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Permit CITY o f TIGARD ELECTRICAL PERMIT PERMIT #: ELC1999 -00362 �1i;► DEVELOPMENT SERVICES DATE ISSUED: 6/18/99 _W 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S 102CA -00925 SITE ADDRESS: 13240 SW VILLAGE GLENN DR SUBDIVISION: VILLAGE GLENN ZONING: R -4.5 BLOCK: LOT : 025 JURISDICTION: TIG Project Description: Add three (3) branch circuits to an existing 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: 2 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: LOUISE KLINKENBERG OREGON ELECTRIC CONST /GROUP 13240 SW VILLAGE GLEN DR 1010 SE 11TH AVE TIGARD, OR 97224 PORTLAND, OR 97214 Phone: Phone: 234 -9900 Reg #: LIC 203 SUP 1302S ELE 26 -95C FEES Required Inspections Type By Date Amount Receipt Wall Cover 5PCT GEO 6/18/99 $2.41 99- 316239 Elea! Service Elect'I Final PRMT GEO 6/18/99 $48.20 99- 316239 Total $50.61 ORIGINAL 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 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. Permit Signature: Issued By: 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: ( _/ 9-9 9 LICENSE NO: Ss q/ - S Call 639 -4175 by 7:00pm for an inspection the next business day RECEIVED ' CITY OF TIGARD Electrical Permit Application Plan Check 4 13125 SW HALL BLVD. JUN 171999 Rec'd By ' Date Rec'd TIGARD OR 97223 MUNITY DEVELOPMENT Y / Date to P.E. Phone (503) 639 -4171, x3 Print or Type Date to DST _� Inspection (503) 639 -4175 Incom late or ilia ible will not be acce tad Permit A 6�e /�t��f 36 .� Fax (503) 684 -7297 P 9 P Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections p permit allowed Name (or name of business) Louise K1 i nkenberg Service Included: items cost Sum Address 1 3240 SW Village Glen Drive 4a. Residential - perunit 1000 sq. ft. or less $110.00 4 City /State/Zip Tigard, Oregon Each additional 500 sq. ft. or Commercial ❑ Residential portion thereof $ •00 1 l imi ted Energy $25.00 Each Manufd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: - (Attach copy of all currant licenses) - 4b. Services or Feeders Electrical Contractor Oregon Electric Group Installation, alteration, or relocation 200 amps or less $60.00 2 Address 1 01 0 SE 1 1 1 AVP 201 amps to 400 amps $80.00 2 City Portland State __OR Zp 97214 401 amps to 600 amps $120.00 2 Phone No. 2 3 4 - 9 9 0 0 601 amps to 1000 amps $180.00 2 Job No. 81 1 23 Over 1000 amps or volts $340.00 2 Elec. Cont. Lice. No. Exp.Date Reconnect only $50.00 2 �695C OR State CCB Reg. No. 2 0 3 Exp.Date 4c. Temporary Services or Feeders COT Business Tax or Metro No Exp.Date - Installation, alteration, or relocation 200 amps or less $50.00 ' 2 Signature of Su r. Elec'n ✓,/ ` ' 201 amps to 400 amps $75.00 2 - 9 P 401 amps to 600 amps $100.00 2 L- Over 600 amps to 1000 volts, License No. 2 R 41 S Exp.Date see "b" above. • Phone No. 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. Each branch circuit $ 2 - Address b) The lee for branch circuits City State Zip without purchase of Phone No. service or feeder fee. . 1 45,430 1 First branch circuit $ 708 1 0 n n The Installation is being made on property I own which is not Each additional branch circuit Z Oo �l,'. /0,, 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 58. 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 $ 00 System over 600 volts nominal Per Inspection $55.00 Classified area or structure containing special occupancy Per hour $55 00 as described In N.E.C. Chapter 5 In Plant * Submit 2 sets of plans with application where any of the above apply. 5. Fees: 4 5 . 0 0 4 Not required for temporary construction services. 5a. Enter total of above fees $ �_ 5% Surcharge (.05 X total fees) $� ^ NOTICE Subtotal $ 6b. 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 DAY El Trust Account q $ $7 . 