
family dwellings U Building over 10,000 square feel four or
O System over 600 volts nominal more residential units in one structure alteration, or extension' 2
O Building over three stories U Feeden. 400 amps or more • Descdptlon:
O Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable In any of 1he above:
O Egressllightingplan U Other: Per inspection I I I I
Submit — sets of plans with aiy of the above. . Investigation fee
The above are not applicable to temporary construction service. . Other more i to
cards, please call jm
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trot an j Pem►it fee
$ R-6 3 tretaiedons men erect hdietlon for rrruilee. Notice: This permit application
Plan review (at _ %) O Visa O MuterCud expires If a permit is not obtained Stale surcharge (83'0) $ I0 y %
Gant erd amber: / within 180 days after it has been
' B" plies accepted as complete.
TOTAL TAL $ ?'
Name of card older as shown on credit crd $
Cardholder signature Amoam 410 (6i00/COM)
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Electrical Permit Fees: Limited Energy Fees: ,. -' -.
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Ene iy Fee $75.00
Number of inspections per permit allowed (FOR ALL SYSTEMS)
Service Included: Items Cost Total 4, Check Type of Wor 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 Manurd Home or Modular 111 Garage Door Opener'
• Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Healing. Ventilation and Air Conditioning Syst•:rrr'
btstalation, alteration, or relocation .
200 amps or less $60.30 2 1:1 Vacuum Systems'
201 amps to 400 amps $ 106.85 2
401 amps to 600 amps $ 160.60 2 ❑ Other
amps to 1000 amps $240.60 2
Over 1000 amps or volts $454.65 2
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Reconnect on ly $68.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation. 0 ao l essn, or relocation Fee for each system 200 amps or less 566.85 2 Y $75.00
.• 201 amps to 400 amps $ 100.30 2 (SEE OAR 910 - 260 -260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts. Check Type of Work involved:
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see "b" above. ❑
Branch Circuits Audio and Stereo Systems
New. alteration or extension per panel ❑ Boiler Controls
a) The lee for branch circuits
wlrh purchase of service or f �-- I
feeder fee. l l Clock Systems •
Each branch circuit $6.65 2
b) 1 he fee for branch circuits ❑ Data Telecommunication Installation
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without purchase of service
or feeder fee. ❑ Fire Alarm Installation branch circuit $46.85
Each additional branch circuit $6.65 ❑
HVAC
Miscellaneous
(Service or feeder not included) ❑ Instrumentation
Each pump or Irrigation chcle $53.40
Each Sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal cicui(s) or a limped energy
panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑ Landscape Irrigation Control'
Each additional Inspection over ❑ Medical
the allowable In any of the above
Per inspection $62.50
Per hour $62.50 ❑ Nurse Calls
M Plant $73.75 ^
I ' Outdoor Landscape Lighting'
Fees: ,
• ❑ Protective Signaling
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Enter total of above fees 3
8% Stale Surcharge $ ❑ Other
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25% Plan Review Fee Number of Systems
See °Plan Review" section on $
front of application. • No licenses are required. Licenses are required for all other Inslallations
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Total Balance Due $ Fees:
❑ Trust Account q Enter total of above tees S
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r BY. Slate Surcharge $
Total Balance Due $
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L'dstsVomokle- 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 — °7 AM PM BUP
Location / b 3 Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) lQ 9 -331 SWR
BUILDING Tenant/Owner V V\ N ELC 3 - a o
Footing ELC
Foundation 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
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
E RICAL e J
Rough -In /_]0
UG/Slab
Low Voltage 6
Fire Alarm
Fina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE = ❑ Please call for reinspection RE: LI Unable to inspect — no access
Fire Supply Line
ADA Date ��2!'t_ Inspector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL