Permit • u ^ CITY O F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00229
�;► DEVELOPMENT SERVICES DATE ISSUED: 4/15/99
r- J 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134CC-04700
SITE ADDRESS: 12443 SW WINTERLAKE DR
SUBDIVISION: CAPSTONE ZONING: R -4.5
BLOCK: LOT : 014 JURISDICTION: TIG
Project Description: Installation of 1 branch circuit.
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:
BRETT EICHENBERGER D + L ELECTRIC, INC.
12332 SW WINTERLAKE PO BOX 1047
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone: Phone: 656 -5623
Reg #: SUP 2662S
• LIC 0088069
ELE 3-161C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT DRA 4/15/99 $35.00 99 - 314555 Elect'I Final
5PCT DRA 4/15/99 $1.75 99- 314555
Total $36.75
This Permit is issued subject to the regulations contained in the Tigard Muniapal Code, State of OR. Speaalty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copie . - - les or direct questions to OUNC at (503)
246 -1987.
Permit Signature: .�Q� Issue' By: , f I. / raa' ' I f '
OWNER INSTALLATION ONLY -
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INST • LLATION ONLY
SIGNATURE OF O� . SUPR ELEC'N: ., r i •' _r�.. t /-/ S -5'
qq DATE:
LICENSE NO: � 10 a6
Call 639 -4175 by 7:00pm for an inspection the next business day .
N /..,-
RECEIVED
T OF TIGARD Electrical Permit Application Plan Ch
1 5 W HALL BLVD. APR 1 1999 Recd y 41
TIG ' OR 97223 Date Recd e / - "/ 5 " .1 7
6 39 -4171, x3 &$ MMUNIT' DEVELOPMEN1 Date to P.E.
Phone 503
( ) Date to DST -
Inspection (503) 639 -4175 Print or Type Permit # Ei4 /999- CYO aAJ
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) (3h e .6 4 ak4 9.65 e / Service Included: Items Cost Sum
Address / `x`1` 3 SS 1� 1 h ? 4d /('c 4a. Residential - per unit
77,y 1000 sq. ft. or less $110.00 4
City/State/Zip ,f /it Each additional 500 sq. ft. or
Commercial El Residential portion thereof $25.00 1
Li mited 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 Installation, alteration, or relocation
A n '7 200 amps or less $60.00 2
Address ,K O
r ` 201 amps to 400 amps $80.00 2
City01 4 r`1 State (P - Zip q7U sl 401 amps to 600 amps $120.00 2
Phone N'o. l 5' 676 .2_3 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. .7 - /O1 e- Exp.Date 10l f / 9' I"
OR State CCB Reg. No. t ?''G r Exp.Date . / /7 / d d 4c. Temporary Services or Feeders
COT Business Tax or Metro Novo° +erec/ Exp.Date R/ r / a c Installation, alteration, or relocation
��
�/ 200 amps or less $50.00 2
Signature of Supr. Elec'ni " , �, �`., 201 am to 400 amps $75.00 2
-
f 401 amps to 600 amps $100.00 2
-
Over 600 amps to 1000 volts,
License No. 2 l G .Z - 5 Exp.Date see "b" above.
Phone No._ (r 4 S 3 F .r rO.S /7 / R'
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
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit I $35.00 •7' 5 47-c 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 $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: 357-0-c) Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ /' }-
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 # $ s
Total balance Due
I ‘DSTS%ELC95.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
q BUP
Date Requested —1 /� — 30' ! / q AM V PM BLD
Location 12J 3 1)z 4,1e/ti or. Suite MEC
Contact Person Ph (0y4 - -seaz3 PLM
Contractor P Ph SWR
BUILDING Tenant/Owner ELC !gem - onZZ_1
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
PA FAIL
<ELE :21 MAI
Service
Rough In A/C,
UG /Slab
Low Voltage
F' _ • larm
V 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 Date L{ _3 Inspector ril_e_e_,4 / Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.