2 5 ' D � G r TIME AFTER WORK IS COMMENCED. p S TF0 Total balance Due i FI (.APP Rev 99 U 6 /_ r A/Hi �� Z OO j M (MOIL d0 A,LIO 096T 666 COS rid 61:60 I2L3 66 /6T /£0 =sal Rf elm 1: 101470t TIGARD:' ELECTRICAL PERMIT Department of Land Use & Transportation Electrical Inspection Section APPLICATION 155 North First Avenue, #350 -12 Hillsboro, Oregon 97124 Information: (503) 640 -3470 Fax: (503) 6934412 PLEASE PRINT Permit ��� �� f S' �� Please complete all sections, 1 through 5. Number D ate 1. Location of installation 4. Complete Fee Schedule below Address 13240 SW Village Glen Dr. Number of inspections per permit allowed Building City Tigard Suite No. Service included: Items Cost(ea.) Sum Tenant Name A. Residential - per unit (if commercial) 1000 sq. ft. or less $110.00 4 Map No. Tax Lot Each additional 500 sq. ft or portion thereof $25.00 Limited Energy $25.00 1 Thomas Map Book: Page: 655 Section: E -5 Each Manuf'd Home or Modular Directions Dwelling Service or Feeder $68.00 2 Commercial n Residential Ell B. Services or Feeders Installation, alterations or relocation 200 amps or less $60.00 2 2a. Contractor installation only: 201 amps to 400 amps $80.00 2 Electrical Contractor OMNI ELECTRIC 401 amps to 600 amps $120.00 2 O Box 1 7 8 8 601 amps to 1000 amps $180.00 2 Address P Over 1000 amps or volts $340.00 2 City LAKE OSWEGO State OR ZIP 97035 • Reconnect only $50.00 2 Date 6/12/95 Job Number 1 60 • Property Owner KLINKENBERG, Louise C. Temporary Services or Feeders Contractor's License No -182C Installation, alteration or relocation Contractor's Boar N. 4 3 89 • 200 amps or less $50.00 2 201 amps to 400 amps $75.00 2 Signature of Su r. Elec `' i ��t�[ -.� 401 amps to 600 amps $100.00 2 License No. 2345$ Phone N.. 63 -4306 Over 6o0 amps tolo0o volts see "B "above D. Branch Circuits 2b. For owner installations: New, alteration or extension per panel • a) The fee for branch circuits with Print Owner's Name Phone No. purchase of service or feeder fee. Each branch circuit $5.00 2 Address b) The fee for branch circuits without purchase of service or feeder fee. City State Zip First branch circuit 1 $35.00 35.00 2 Each add'nl branch circuit -2 $5.00 1 0 . 0 0 2 The installation is being made on property I own E. Miscellaneous (Service or Feeder not included) which is not intended for sale, lease or rent. Each pump or irrigation circle $40.00 2 Owner's Signature Each sign or outline lighting $40.00 2 g Signal circuit(s) or a limited energy panel, alteration 3. Plan Review section (if required) or extension $40.00 2 Please check appropriate item and enter fee in section 5B. F. Each additional inspection over the allowable 4 or more residential units in one structure in any of the above Per inspection $35.00 Service and feeder, 800 amps or more Per hour $55.00 System over 600 volts nominal in Plant $55.00 Classified area or structure containing special occupancy as described in N.E.C. Chapter 5 5. Fees Submit 2 sets of plans with application where any of the A. Enter total of above fees $ 45 . 00 above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $ 2 . 25 services. Subtotal $ This permit becomes null and void if the work authorized by the permit Is B. Enter 25% of line A for not commenced within 180 days from date of issuance of such permit or Plan Review if required (Section 3) $ if the work authorized is suspended or abandoned at any time after work Subtotal $ is commenced for a period of 180 days. Electrical Permits are non- ❑ $ refundable and non - transferable. Trust Account For inspections call Balance Due $ 47 . 25 681 -3699 or 681 -3698 24 -hour recorder, one working day in advance of need BL28 . 3/95 • CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175. Business Line: 639A171, Date � V r ! Requested � R'1 � [ q AM PM :x BLD Location ( 3 Z`"[ 0 1 & ((j ■Suite MEC Contact Person LO SQ. i • Ph CO 3q —3220 PLM Contractor Ph 7O0 i SWR BUILDING Tenant/Owner ELC L l p 49 -1203(,2 Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab 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 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 • 4ECTRibT1 Service Rough In UG /Slab Low Voltage larm _ 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 t I Date L Inspector Other Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.