Permit , CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00179
l� DEVELOPMENT SERVICES DATE ISSUED: 4/9/04
+L ` II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S110DC -00700
SITE ADDRESS: 11205 SW SUMMERFIELD DR
SUBDIVISION: WILLOW BROOK FARM ZONING: R-25
BLOCK: LOT : 016 JURISDICTION: TIG
Project Description: Installation of (2) branch circuits for rooftop unit.
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: •
CONGREGATE CARE ASSET V, LTD PTN D + L ELECTRIC, INC.
BY FALCON FINANCIAL PO BOX 1047
PO BOX 12188 OREGON CITY, OR 97045
SALEM, OR 97309
Phone: Phone: 656 - 5623
Reg #: SUP 2662S
LIC 88069
FEES ELE 3 -161C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/9/04 $53.50
[ELPRMT] Investigation 4/9/04 $53.50 Rough -in •
[TAX] 8% State Surcharge 4/9/04 $4.28 Elect'I Final
Total $111.28
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 9 -I' -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1- 800 -3. - 344.
r / .
Is • ued By: � � .,; _ 424 Permit Signature:
ir
OWNER INSTALLATION ONLY l
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CO TRA TOR STALLATION ONLY
/l
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: 7 v -
•
Call 639 -4175 by 7:00pm for an inspection the next business day
•
04/1072002 13:08 FAX 5035981960 CITY OF TIGARD Cf1j001
sb
Electrical Permit Application
Date received: Permit no.: ,� „ -
.•�,antr''l;t, City of Tigard i'roject/appl.no.: I Ex.ircdate:
City y
Cio Tisard Address: 13125 SW Ha/1 Blvd, Tigard, OR 97223 Date issued: By 7�
Phone: (503) 639.4171 I'/ Receipt no.:
Fax: (503) 598 -1960 Case file no.: 1 Payment type:
Land use approval.
.
O 1 & 2 family dwelling or accessory C] Commercial/industrial ❑ Multi - family 0 Tenant improvement
O New construction O Addition/al teration/replacemen; 0 Other: 11 Partial
■
JOB SITE INFORMATION ..
Job address: J/ ZGS' $W S .,s ,: /,/ ,P/r( Bldg. no.: Suite no.: Tax map /tax lot/account no -:
Lot: Block: !Subdivision:
Project name: I Description and location of work on premises: AA e.i/ p
Estimated date of completion/inspection:
CON77ZAC1'UR I'
AII'LICAI1U I. EL SUILLULL ,
Job not Fee Max
Business name: / I L �L✓ 72v c , V.i6 Description Qty. b {ea) Total no. insp
~ Address: r'c X JQ y7 - a r rc t�deut1 n •single attached garage.
multi-family
dncllin bruit. l dudca altdrtxl atge. + I
City: &e'er, ✓ c. es State: o pe ZIP: 7o ',s • S.•nitrirxxladed:
Phone: G �G - -s-e Fax :e-� - /57j Ismail: I I • s q. ft. or less 1
CCB no.: R'/S' O 6 f I Dec, bus. Ho. no: y F 3 ,/ Each additional 500 sq. h. or portion thereof
r Limited energy. residential
/ . - tro lie. no.: 7e) - Limitcd energy, non resi denti al ( 2
Ili
y �d�� JO
I. : Each manufactured home or 'nodular dwelling
ignature of s pervising electrici (required) D to Service and/or feeder 2
Sup. elect. name (print) :P / - ,,,, -Pxcenseno: G ServICC90Tfeeders-insYallation,
a or relocation:
. _ _ '. PROPER1'1' OWNER -r
. 200 amps or less
Name (print): u ry,"„ t i f / ', e. / Cy /? MN'? S6' 201 amps to 400 arnps 2 r
401 amp. to 600 amps 2 1
Mailing address: // .Z U 5 Slit/ SG.. 1, A-t /:!-, / / 601 an:p: to 1000 amps 2 I
City: %' . ,/ State: /e ZIP: et Over 1000 amps or volts , 2
Phone.: - - -393 b Fax: E -mail: — Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services orfcefers -
which is nor intended for sale, lease, rent. or exchange according to tnzullattoa alteration, or relocation:
ORS 447, 455, 479. 670, 701. 200 amps or less -
201 amps to 400 amps 2 2 l
Owner's signature: Date: 401 to 600 amps
ENGINEER . • . , Branch circuits new, alte ration,
or extension per panel:
Name: .4. Fee for branch circuits with purrs ase of
Address: service or feeder fee. each branch circuit 2
City: • I State: . I ZIP: B. Fee for branch circuits without purchase /�/, Q
Phone: l Fax: E of scrt•ice or feeder fee, firs: branch circuit T( 2
Each additional branch circuit: 1 I 4 0 < -
1'LAN. itEwEiV (Pleus -dicCk all that appJ■) , : .' MIrc- (Service or feeder not Included):
O Service over 225 amps- Cortttitercial 0 Health -care facility Each pump or irrigation circle 2 -
O Service over 320 amps -rating of 16:2 O. Hazardous location Each signor outline lighting 2
family dwellings Cl Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel.-
T-. System over600 volts nominal morn residential units in one so-velure alteration, or es tension* - 2
U Building over three stories 0 Feeders, 400 amps or more *Description: •
O Occupant load over 99 persons U Manufactured smseoues or RV park Each additi.00al inspection over the alloaabte in any of the above:
O Egress/Ii ghcingplan 0 Other. Per inspection 1 I I
Submit sets of plans with any of the above. Investigation fee �,1. •
The shove are not applicable to temporary construction service. Other
Na all isdxti
1 Juror.s accept credit cads, please call Jurisdicdca for more infonnstion. Novice: This lxtmil application
fcc $ .�
O Pisa Q Plan review (at MasterCard expires if a pcnnil is not obtained — '7") S (/
Credit C cumber . I / within 180 days eRur it has Boer, State surcharge (8%) $ I '
E p acceptea as complete,
$ • i/ / • ' 4
Name of cardholder as ibower on credit card
r S
Cardholder denature Amount 440 -4615 (t,AO/L;OM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location l 1 Z—� S \' 'm N\ Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR o�
BUILDING Tenant/Owner ELC D -0
(� I
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation — = - R. _�;� -
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
; PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS—PART FAIL
EL CTRIC
Service
Rough -In
UG/Slab
Low Voltage
F - larm
1 ;"'`. S PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA �} C
Approach/Sidewalk Date 1 ` J Inspector A - Ext
Other:
Final DO NOT REMOVE this Inspection record from the Jo ' site.
PASS PART FAIL