Permit ,`t CITY OF TIGARD ELECTRICAL PERMIT
• PERMIT #: ELC2004 -00747
,L`�I�� DEVELOPMENT SERVICES DATE ISSUED: 11/22/2004
•
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: Rewire (4) replacement roof top NC units.
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: 3 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 367
PO BOX 12188 WEST LINN, OR 97068
SALEM, OR 97309
Phone: Phone: 503 - 656 - 5623
Reg #: LIC 88069
ELE 3 -161 -C
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/22/200' $66.80 •
[TAX] 8% State Surcharge 11/22/200' $5.34 Rough -in
Elect'l Final
Total $72.14
•
•
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 -800- 332 -2344.
Issued By: 7, Permit Signature: • ■s y , D
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 639 -4175 by 7:00pm for an inspection the next business day
•
11/22/2004 10:02 5036501918 D &L— ELECTIC PAGE 02 ■ •
w
El Permit A lication Received a ,4,4t Electrical
R Dnte/B : z '"
' /S' Permit No.:t✓ ., !/ a % 7 y
Planning Approval Sign
City of Tigard Date/B : Permit No.:
13125 SW Hall Blvd. NOV 2 2 2004 Plan Review Other
Tigard, : Permit No.:
ar Oregon 97223 Land Use
g d, Poet- Review
Phone: 503-639-4171 Fa • • 1.491E G A %�,._,,'), ,.:,, �
Date/By: Case No.:
Internet: www.ci.tigard.or 'mr1 s jl, J _ Juris.: El See Rage 2 for
24 hour Inspection )ttques :
39 IAN "" Nan a /Metho '� I - Supplemental information -
gg ,�nn,,��rr� { Yutl� " V 4
fl, '�' � ��.. • a � r .+ .d. .:k...' . .5 , ,:2' ` ". ....;.'. ',•' I; �'! `' •e. • ..Tt ,i , '' . •�. I i!i:.Ll• ;l.E.:�,fi• '�' 1' i t
Demolition Service over 225 amps- NI Service facility
New construction cortutterciel 0 Hazardous location
111 Addition /alteration/re i lacerrlent • Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
IMIUMIIMM :;t:1 .;:vizigfagysimisin I & 2 family dwellings our or more residential units in
❑ System over 600 volts nominal one structure
PI & 2 -Famil dweller • • Commercial/Industrial p Building over three stories ❑ Feeders, 400 amps or more
1 II Accesso Buildin: II Multi- Family ❑ Occupant load over 99 persons El Manufactured structures or RV park
. ❑ Egress/lighting plan ❑ Other 1■ Master Builder 1r Other submit sets of plans with any of the above
eI'O: uJI�V.P�'eK�r Ei�4,' T heabov ,licabletotem∎ ora construction serve .
e are not a ce
address: o Al SGc 3,,,•.
Job site f� J ..•:�i , ' �I; Z���l ..�ru�.�;��t..3��dTdi�';��Gt" o:.. ... ,
Bld /A t. #: Number of inspections per permit allowed
Suite #: �' p -- Description Qty Fee (ea.) 'total I
Pro ect Name:.] / r ff _ ........1._ ' \ se- _Description
residential-single or multlAunily per
Cross street/Directions to job site: Q , • . • c.e N. dwelling unit. Includes attached garage.
