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11867 SW GREENBURG 1-3 1
CITY OF TIGARD — ELECTRICAL PERMITPERM —
DEVELOPMENT SERVICES � / DATES UIED: E 10/00 0-00240
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-417'1 �r
PARCEL: 1S135DC-0010n
SITE ADDRESS: 11867 SW GREENBURG RD 1-3 `/ice
SUBDIVISION: �^r -7 '' ZONING: C-P
BLOCK: 1 LOT : ISDICTION: TIG
Prosect Description: Installation of one 200 amp service/feeder and 16 branch circuit
RESIDENTIAL UNIT TEMP SRVC/FEEDERS — MISCELLANEOUS
1000 SF OR LESS: 0 - 200 arrrp: 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: PER INSPECTION:
201 400 amp: 1 st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 16 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp/volt. >=4 RES UNITS: >600 VOLT NOMINAL:
Reconnect on> _ SVC/FDR >= 225 AMPS: _ CLASS AREA/SPEC OCC:
Owner: Contractor:
NORTON, TIMOTHY W + KATHRYN M NABCO INC
20917 NW 11TH CT 8560 SV'J MIAMI
RIDGEFIELD, WA 98642 WILSOINWIL LE, OR 97070
Phone: Phone: 317-8932
Reg#: LIC 93590
ELE 3-491C
SUP 3801S
FEES Required Inspections
Type By Date Amount Receipt v Elect'I SE,rvice
PRMT DEB 5/10/00 $149.85 0002-47 Elect'I Fi-tal
SPCT DEB 5/10/00 $11.99 0002-47
Total $161.84
This Permit is issued subiect 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 d work is
suspended for more than 180 days ATTENTION Oregon law requires yoL'to follow rule;adopted by the Oregon Utility Notification Center Those
rules are set forth in OAR 952-001-0010 through OAV52-001-0080 You may obtain copies of Use rules or direct questions to OUNC at 15031
246-1987 �(
PERMITTEE'S SIGNATURE �/ � !SSU6 8Y: � y
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 S�R. ELEC'N: —. 1"C y��3-1 DATE:
LICENSE NO: Ok')l J
Call 639-4175 by 7:00pm for an inspection the next business day
r
CITY OF TIGARD Electrical Permit Application Plan Check# ,
13125 SW HALL BLVD. Recd By
TIGARD OR 97223 Date Recd -
Date to P.E.
Phone(503)639-4171, x304 Date to DfST _-
Inspection(503)639-4175 Print of Type Perrril P fly'' b-c y0
Fax(503) 598-1960 Incofnplete 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) _ Service included: Items Cost Sum
Address_ I 1 5(.P'.4: �Y t n t r t om/ _ 4a. Rasidential-per unit
CitylState/Zipn�1� '�_ Each sq tl or less _ _ $ t1775 4
Each additional 500 sq.fl.or
portion thereof _ _ $ 26.75 1
Commercial ❑ Residential Limited Friergy $ 60.00 -Each Manufd Home or Modular
2a. Contractor Installation only: Dwelling Service or Feeder $ 72.75
(Prior to permit issuance,applicants must provide contractor license 4b.Services or Feeders
in`-rmat.on for COT data base). Installation,alteration,or relocation
Electrical Contractor )\),A t5Cy INC. , 200 amps or less $ 64.25 ( Lif 1 s 2
201 amps to 400 amps $ 85.50 2
Address S�CC ►,ni c.r,�►l.
City_k; r L State .9 }O 401 amps to 800 amps _ $ 128.50 2
� zip- bat amps to 1000 amps _ $ 792.50 2
Phone No. '_703 3 11-- is`132.. Over 1000 amps or volts _ $ 363.75 2
Job No Reconnect only _ $ 53.50 2
Elec. Cont. Lice. No.3-4110Exp.Date /!1 u�Cla 4c.Temporary Services or Feeders
OR State CCB Reg No _1519� D Exp Date-�o Installation,alteration,or relocation
COT Business Tax or Metro No. Exp Date. 200 amps or less $ 53.50 _ 2
201 amps to 400 amps $ 80.25 2
Signature of Su r. Elec'n 401 amps to 600 amps $ 100.00 _ 2
9 P Over
600 amps to 1000 volts,
e
License No. 3X0 1 g _ Exp.batetu�o�
Phone No. l� ar9�2 _ 4d.Branch Circuits
- New,alteration or extension per panel
a)The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 1 U 2
Address _ b)The fee for branch circuits
--- ------- without purchase of service
City State _Zip _._ or tender fee.
Phone No. - First branch circuit $ 37.50
T - Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e.Miscellaneous
intended for sale,lease or rent. (Service or feeder not Included)
Each pump or irrigation circle $ 42.75 _
Owner's Signature Each sign or outline lighting $ 42.75
Signal circult(s)or a limited energy
# panel,alteration or extension $ 60.00
3. Plan Review section (if required): Minor Labels(10) - $ 100.00
Please check appropriate item and enter fee io section 5B. 4f.Each additional Inspection over
4 or more residential units in one structure the allowable in any of the above
Per inspection $ 50.00
Service and feeder 225 amps or more Per hour _ $ 50.00
System over 600 volts nominal In Plant $ 5900
_C)assified area or structure containing special occupancy as
described in N E C Chapter 5 5. Fees: e
5a.I Met total of above fees $ / 8
Submit 2 sets of plans with application where any of the above apply 8%Surcharge(08 X total fees) $
Not required for temporary construction services. Subtotal $ r/
5b.Enter 25%of line 5a for
NOTICE Plan Review if required(Sec.3) $ _
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WI71 tIN 180 DAYS,OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS liusl Account p
AT ANYTIME AFTER WORK IS COMMENCED Total balance Due $ /0,
I\dsI0f irms\cicctric doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested ✓' C1 r)0 AM PM _.. BLD
LocationL_L �� l/1i� ;3crit� " -� MEC _— -
Contact Person �. PLM 4i—
Contractor Ph SWR
BUILDING Tenant/Owner _ _ ELC
Retaining Wall EL R
Footing Access: /
Foundation ! O �< FPS
Ftg Drain ' J
Crawl Drain Inspection Notes „ .t t� �;� i � yam, SGN
Slab
Post&Beam SIT _
Ext Sheath/Shear , / Y
Ii it Sheath/Shear
Framing
Insulation � ----�- -- --�_-�-
Drywall Nailing ---__---
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: - -- --- -_
Final - ---------- �_- --_-_---------___-_�.�----- -
PASS PART FAIL _ ------ - ---------- -- --- ----- - - ----
PLUMBING
Post&Be im - -- --- -_- _—
Under Slaa
Top OutWater Service
Service
Sanitary Sewer - - - - -- -- ---
Rain Drains
Final --
PASS PART FAIL
MECHANICAL
Post& Beam -
Rough In
Gas Line
Smoke Dampers
Final -- _ -
PASS PART FAIL
CTRICA -- -
Service
Rough in -
UG/Slab
Low Voltage - -
Fire Alarm
PASS 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 Date
Other _ 4Inspector (�� Ext _
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.