Permit CITY OF TIGARD
4.1 'DEVELOPMENT SERVICES ELECTRICAL PERMIT
PERMIT #: ELC1999 -00382
SSUED: 6/25/99
' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111CD -08600
SITE ADDRESS: 15935 SW SERENA CT
SUBDIVISION: KERWOOD ESTATES ZONING.: R -4.5
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Installation of two branch circuits. Job No. 32059 -R.
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: 1 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:
HAWK, THOMAS K AND NIKKI L ADAMS ELECTRIC CO INC
15935 SW SERENA CT 2340 SE CLATSOP
TIGARD, OR 97223 PORTLAND, OR 97202
Phone:. Phone: 234 -9651
Reg #: LIC 00000596
SUP 2056s
ELE 26 -5C
FEES
Type By Date Amount Receipt Required Inspections
PRMT DEB 6/25/99 $42.85 99- 316412 Elect'I Service ;
Elect'I Final
5PCT DEB 6/25/99 $2.14 99- 316412
Total $44.99 'ORIGINAL '.
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 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.
Permit Signature: Issued B , / ' 1 word
A__ __...../.. i.. . . _ . / ./1.1.../...." .
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• ....4...4 `-49341/ ei--16 DATE: 6 - A.5" -- 79
LICENSE NO: O
Call 639 -4175 by 7:00pm for an inspection the next business day
RECEIVED
CITY OF TIGARD Electrical Permit Application Plan C •
13125 SW HALL BLVD. JUN 2 1 1999 Recd
TIGAR OR 97223 Date Recd - /
Phone (503) 639 4171, x30 OMMUNITY DEVELOPMENT Date to P.E.
Print or Type h'1ric 19 99 - 00a(o Date to DST
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # PLC. /9 9 -ae3S a
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business)70 -) Wig ci. /` Service included: Items Cost Sum
I
Address A.59 3S .3; CA-T . SE /e.:E J A C,, 4a. Residential - per unit
.�. 1000 sq. ft. or less $110.00 4
City /State/Zip 1 /9 , v l - 7 9 / .. y Each additional 500 sq. ft. or
Commercial El Residential 1=1 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 Contractor A D,rn -.0 pfwitic , Installation, alteration, or relocation
Address . (.3 0 S - ; -- --CO i° 201 amps to or less $60.00 2 -
201 amps to 400 amps $80.00 2 -
City l�n2:.AA -ii State d Zip ,7_= O 3. 401 amps to 600 amps $120.00 2
Phone No. .. 8`1"
- 9 G / 601 amps to 1000 amps - $180.00 2
Job No. 3 2c,.5 9 -- 1Z Over 1000 amps or volts - $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 26 - �'G Exp.Date /d -- ! 9_5
OR State CCB Reg. No. -556 Exp.Date c., -/ 7 •'p0 / 4c. Temporary Services or Feeders
COT Business Tax or Metro No. / 0 74, Exp.Date 7 -J - 9:,9 Installation, alteration, or relocation
200 amps or less $50.00 2 - 201 amps to 400 amps $75.00 2
Signature of Supr. Elec'r 4 -/ 401 amps to 600 amps $100.00 2
-
Over 600 amps to 1000 volts,
License No. -- L - , S Exp.Date / d '-/ - 6 / see "b" above.
Phone No. '2,3 9 - 9 Fri 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 b
City State Zip without purchase of 31 -6
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.
* Submit 2 sets of plans with application where any of the above apply. Jr. Fees: $ v
Not required for temporary construction services. 5a. Enter total of above fees lb $
5% Surcharge (.05 X total fees) 14 $
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 f 4 da'
(b . ' ` 7l yep -3 /69/ -
I:\DSTS \ELC96.APP Rev 9/96
•
7/25/99 Activities for Case #: ELC1999 -00382
6:37:32 PM
• Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 6/21/99 DEB DONE No Hold DEB 6/25/99
ELCA003 Permit created 6/25/99 DEB DONE No Hold DEB 6/25/99
ELCA730 Elect'I Service . 6/25/99 6/25/99 No Hold DEB 6/25/99
ELCA799 Elect'I Final 6/25/99 6/25/99 . 7/1/99 CD FAIL No Hold AKJ 7/1/99 no access
ELCA500 (F) Issue permit 6/25/99 DEB DONE No Hold DEB 6/25/99
ELCA799 Elect Final 7/5/99 7/5/99 7/2/99 CD PASS No Hold AKJ 7/5/99
ELCA800 Case finaled 7/5/99 AKJ DONE No Hold AKJ 7/5/99
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
° 10!CO BUP
Date Requested AM PM BLD
Cat
Location I .�1 � ,} P A- Suite MEC f 'cm -60 2,6,2
Contact Person — 11/ l ( Y1A/O Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC I qq - ? g ' 2.
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm /
Susp'd Ceiling "� �� 7g ``77 7 G
toc 2-4 - 7
Roof
Misc: 4".4+
Final
PASS PART FAIL El-C- /9f 9 - 0 V 3 P
PLUMBING
Post & Beam
Under Slab
Top Out e
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
Post & Beam
Rough In
Gas Line
S oke Dampers
SS PART FAIL i
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
li p 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 reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other D ate 7/21g Cf 9 Inspector ,P Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .