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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2001 -00206 4 - DEVELOPMENT SERVICES DATE ISSUED: 04/24/2001 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S 102BC -01807 SITE ADDRESS: 10360 SW WALNUT ST SUBDIVISION: NO. TIGARDVILLE ADDITION ZONING: R -4.5 BLOCK: LOT : 026 JURISDICTION: TIG Project Description: Fire restoration. Temporary and permanent service replacement, replacing smoke damaged circuits. Job #17422 RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 1 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: 1 W /SERVICE OR FEEDER: 15 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: THOMAS, MARC C + CAROL A ROSE CITY ELECTRIC CO INC 10360 SW WALNUT ST 4012 NE CULLY BLVD TIGARD, OR 97223 PORTLAND, OR 97213 Phone: Phone: Reg #: 20P-61§1127S LIC 3567 ELE 26 -113C FEES Required Inspections Type By Date Amount Receipt Rough -in PRMT CTR 04/24/2001 $246.90 2720010000( Wall Cover Elect'I Service 5PCT CTR 04/24/2001 $19.75 2720010000( Elect'l Final Total $266.65 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 -6699 or 1 -800- 332 -2344. 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: (Yl � l o i o -16-er tte---6Th DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day I h li ) 'ivt. 1 A - --i-D Electrical PermitApplicati 1 1 Date received: 4- %Z 2) Permit no.. , 10/ -00_20 (o 4 4t: :•I I City of Tigard Project/appl.no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, T�}��R•r'94223 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 APR 2 4. 2001 Case file no.: Payment type: Land use approval: ... e 1 OVA.LO ?PJIE 9 �Ul� TYPE OF PERMIT ►• & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family O Tenant improvement 0 New construction > ddition/alteration/replacement 0 Other: 0 Partial JOB SITE INFORMATION Job address: 0 "VD° 5 W (,t r„Qy Bldg. no.: Suite no.: Tax map /tax lot/account no.: F ' Lot: I Block: ISubdivision: v1et4s._ 1 r i & Project name: LA til -- 0 w S I Description and location of work on premises: ,,Li . �,., _ / .( - , ,, - Estimated date of comps on/inspection: / CONTRACTOR APPLICATION FEE SCHEDULE Job no: , - •(l Y 1 - -- , • /1 Fee Max Business name: //. o Z{, A 1_ "� - 1, l2 c_ (� Description Qty. (ea.) Total no. (lisp q0 L /1J L w // / v � New ellinguntit.Incl u Includes muld-family per dwelling unit. Incldes attached garage. City./. 0- - I,r J � State:OYC. I ZIP: 63 7a 3 Service included: Phone _ , . , , _ , ,, Fax: 3 - p b, E -mail: 1000 sq. ft. or less 4 CCB no.: 3s 7 Elec. bus. lic. no: Z (, 113.c.. Each additional 500 sq. ft. or portion thereof Limited energy, residential 2 City /meta• ic. no.. 6 a I Limited energy, non- residential 2 Each manufactured home or modular dwelling Signal o su g ectncian (required) Date Service and/or feeder 2 Sup. elect. name (print): , 1... � . � L R License no: _ � - Services orteeders - installation, 4 --- _ r - .____ alteratien or relocation: P ROPERTY O „ . 200 amps or less 2 Name (print): -r 0 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: / 3 0 4 kJ Wa-1 601 amps to 1000 amps 2 Cit 1 ( d I State(S i2 I ZIP: Q -7,9,93 Over 1000 amps or volts I 2 Phone: I Fax: I E -mail: Reconnect only t Ow' er installation: The installation is being made on property I own Temper--; services or feeders - . - which is not intended for sale, lease, rent, or exchange according to Installation, alteration, orrelocation: 20 amps or less 2 20 ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2 Owner's signature: Date: 401 to 600 am s 2 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 I S 2 City: I State: • I ZIP: B. Fee for branch circuits without purchase Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2 Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Servlce or feeder not Included): O Service over 225 amps- commercial O Health -care facility Each pump or irrigation circle 2 O Service over 320 amps- rating of 1 &2 O Hazardous location Each sign or outline lighting 2 family dwellings O Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, O System over 600 volts nominal more residential units in one structure alteration, or extension* 2 O Building over three stories O Feeders, 400 amps or more *Description: O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above: O Egress/lightingplan 0 Other. Per inspection I 1 ; Submit sets of plans with any of the above. In »estigaricn fez The above are not applicable to temporary construction service.