Loading...
Permit CITY OF TI G A R D ELECTRICAL PERMIT PERMIT #: ELC2000 -00085 � i & DEVELOPMENT SERVICES DATE ISSUED: 02/29/2000 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S 110CC -10500 SITE ADDRESS: 15765 SW QUEEN VICTORIA PL SUBDIVISION: KING CITY NO. 3 ZONING: BLOCK: LOT : 018 JURISDICTION: KIN Project Description: Install 1 branch circuit in single family dwelling. 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: 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: JENSEN, LAURA BONNELL TRUSTEE 15765 SW QUEEN VICTORIA PL KING CITY, OR 97224 Phone: Phone: Reg #: ORIGINAL FEES Required Inspections Type By Date Amount Receipt Elect'l Service PRMT . KJP 02/29/200C $37.50 00- 321894 Elect'l Final 5PCT KJP 02/29/200C $3.00 00- 321894 Total $40.50 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 A.- S ISSUED BY: A Pe _9 e / NER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: _0, i DATE:X °? - 0( _.,66e__A CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day CITY OF TIGARD Electrical Permit Application Plan Check # ■ 13125 SW HALL BLVD. Rec'd By TIGARD OR 97223 Date Rec'd Date to P.E. Phone (503) 639 -4171, x304 • Date to DST Inspection (503) 639 -4175 Print of Type Permit # 1.-C Le OO- 0)o AS Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development ' '"5J ,v Number of Inspections per permit allowed Name (or name of business Service included: Items Cost Sum 4 - Address / 57(9 5CJ LL V, / e r / " " 4a. Residential - per unit • City/State /Zip � / � ( Or d 1000 sq. ft: or less $ 117.75 4 '!- Each additional 500 sq. ft. or portion thereof $ 26.75 1 Commercial El Residential El Limited Energy $ 60.00 Each Manufd Home or Modular 2a. Contractor installation only: Dwelling "Service or Feeder $ 72.75 2 • (Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders information for COT data base). •Installation, alteration, or relocation Electrical Contractor [)�J t- - 200 amps or less $ 64.25 2 Address 201 amps to 400 amps $ 85.50 2 401 amps to 600 amps $ 128.50 2 City State Zip - 601 amps to 1000 amps $ 192.50 2 Phone No. Over 1000 amps or volts $ 363.75 2 • Job No. Reconnect only $ 53.50 2 Elec. Cont. Lice. No. Exp.Date 4c. Temporary Services or Feeders . OR State CCB Reg. No. Exp.Date Installation, alteration, or relocation COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2 201 amps to 400 amps $ 80.25 2 • Signature of Supr. Elec'n 401 amps to 600 amps $ 100.00 2 Over 600 amps to 1000 volts, • see "b" above. License No. Exp.Date ' Phone No. 4d. Branch Circuits . New, alteration or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or . The fee for branch circuits b) feeder fee. Print Owner's Name � `- l i � r Arad N EL Each branch circuit $ 5.35 2 Addre l �7 ?fe7 9 W. V fit $j�'I/f without purchase of service City CY ( r (-� State ? p Zip T _ or feeder fee. 7 e ,-� Phone No. , 7 5 ) First branch circuit / $ 37.50 3 Ti ✓ Each additional branch circuit _ $ 5.35 The installation is being made on property I own which is not 4e. Miscellaneous intended for sale, lease or rent. (Service or feeder not included) - Each pump or irrigation circle $ 42.75 ' Owner's Signatur- ,A� _ / / .- . /,_ Each sign or outline lighting $ 42.75 Signal circuit(s) or a limited.energy * panel, alteration or extension $ 60.00 • 3. Plan Review section (if requir- d): - Minor Labels (10) $ 100.00 ' Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over 4 or more residential units in one structure the allowable in any of the above Service and feeder 225 amps or more • Per inspection $ 50.00 Per hour $ 50.00 System over 600 volts nominal In Plant $ 59.00 Classified area or structure containing special, occupancy as described in N.E.C. Chapter 5 5. Fees: • 5a. $ a. Enter total of above fees * Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ 3 _ 0 0 Not required for temporary construction services. Subtotal $ 5b. Enter 25% of line 5a for NOTICE - Plan Review if required (Sec. 3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # 5 oO AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ qv . is \dsts \forms\clectric.doc . 3 /6 /00 Activities for Case #: ELC2000 -00085 8:48:15 AM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ELCA001 APPlication received 3/6/00 ST DONE No Hold ST 3/6/00 ELCA003 Permit created 2/29/00 KJP DONE No Hold KJP 2/29/00 ELCA730 Elect'I Service No Hold KJP 2/29/00 • ELCA799 Elect'/ Final 3/1/00 CD • PASS No Hold AKJ 3/1/00 ELCA500 (F) Issue permit 2/29/00 KJP DONE No Hold KJP 2/29/00 ELCA800 Case finaled 3/1/00 AKJ DONE No Hold AKJ 3/1/00 • • • • • • Page 1 of 1 - `'CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested 3/1 0 AM PM BLD Location r S)' S Q 0 i olovAsaite MEC Contact Person Ph 69 ZY — S 0g PLM Contractor Ph SWR BUILDING Tenant/Owner ELC 2000 -oc0 9,5 Retaining Wall ELR Footing Access: • Foundation - FPS Ftg Drain SGN Crawl Drain Inspection Notes: , Slab l' " (, , SIT Post & Beam • - Ext Sheath /Shear Int Sheath /Shear Framing Insulation - Drywall Nailing _ . Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING irea 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 EC,ECTRf'CA Service Rough In UG /Slab Low Voltage Fire Alarm PART 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 reinspec • 'n RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date f Inspector .act Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.