Permit •' ' ELECTRICAL PERMIT
CITY OF TIGARD PERMIT #: ELC2006 -00352
n DEVELOPMENT SERVICES DATE ISSUED: 6/26/2006
"III 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 25111 CA -02100
SITE ADDRESS: 15493 SW SUMMERFIELD LN ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.7 LOT : 332 JURISDICTION: TIG
Project Description: Replace panel.
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: 1 W /SERVICE OR FEEDER: 2 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
NORM & BAR CLARK TRI STAR ELECTIC INC
15493 SW SUMMERFIELD LN PO BOX 231175
TIGARD, OR 97224 TIGARD, OR 97281 -
Phone: 503 - 598 - 8437 Contact #: FAX 503 - 590 -2302
PRI 503 - 860 -5249
FEES
Description Date Amount Reg #: ELE 34 -620C
[ELPRMT] ELC Permit 6/26/2006 $93.60 LIC 153559
[TAX] 8% State Surcharge 6/26/2006 $7.49 SUP 3832S
Total $101.09 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- 800 - 332 -2344. , //
Issued By: f � 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 an inspection 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.
E1 *ctrical Permit ApR IVED 1 u lt (11 Ill I. I ` °NI\
City of Tigard JUN 2 6 2006 .ve 6' Q (� /� P tNo.iLeN oO3,��Z '
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fast 503.598.19 OF TIQARD DateB
Inspection Line: 503.639.4175 y. Other Permit:
.639.1 r .� '� -f.. Date 'uric: ® See Page 2for
Internet: www.ci.ti BUILDING DIVISIO' 1 l r'I
gt .639. 1 Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction I '0 Addition/alteration/replacement Please the is all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, cormn'l ❑Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
XI I - and 2 family dwelling ❑ Commercial /mdustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi-family ! ❑ Master builder ❑Other. ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
: JOE SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
Job no.: I Job site address: I C ui &i -`eid ❑ -care facility ❑der
3
ti i Subm 2 sets of plans w any of the above.
City / State/ZIP: \ C x - d ) OR o 1 a ay Lti • The above are not applicable to temporary construction service.
i
Suite/bldg./apt no.: I Project name: De. FEE I Qtr. I p . . I Total I ••
Cross street/directions tolob site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. 1 or less 145.15 4
Subdivision: ( I 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
DESCRIPTION OF WORK Each manufactured or modular
_ V e ,p l Ci J J el - fXY t CAI v €. I
dwelling, or feeders ins patio 90.90 2
11 Services or feeders insfailatioo, alteration, and/or relocation
200 amps or less 7 80.30 00, 3C) 2
i 201 amps to 400 amps 106.85 2
ti PROPERT7I OWNER I ❑ TENANT 401 amps to 600 amps 160.60 2
Name: CA r u 1 Um.,_ L ..'zcs sA, 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: , Temporary services or feeders installation, alteration, and/or
Phone: ( ) 5-11 - p Y .11 I Fax: ( ) r elocation —
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
la APPLICANT I 0 CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each n
Business name: ' branch circuit G 6.65 '3.30 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'' branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) i I F es; ; ( ) Pump or irrigation cirde 53.40 2
Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
' CONTRACTOR RACTOR energy panel, alteration, or
Business name: 1 I 1 st ._ E l c c r 1 C rns'on. Describe: Page 2 2
Each additional inspection over allowable in any of the above
Address: �' ®� �j �X `� I (� Per inspection 62.50
City/State/ZIP: I l and / C) I 1 a g ` Investigation per hour (1 hr min) 62.50
Phone: ( )g( , 3 Fax: (C r) 503 a3 0 a Industrial plant per hour 73.75
ELECTRICAL PERMIT FE *
CCB Lic.: 153 569 I Electrical Lic.: 614 -( Suprv. Lic.: 5g 32 S Subtotal
Suprv. Electrician signature, required:114Jf% 4_ ! Plan review (25% of permit fee)
Print name: IR t c ; m z- - I Date: 2./j9/ D (O State surcharge (8% of permit fee) 1 , 49
TOTAL PERMIT FEE /01 c D9
Authorized signature: ! This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: I Date: • Fee methodology set by Tri•County Building industry Service Board
•• Number of inspections per permit allowed.
is1BuildmglPemtaEtG-0amitApp.doe 12/03 440.4615T(IO'O2/COM/WFB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005.00352
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/26/2006
Phone: (503) 639 -4171 lep
Inspection Requests (24 Hrs.): (503) 639 -4175 1.!..
INSPECTION WORKSHEET FOR DATE: 7/20/2006 TIME: 1 :04AM PAGE: 54
t au s't l - 1 , ,Site wa /-
SITE ADDRESS: 15493 SW SUMMERFIELD LN CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.7 LOT #: 332 TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: Replace panel.
OWNER: CLARK, NORM & BARBARA PHONE #: 503 - 598.8437
CONTRACTOR: TRI STAR ELECTIC INC PHONE #: 503.860.5249
Inspection Request Scheduled For: Date: 7/20/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 033357 -01 503- B60.3838 N
Corrections /Comments /Instructions:
_ . 1 L_ Lo n1' - -. _ Ai/7�° r
•
dip r
g PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Clfre Date: .Zo.0 v Phone #: (503) 7.18 - 2-6g1