Permit t
Ai CITY OF TIGARD
w . �i�;� DEVELOPMENT SERVICES PERMIT #: 279
9 DATE ISSUED: 05/12/97
PARCEL: 1S134CB -01800
SITE ADDRESS...:1213O SW SUMMER ST
SUBDIVISION -SUMMER HILLS PARK ZONING:R -4.5
BLOCK • LOT -21 JURISDICTION: TIG
Proj ect Description : instl limited energy panel /1 job # ?
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY - 1 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- —• - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 — 400 amp... - 0 1st W/O SRVC OR FDR.: 0 PER HOUR • 0
401 — 600 amp......: 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 — 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS • ) 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR )= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: -- FEES
JOHN /HELEN ANDREAS type amount by date recpt
12130 SW SUMMER ST PRMT $ 25.00 TAT 05/09/97 97- 294382
TIGARD OR 97223 SPCT $ 1.25 TAT 05/09/97 97- 294382
Phone #:
Contractor:
PHILLIPS ELECTRONICS $ 26.25 TOTAL
(DBA FOR MASTER ALARM L.L.C.)
1110 NW FLANDERS REQUIRED INSPECTIONS
PORTLAND OR 97209 Ceiling Cover Underground Cove
Phone #: 227 -0571 Wall Cover Elect'l Service
Reg #..: 000433
This permit is issued subject to the regulations contained in the i■/PvAA_X.LL
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm i t t \ S i gnat _ire
applicable laws. All work will be done in accordance with / /) �
approved plans. This permit will expire if work is not started , U /
within 180 days of issuance, or if work is suspended for more L AL. — .. . ._ I ..e
than 180 days. I s s L e d By /
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: ___ LL y/f�fidi — DATE: .S—/2 -97
r
LICENSE NO: __ Z9tTLL� ____ — _ _
Call for inspection — 639 -4175
CITY TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # =L_ _ _
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) � Ft 't) Service included: Items Cost Sum
I
Address 12- (.30 S. C O SCfi4Jt4Qy`�1 e- 4a. Residential - per unit
I
04,', � � 2.2.3. 1000 sq. ft. or less $110.00 4
City /State /Zip - Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial ❑ Residential R Limited 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 'l c:c.0 Installation, alteration, or relocation
200 amps or less $60.00 2
Address !C �� o L . a • - 201 amps to 400 amps $80.00 2
. �• = -
City .(if7 State I Zlp 770`1' 401 amps to 600 amps $120.00 2
Phone No. �Z ?-- 4 T'( 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. 26 2 C..r Exp.Date /C-/-?7
OR State CCB Reg. No._ 3 Exp.Date , 2 i ' 7 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n ":�� " j���` X . 201 amps to 400 am $ 5.00 2
401 amps to 600 amps $100.00 2
c Over 600 amps to 1000 volts,
License No. 1,,2.9.9 Exp.Date /0 - /4 s see "b" above.
Phone No. # 2,2 7 -017/ 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 $35.00 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 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: .4 S 4:4'
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ / i�
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 g
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ j
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
5 -LS
G53;. 9— /v LJi-Q — iz/
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
l.� -1
Date Requested: A.M. P.M. MST:
Location: - 1.-t3,0 ,4k4) 4(4 m BUP:
Tenant: Suite: Bldg: MEC:
Contractor: ',�/ Phone: 590 2 -7 y f PLM:
Owner' n N D Phone: ELC: 7 7- ell7 q
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ECTRIC SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service • Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Fumace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG • _ -
Shear /Sheath Fire Spklr /Ahn Crawl/Found Dr Heat Pump _ .w Volt _ , , / . , . ,_4, e /
Approved Approved Approved pproved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved pproved Not Approved
FINAL FINAL FINAL FINAL FINAL
e v r- . S S - iT" itSS
El Call for rein v io ID Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: / t6/ t Date: 6 -/- • yi Page of