Permit ' CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00129
rl� DEVELOPMENT SERVICES DATE ISSUED: 2/17/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 110 D D -0 0109
SITE ADDRESS: 11055 SW SUMMERFIELD DR 6 ZONING: R -25
SUBDIVISION: SUMMERFIELD APARTMENTS LOT : 013 JURISDICTION: TIG
Project Description: Unit 6, 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 4517S
Total $26.19 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 - 246 -6699 or 1 -80 32-
Issued By: - Q,tA..> Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for aninspection that business day.
• This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
0 ;/1O/2Q06 11:49 FAX 5035981960 CITY OF TIGARD Q 002
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received A
1 J � Permit No.: , It
AO
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other omit:
U tz „ir ± i� fi
f1
Phone: 503.639.4171 Fax: 503.598.1960 ` l�'1 Date/By Inspection Line: 503.639.4175 s,!�!� ,1 _'_.. Date ReadyBy: i ' ^ A iii Sec Page 2 for
Internet: www.tigard or.gov NodBed/Method: - W' Supplemental information
TYP$ P LAN REVIEW:
❑ New construction ❑ A - tion/alteration/replacemcnt Please check all that apply.
['Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition Other:
[]Service over 320 antes - rating ['Bulldog over 10,000 sq. f1.,
- • . CATEGORY' OF CONSTRUCTION : r .:; • • • of 1 - and 2- family dwellings 4 or more new residential
❑ 1 - rd 2 -family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
ulti- family ❑ Master builder ❑ Other ['Occupant load over 99 persons []Manufactured structures or
JOB SITE INFORMATION AND LOCATION .. ❑Cgress/lighting RV park
4 ❑Health -care facility ❑Other. •
•
Job no.: Job site address: du NN act £.-n ' Submit? sets of pions with any of the about. •
City/State /ZIPS --rt&, i 1') . C” ei 7 23.4- The above arc not applicable to temporary construction service. •
:FEE*. SCHEDULE:. . •
Suite/bldg. /apt. no.: to ", k 1 Project name:S , y , %e Dexr+ptlon I Q4.• I Fee. I '.W' I "" -
Cross street/directions to job site: , New residential single- or multi family dwelling unit.
u - w 1� ' , �-� �.� Includes attached garage.
OFF- CF C.I`• j Wc1,-r- _ w 1,000 sq. R or less 14.5.15 4
Subdivision: Lot no.: Ea. add'1500 sq, ft. or portion 33.40 I
_ Limited energy, residential 75.00 2
Tax map /parcel no.: — Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK -. • . Each manufactured or modular
'— dwellin , service and/or feeder 90,90 _ 2
Gl.; e— (Z%ye' t..
"'� 40 r.---.v 'P vQ-- 1 i G;607 il Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
• , 201 amps to 400 amps 106.85 2 •
• V • ROPERTY: OWNER . 0 TENANT .• • p 401 amps to 600 amps 160.60 2
Name: 4‘scee.e. � u j, `s ii C.-- L.. 601 amps to 1,000 amps 240.60 •
: . 1� - 0,..E
�iCJ Over 1,000 amps or volts 454.65 2
Address:
l5 _ �1' t t2� + ve , L 7 : .. _ O Reconnect only I 66.85 I 2
City /State/ZIP: 'P► al+ 7 Zo i Temporary services or feeders installation, alteration, and /or •
relocation
Phone: et33) 5 t , r 57 i 2_ Fax: CC:,4) P 3 0 7 200 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
PLICANT l: 43 CONTACT PER . , • . • A. Fcc for branch circuits with
service or feeder fee, each 6.65 2
Business name: 5 • ,ti) cytl` -v-p-...., U ev sL 1 mc...s brunch circuit
•
B. Fee for branch circuits
Contact name: W'ON1L4_3 without service or feeder fee, i 46.85 2
rst branch circuit _
Address: [ 5 go 5.2., IQ i; n � is Each add'I branch circuit 1 6.65 2
City /State/ZIP: i�,,, s j) 4,.1 f\- tie Miscellaneous (service or feeder not Included)
i Pump or irrigation circle 53.40 2
Phone: ( .) r ? 5 Fax.. � x >) r J 4 --IL, "yam Sign or outline lighting 53.40 2
E -mail: C h4c1 e - . _ • n. - e . w • , _ _ A.? Signal circuit(s) or limited -
CONTRACTOR: energy panel, alteration, or
• _ • • extension. Describe: Page 2 2
Business name: u c 2 ..
r .(r T 4
Each additional Inspection over allowable In any of the above
Address:
P. v . 01.. c) r Per inspection 62.50
City/State /ZIP: Per ` t.1 > 0 p C I 7 2-9 4- Investigation per hour (1 hr min) 62.50
t Industrial plant per hour 73.75
Phone: 5) A6 i 715 Fax: 3) 25 " 71 : " ELECTRICAL. :PERMIT ' FEES•
CCB Lic.: N i e) Electrical Li.c.: (�.- /0&,c,(4. Suprv. Lie.: 1t,j5 j'7 Subtotal Q 4 9 ,4 .
Suprv. Electrician signature, required: _ Plan review (25% of permit fee) `
State surcharge (8% of permit fee) r .51
Print name i_ N Date: al l V I (7(
TOTAL PERMIT FEE ��
n
,� t { , 1 8
Authorized signature: This permit application expires If a permit it not obtained within 1 0
days after It bus been -accepted as complete
Print name: Date: • Fee methodology set by Tri-Counry Building Industry Service Board
Number of inspections per permit allowed.
I;lauildin5Pcrmi tlet...PcnniNpv.eoc 12/30/05 440-4615T(IOIO2/COMMee
CITY OF TIGARD . � LX___.-
BUILDING DIVISION PERMIT #: a-o _ 0()/ Z q
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 � i*
Inspection Requests (24 Hrs.): (503) 639 -4175 . �'I I..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: l D % /
! / ' 1 'CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 — (p — 0 cc, Pour Time:
Code # Inspection Desc 'ption Confirm # Contact # Message
6.. / 3/ 6 - 7 / g 7
Co - ions /Comments uctions:
1 9c1 E►
1/j 1
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G"A N68 Date: 4i/04 Phone #: (503) 718 -04