Permit ELECTRICAL PERMIT
CITY OF �`IG4RD
} PERMIT #: ELC2005 -01004
DEVELOPMENT SERVICES DATE ISSUED: 11/17/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 1S134CB - 01600
SITE ADDRESS: 12190 SW SUMMER ST ZONING: R -4.5
SUBDIVISION: SUMMER HILLS PARK LOT : 017 JURISDICTION: TIG
Project Description: 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:
DOUG GALLOWA ASTRO ELECTRIC
12190 SW SUMMER ST 1417 NE 76TH AVE.
TIGARD, OR 97223 VANCOUVER, WA 98665
Phone: 503 - 590 -1794 Phone: 503 - 384 -0400
FEES Reg #: ELE 37 -88IC
SUP .4626S
Description Date Amount LIC 143117
[ELPRMT] ELC Permit 11/16/200' $46.85
[TAX] 8% State Surcharge 11/16/200` $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60 •
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 -0080. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246-1987 or
1 -800- 332 -2344.
Issued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sal , ease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELECTRICIAN: DATE:
LICENSE NO.:
Call 503439 -4175 by 7:00 AM for an inspection that business day.
Note: If you cannot schedule an inspection while the system is down, please call 503 - 718 -2433 for assistance.
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.
b S
Electrical Permit Applicati,n FOR OFFICE USE ONLY
City or gard � �; ' �� , , I Received Plan Review
Y. 11 // /0 /05 U .. �,JQ r /�e5_ e
PennitNo.: �,/
13125 SW Hall Blvd., Tigard, OR 97223 o p/
Plan Ri
Phone: 503.639.4171 Fax: 503.598..1960 ,- ' � �C•.;- I 1 Date/By.. OtherPemut:
Inspection Line: 503.639.4175 - _ UJ J __ I' Date Ready/By: toj.s / Hi See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: . eo Supplemental Information
`' TYPE OF 'WORK PLAN REVIEW
El New construction 'A dd Please check all that apply:
El Demolition ❑ Other: ❑Service over 225 amps, comm'I 0 Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
da l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building 0 System over 600 volts nominal units in one structure
El Multi - family ❑ Master builder ❑Building over three stories 0 Feeders, 400 amps or more
❑ Other:
0 Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
S Sy M 1 £' S 1 ❑Health -care o plans ❑��.
Job no.: Job site address: 42 / To S
Submit 2 sets of plans with any of the above.
City/ State/ZIP: `) ,4 a2) O,92. The above are not applicable to temporary construction service.
Suite/bldg./apt no.: Project name: AOId lion 4,4 r its Dacri
I cp FEE* SCHEDULE
ptioa I Qty. I Fee. I Total *'
Cross street/directions to job site: N ew residential single - or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
Ain OF WORK Each manufactured or modular
!'t D� ITS O� �..') R 1 N dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: J ) ( Q G- / L t 9 t.• _ gi 601 amps to 1,000 amps 240.60 2
Address: I 2, / (30 s lj S u h E2 S 1 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: ^/ 6 A. G ; t 012 Temporary services or feeders installation, alteration, and/or
(� 3) <VI O -, ` ' 7 � 4 f ( ) relocation 00 am
Phone: I Fax: 200 amps or less 66.85 I
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
❑ APPLICANT I )Rf CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: h Q K 360 �i 7Q g-031c- branch circuit
Contact name: J B. Fee for branch circuits
without service or feeder fee, '
each branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: 4 snap E I C extension. Describe: Page 2 2
Address: / 1 17 N 6: 76-1 ST -I* Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: (f,4 N C.Q I i () el f tj r e Gr S6G , e•-" Investigation per hour (1 hr min) 62.50
Phone: ('3 3 ' ¥ —0 ¢00 Fax: (360) Cera— 5 3-7 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: ist3 / Electrical Lic.: rQ /c Suprv. Lic.: 462 Subtotal
p & /40 9 `7 /°67 /� /i m 7 Pl an review (25% of permit fee)
Suprv. Electric st ature, required: �f _ ( /°
Print name: / -j�}- ff S L yfi— v Date:: t / ! 6 f State surcharge (8% of permit fee)
/ O�
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed
i:\ Building Wermits\ELC- PamitApp.doc 12/03 440.4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page -2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
eck Type of Work Involved:
iN Audio and Stereo Systems*
❑ glar Alarm
❑ Gara: ; Door Opener*
❑ Heating, tilation and Air Conditio ing
System*
❑ Vacuum Systems
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system. ... $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo System:
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecomm ication Installation
❑ Fire Alarm In . llation
❑ HVAC
❑ Instrum - ntation
❑ Intercom and Paging Systems
❑ Lan scape Irrigation Control*
•
❑ Medical
❑ Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\Building\Pertnits ELC- PennitApp.doc 04/03
CITY OF TIGARD -.. -
BUILDING DIVISION' PERMIT #: EL 200 -01004
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/17/2005
Phone: (503) 639 -4171 ; N
Inspection Requests (24 Hrs.): (503) 639 -4175 F.
' INSPECTION WORKSHEET FOR . DATE: 11/18/2005 TIME: 7:17AM PAGE: 11
SITE ADDRESS: 12190 SW SUMMER ST CLASS OF WORK:
SUBDIVISION: SUMMER HILLS PARK LOT #: 017 TYPE OF USE:
PROJECT NAME: GALLOWA
DESCRIPTION: 1 branch circuit.
//
1/ GALLOWA, DOUG PHONE #: 503 -590 -1794
CONTRACTOR: ASTRO ELECTRIC Ci W\ p , i \ PHONE #: 503 - 384-0400
Inspection Request Scheduled For: Date: 11/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
- . 021887 -01 360-798-0315 N
Iei eA FiNA1.
-ctions /Comments/ .: ructions:
i- !�4:-' al.oi' g L� 1� ► \:�t90 >p ,, .∎t ^,
T
-.,c-\
115, , \---/v
IN PAS'-,\ ❑ PARTIAL APPROVAL ❑ CANCEL 111 NO ACCESS
,,� • L � 1 ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / Date:// 7, ii Phone #: (503) 718 -