Service Included: 145.15 4
1000 sq ft. or less
Each additional 500 ... ft. or • •rtion thereof 33 I '
Limited energy, residential 75.00 2
Subdivisio11:41/ //61.4i &GP apV J Lot #: • Limited energy, non residential - 75,00 2 -
Tax ma • / s areel #: Each manufactured home or modular dwelling 2
service and/or feeder
. '' ' :: ; ' ' u + +- P .�..:Tr•. Services or feeders- Installation,
- . , alteration or relocation:
IF 200 amps or less
80.30 2
d i 201 amps m 400 amps ]06,85 2
401 amps to 600 amps 160.60 r 2
;' p�t� ,, P+ y 601 amps to 1000 amps 240,60 2
yn, s� j sL o as lli ' t;hlil'�a :A :l #!(«�I ;.O!i!f�1H 11: ' '�;I�! +�! r, '!,.N!dlA li ` BNNF W AtC t Over 1000 amps or volts 454.65 2
Name: ,'% i ,,r s.. e d, , Reconnect only 66.85 2
Address: j�� B / cX /y /// Temporary services or feeders - installation,
alteration, or relocation: 66.85 I
City /5'tate/Zlp: $•i �n M / '� , 7 Jo 2. 200 amps or less 100.30 2
r 201 amps to 400 amps ,
Phone: Fax: y` ,`. 401 to 600 amps 133.75 2
I� a a.I ' f DIR „ v;.�!';�� a!!�.l�i!. ;A Branch circuits - new, alteration, or
per panelIntt
:
l:
A . Fee for branch circuits with purchase of 6.65 2
Address: ) Z1;4/ 7e2 service or feeder fee, each branch circuit
City /State /Zl p 1l/ t o f '/ C•f N J' B• Fee for brunch circuits without purchase of U/ $� 2
service or feeder te, fast branch circuit / 46.85 V.
Phone: le --Cr -57. 3 I Fax: `si7 - /TiP Each additional branch circuit circuit 3 6.65 / Y, fa)--- 2
E-mail: Misc.(Service or feeder not included): 5
! t; ' ,k a •t r a •ify 'g . fl ,, „ i Bach ptmtp or uriBatioa circle 3.40 2
.0 G . Ih�Gt`' i� ey ,,i,ii�1 yL;. 7.7 i,f& Each sigh or outline lighting 53.40
1 Job No: Signal circuit(s) ora limited energy panel,
� alteration or extension Page 2 2
i Business Name: D L. /��7iC�c. .'i✓G Description: 'l
, Address: 'o ,r, _ e
�p �y Each additional Inspection over the allowable in enZ of the above:
Cit / State /Zip:�•YT c''Iap c. l /��P/ Per inspection per hour (min.Ihour) 62.50
Phone:3 /.73 --656 —sr 2 3 Fax:51a.J -45 /S /5 investigation fee:
■
CCB L ' ic. #: gi 2 9 Lie. #: 3 - / ‘ / - G Other:
ii ; : . , , , . u I r : gi . � v , , , r h tiI.....,,►t�x:: .. . ?; " ,a ,, I t , t ,' : . . . , , , - ' . • �;
Jiltlii .. .. -
i : ki • i � i, " `.+ l h f ':, fi.1,
n ; .' ' . . _e•nFi
Supervising electric' .� �� Subtotal a 6, 8fl
si attue re uirt 7 `7 Plan Re view (2 of P ermit Fee) _ $ --
Print NaIne:Llo '4' /1/ Le arns.•. . Lic. #;,,y‘GZ.. S State Surcharge (8% of Permit Fee) _ $ ..S- 3 y
TOTAL PERMIT FEE $ _'L . /9
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: - Date: 180 days after it has been accepted as complete.
•Fee methodology set. by TO-County Building Industry Service Board.
(Please print name)
i :\Dsts\Permit Forms \ElcpermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested Q.` \ � AM PM BUP
Location > �� Sq`l S v1m Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC �Ob�� b' LI
Footing
Foundation ELC
Access:
Crawl ELR
Dr ain (� ` ci ?
Crl Dr 1 \
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation - C p \'Q 'A 0'
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm 6-/
Susp'd Ceiling Roof
Other:
Final
PASS PART FAIL
PLUMBING \f‘\)
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
��11ST FAIL
FI FS:TRIr
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
PBS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA () CZ
Approach/Sidewalk Date - S Inspector ' - ..:� - � A • -•• Ext
Other:
Final DO NOT REMOVE this Inspection record om the ob site.
PASS PART FAIL