Permit C ITY O r ^ T I GARD - ELECTRICAL PERMIT
` PERMIT #: ELC2006 -00127
,, „01,• DEVELOPENT
Tigard, VI 97223 503 - 639 -4171 DATE ISSUED: 2/17/2006
13125 PARCEL: 2S110DC - 01000
SITE ADDRESS: 11295 SW MEADOWBROOK DR 1 ZONING: R - 25
SUBDIVISION: WILLOW BROOK FARM LOT : 014 JURISDICTION: TIG
Project Description: Unit1, install service for washer and dryer.
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: 1 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:
SUMMERFIELD ASSOCIATES, LLC JET ELECTRIC INC.
% HSC REAL ESTATE PO BOX 20765
1500 SW 1ST SUITE 1020 PORTLAND, OR 97294
PORTLAND, OR 97201
Phone: 503 - 546 -5712 Contact #: PRI 503 - 258 -1715
FAX 503 - 258 -1716
FEES
Description Date Amount Reg #: ELE 26 - 1068C
[ELPRMT] ELC Permit 2/17/2006 $24.25 LIC 141920
[TAX] 8% State Surcharge 2/17/2006 $1.94 SUP 45175
Total $26.19 REQUIRED ITEMS AND REPORTS
This Permit is issued subject 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 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 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 - 246 -6699 or 1- 32 -2344.
Issued By: 40..L/..) Permittee Signature :
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:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
02/10/2006 11:49 FAX 5035981960 CITY OF TIGARD Z002
r
1. • • ■-(•
1 ' .FOR Oi hIC E 1JSF ONLY `
Electrical Permit Application , .
City of Tigard oa Ret:tclB eivcd D , �'r Fermat No.: e 0 ' 061 2.7 1.1 13125 SW hall Blvd., Tigard, OR 97223 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 u trtsiC�uNl6rj1l'+A Date/By: �,
Inspection Line: 503.639.4175 '__.. Date ResdyBy: El See Page 2 Cur
Internet: www.tigard- or,gov Notined/Method: - I Supplemental inrermunon •
• . TYPE OF,WORK.: PL
AN REVIEW.
❑ New construction ❑ A 'don/alteration /replacement Please check all that apply:
❑ Demolition Other: ❑Service over 225 amps, comm'l ❑Hazardous location
Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
• . CATEGORY OF • CONSTRUCTION . . ,: • • of t- and 2- family dwellings 4 or more new residential .
['System over 600 volts nominal units in one structure
❑ 1- id 2-family dwelling ❑ Conunereial /industrial ❑Accessory building ['Building over three stories ❑Feeders, 400 amps or more
2 family ❑ Master builder ❑ Other: ['Occupant load over 99 persons OManufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
L ❑Heahh -cart facility ❑Other:
Job no.: 1 Job site address: it 29 c r-{ g A-0003 i i l •L 1 :nQ ., Submit ? sets of plans with any of the above. •
City /State /ZIP` - r'1 t' p- c., �"1 �I .2„ The above arc not applicable to temporary construction service.
i - �, :FEE ".SCHEDULE;.
Suite/bldg./apt. n0.:4 IT I, Project namet 'rt l( LZF1 el..17 DeecrIVIO l W I Qty. I Fee. Tenul
Cross street/directions to job site: O ti,A /j), ') � . -114— New residential single - or multi - family dwelling unit.
tt includes attached garage.
OFD G Frei W��. -T - � l,000 sq. t:. or less 1 145,15 4
Subdivision: Lot no.: Ea. add'l 500 sq. Ft, or portion 33.40 1
_, - Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non- residential 75.00 2
. DESCRIPTION or WORK Each manufactured or modular
�
dwelling, service and/or feeder _ 90,90 2
E
"'>���� � , v %i -' I tJli ` lfi •• Services or feeder8 lnstsflation, alteration, and /or relocation
200 amps or less 80.30 2
. 201 amps to 400 amps 106.85 2
. J4 oPERTY. - OWNER • • ❑ T . • •..•.: • ' 401 amps to 600 amps 160.60 2
Name: ' ' " Liz, N P �1 l+ 601 amps to 1,000 amps 240.60 2
e �l.(d 1—ArI� peer 1,000 amps or volts 454.65 2
Address: i sac, 5 \,,,4 (.1:-t- �� . 44e j 3 42 -. 'r° I 02,z,- —
Reconnect only 66.85
City /State /Z.IP: ' _i ' 7 2,1::, ( Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( '3) 5 it ', - 5 2_ Fax: e- 3 - _ 0 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
—
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps , 133.75 2
Owner signature: , Date: _ Branch circuits - new, alteration, or extension, per panel
ApPLIEANT CONTACT PER A, Fee for branch circuits with
service or feeder fee, each 6,65 ?
5 Business name: w ,D cT � , 1�� �j _C;;_L • :QC
t B. Fee for branch circuits
Contact name; ii l . 1.\- L. 44....2._ without service or feeder fee, I 46.85 2
fnrst branch circuit _
Address: 15 o -6 N ( l . Each add branch circuit I 6.65 2
City /State /ZIP: k 4 ae - L a I,,,3 R „4 -- Miscellaneous (service or feeder not included)
Pump or irrigation circle 53,40 2
Phone: 2/7 ,) gel.
- .�` i'--6 p i 7_,5 F CA- r - Z'
CA- IC; . —It Sign or outline lighting 53.40 2
E -mail: Ch4cl (✓ r” t t,_ , LI u v.im _, Pte • . Signal circuit(s) or limited-
CONTRACTOR: energy panel, alteration, or
__ — — extension. Describe: Page 2 2
Business name: / + e— E " � 2 (- t .. , . �,L ^� �'. C
,�I _ Each additional inspection over allowable to any of the above
Address:
P„, " �= 7 Pcr inspection 62.50
City /State /ZIP: Po i t__&►.Y ;) Op-- ci 7 2_! j 4' Investigation per hour (1 hr min) 62.50
_ -- Industrial plant per hour 73.75
Phone:) r -� I Fax: ) > � i ELECTRICAL.:PERMVIIT •F`EES' - r
CCB Lic.: j y I c1 Electrical Lie 4 1Lat,�� Suprv. Lie.; t� I � Su btotal A .
• / 2 .,
Suprv. Electrician signature, required; Plan review (25% of permit fee)
State surcharge (8% of permit fee) r 'II
Print n ame . _ (�`,
t--- L7 - �V Date: l i�% `E — TOTAL PERMIT FEE
Authorized signature: Ibis permit application e xpires If a permit is not ob w lthln l el
days after it bas been accented as Comptcte
Print name: Date: • Fee methodology set by Tri- County Building industry Service Board
- — .. Number of inspeciio per permit allowed,
I;\ Building \Pcm,itetELC•PcrrnitA00.aac 12/30105 440-4615T(10 /02 /COM /Wt$
CITY OF TIGARD e
BUILDING DIVISION PERMIT #: ZOO( ` 66 0-7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 " 1 1 0.
Inspection Requests (24 Hrs.): (503) 639 -4175 — I �!
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: ` J.6-1.-e79-1 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 -( -0 (e Pour Time:
` Inspecti n Des ription Confirm # Contact # Message
3 / 0- 7/87
Corrections /Commen /!In ctions:
i OV a"� l
K 1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: (\S v) Date: 0 Phone #: (503) 718 P 4