° l Other Permit fee $ 1.9e.`1° Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application O 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 %) .... $ I e t 7S Expires accepted as complete. TOTAL $� Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00/COM) Electrical Permit Fees: Limited Energy 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 n Heating, Ventilation and Air Conditioning System* Installation, alteration, or relocation 200 amps or less ( $80.30 yo 2 El Vacuum Systems 201 amps to 400 amps $106.85 2 401 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 • T rempora:y Services or Feeders a TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation r Fee for each system $75.00 200 amps or less 1 $66.85 4w O 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, O see "b" above. Audio and Stereo Systems Branch Circuits . ❑ Boiler Controls New, alteration or extension per panel a) The fee for branch circuits with purchase of service or g ❑ Clock Systems feeder fee. (� $6.65 ? � 2 Each branch circuit ❑ Data Telecommunication Installation b) The fee for branch circuits without purchase of service U Fire Alarm Installation or feeder fee. First branch circuit $46.85 r7 HVAC Each additional branch circuit $6.65 Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 L I Intercom and Paging Systems Each sign or outline fighting $53.40 Signal circuit(s) or a limited energy panel, alteration or extension $75.00 n Landscape Irrigation Control Minor Labels (10) $125.00 ❑ Medical Each additional inspection over the allowable in any of the above El Nurse Calls Per inspection $62.50 Per hour $62.50 In Plant $73.75 0 Outdoor Landscape Lighting • Fees: ❑ Protective Signaling Enter total of above fees $ 24(4 90 ❑ Other 8% State Surcharge $ r l Number of Systems 25% Plan Review Fee * No licenses are required. Licenses are required for all other installations See "Plan Review" section on $ front of application. ,� t Fees: Total Balance Due $ Enter total of above fees $ ❑ Trust Account # o 8% State Surcharge $ Total Balance Due $ i:\dsts\forms \elc- fees.doc 10/09/00 • CITY -OF TIGARD BUILDING INSPECTION DIVISION MST ' 24 =Hour Inspection Line: 639 -4175 Business Line: 639 -4171 �^ BUP Date Requested L / 3 d AM PM BLD Location /0 3 (e Suite MEC Contact Person KO. ��rdc Ph PLM Contractor Ph 0- S 7 c (Co SWR - BUILDING Tenant/Owner 75'/ 3 '/ 0 ELC 20 6/ d a 2-040 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 / t Misc: ( -6 etc — � 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 ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk t Other Date 1 / tea/ _ Inspector - Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 • �/ BUP Date Requested u" 3 AM PM BLD Location /o 3Go Sol CAGf1 ti/fe J' Suite MEC Contact Person ,k"1/4 Ph Y PLM Contractor Ck Y s Ph f- 33 ci f / SWR • BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation // ��,, FPS Ftg Drain L.,“ N L47 7 SGN Slab Crawl Drain Inspection Notes: Ld /� /� � (5.–ZO Post & Beam I I 9 SIT Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final F / � ^ �� 3 3 PASS PART FAIL ire. ' c `'I �( PLUMBING Post & Beam Under Slab Top Out Water Service 44 .4 c ! , j / C Sanitary Sewer / Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL Service T \ Rough In UG /Slab Low Voltage Fire Alarm ' PART FAIL Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. P t City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: ] able to inspect - no access ADA Approach /Sidewalk Other Date — 10 ` / Inspector ,7 _ E xt Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.