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CITY O F TIG,AR D ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMI-r #: ELC99-01 -71
4ww 13125 SW Hall dlvd., Tigard,OR 97223(503)639.4171 DATE ISSUED: 03/08/99
PARCEL: 2S102CB--06200
SITE ADDRESS. . . : 104 75 SW GRANT Cl
SUBDIVISION. . . . :WINSOME TERRRACE ZONTNG:R--4. 5
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :006 JURISDICTION: TIG
Project Description: Add a first branch circuit.
---RESIDENTIAL UNIT---- -- - TEMP SRVC/FEEDERS------- -----MISCELLANEOUS---
1000 SF OR LESS. . . . : FJ 0 iR17.10 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADDIL 500SF. . . : 0 201 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0
LIMITED ENERGY. . . . . : 0 401 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
MANF. HM/ SVC/FDR. . : 0 601+amps-1000 Volts. : 0 MINOR LABEL ( 10) . . . : e
—
----SERVICE/FEEDER------ CIRCUITS----- ---ADD' L INSPECTIONS— .
0 200 amp. . . . . . : 0 W/SERIIICE OR FEEDER: 0 FIER INSPECTION. . . . . : 0
201 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : I PER HOUR. . . . . . . . . . . : 0
401 600 amp. . . . . . : 0 EA ADDIL BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
GO 1 1000 amp. . . . . : 0 -----------------PLAN REVIEW SLCT I ON--
10.00+ amp/volt. . . . . : 0 )=4 RES UNITS. . . . . . . . : ) 600 VOLT NOM I NHL. .
Reconnect only. . . . . : 0 SVC/FDR ) = 225 AMPS. . : CLADS AREA/SPEC OCC. :
Owner: FEES —__-----._---_
ALAN R HOROWITZ type amount by date recpt
10475 SW GRANT COURT PRMT $ 35. 00 GEO 03/08/99 99-313496
TIGARD OR 97223 5ruCT $ 1. 75 GEO 03/08/99 99-313496
Phone #:
Contractor: ----------------------------
BOONES FERRY ELECTRICAL $ 336. 75 TOTAL
PO BOX 628 REQUIRED INSPECTIONS
WILSONVILLE OR 97070 Elect' I Service
Phone #: 682-4936 Elect' l Final
Reg #. . : 000884
This permit is issued subject to the regulations contained in the Tigard Mlinicipal Code, State of Oregon Specidlty 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 folio" the rues .4doptrd by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952-01-0010 through OAR 952AMI 1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)2A(,-1987. 1;1
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-------------------------------OWNER INSTALLATIONThe installation is being made on property I own which is not intended for
sale, lease, or rent.
OWNER' S SIGNATURE: DATE-
INSTALLATION ONLY--------
SIGNATURE OF SUPR. ELECIN: DATE:
LICENSE NO:
+•++++++++++++++++..•+++++I...............................f..........I................
Call 639-4175 by 7:00 p. m. for an inspection needed the next business day
.........................4........................*++*.......................4-+
RECEIVED
CITY OF TIGARD Electrical Permit Application Plan Chec<q
13,125 SW HALL BLVDMAR 6 8 IT'ct Rec'd By _
Date Recd
TIGARD OR 97223 UNI(Y UEVEL91`Wi�ENI Date to P.E.
Phone (503)639 4171, Print or Type Date to DST- _
Inspection (503) 639-4175 Incomplete or illegible will not be accepted Permit a -C3/
Fax (503)684-7297 Called -
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development _.__ _ Number of Inspections per perm!t allowed
Name(or name of business),0AA) fQBD L T-7_____- Service included: Items Cost Surn
Address- 10475 SW Grant Ct . __ 4a. Residential-per unit
1000 sq.It.or less $I to 00 4
City/State/Zip T i a a-r-d., OR 97223
7223 _ Fach additional 500 sq It nr
Commercial ❑ Residential ❑ portion thereof $25 00 1
Limited Energy � $2500
Each Manul'd Home or Modular
Dwe4mg Service or Feeder $68.00
?_a. Contractor installation only:
(Attach Lupy of all current licenses) s Services or Feeders
In
Electrical Contractor A00 N E S FERRY ELECTRIC Installation,alteration,or relncaiion
Address P 0 A o x 628 -- 200 amps or less $60 00 2
201 amps to 400 amps $80.00 2
City �'i o n y 111 a State_QF Zip 97070 401 amps to 600 amps $120.00 _ 2
Phone No 6 8 2-4933 5 601 amps to 1000 amps $180.00 2
Over 1000 amps or volts $340.00 2
Job N0. - - Reconnect only $50.00 2
Elec.Coal. Licr--�. No. 3-2 2 3 C _Exp.Date 1/31/99
OR State LCB Reg. No. _txp.Date 2/91/99 4c.Temporary Services or Feeders
COT Business Tax or Me o No.?EE'S l Exp.Date 8/1/99 Installation,alteration,or relocation
200 amps or less i $50.00 2
Signature of Supr. Ele i 201 amps to 400 amps $ 2
401 amps to 600 amps $100.0100.0 0 2
Over 600 amps to 1000 polls,
License No 3170 S Exp.Date 2,011101 see"b"above.
Phone Nr 682-4936 - 4d.Branch Circuits
r 4'
New,alteration or extension pot 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 lee for branch circuits
City„ State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit 1 $35.00 99 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 rant. 4e.Miscellaneous
(Service or feeder not ind,ided)
Owner's Signature Each pump cr irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review se,-tion (if required):' Signal 1,alteration
or o limited ion -
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 41.Each additional Inspection over
Service and feeder 225 amps or more the allowable In any of the above
System over 600 volts nominal Per It.;pection $35.00
Classified area or structure containing special occupancy Per hour $55.00 as described in N.E.C.Chapter 5 In Plant $5500
"Submit 2 sets of plans with application where any of the above apply. Jr. Fees:
Not required for temporary construction services. 5a.Enter total of above fees $ -3�- -
5%Surcharge(.05 X total fees)
NOTICE Subtotal S �--�y-
5b.Enter 25%of line So for
PERMITS BECOME VOID IF WORK OR CONSTRULTION AUTHORIZED IS Plan Review if required(Sec.3) g NOT COMME14CED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal g -
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. Trust Account s�._
Total balance Due
I
I\DSTSiEt CB6 APP Aa ir198
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 G Business Line: 639-4171 BUP _
Date Requested—2-."L C AM__— PM - BLD
Location_ 7 �7 ' Suite _ MEC
Contact Person —
Ph /nPLM
Ph SWR
Contractor ELC
BUILDING Tenant/Owner - -- ELR _
Retaining Wall
Footing Access FPS
Foundation _
Ftg Drain S�'N --
Crawl Drain Inspection Notes: r'T
Slab ----- --- --- --
Post&Beam _
Ext Sheath/Shear
Int Sheath/Shear
Framing `- --� — -
Insulation
Drywall Nailing ------�'`-'• �- � �
Firewall -
Fire Sprinkler - _------------.._----- -
Fire Alarm -
Susp'd Ceiling --------- — ___— ---r -
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
E>(. CTRL
t-ffi
Service —
Rough In 1�' t1 —
UG/Slab
Low Voltage
Fire Alarm —
Fi
ASS PART FAIL -
WE
Backfill/Grading -
Sanitary Sewer required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Storm Drain [ �Reinspection fee of$
Catch Basin [ Unable to inspect-no access
Fire Supply Line [ 1
please cllll for reinspection RE:
ADA
Approach/Sidewalk - 9 —Irspector _ ,1'�-*-� ��.�Ext
;gate
Other _ --
Final
PASS PART FAIL DO NOT REMOVE this inspection record frorn the job site.