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Permit
rf• A CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00244 41 4. DEVELOPMENT SERVICES DATE ISSUED: 5/10/2004 +L � I � 13125 SW Hall Blvd., Tislard, OR 97223 (503) 639 -4171 PARCEL: 1S133AD-07600 SITE ADDRESS: 10785 SW SUMMER LAKE DR SUBDIVISION: AMART SUMMERLAKE ZONING. R -7 BLOCK: LOT : 120 JURISDICTION: TIG Project Description: All encompassing low voltage, 1 100amp feeder, 12 branch circuits. Work installed in 1994. 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: 12 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: HOEYE, ROBIN FRANKLIN OWNER 25391 SW HUGHES LN. CANBY, OR 97013 Phone: 503 - 970 -0414 Phone: Reg #: FEES Description Date Amount Required Inspections [ELPRMT] ELC Permit 5/10/2004 $221.65 [TAX] 8% State Surcharge 5/10/2004 $17.74 Rough - Low Voltage Inspection Total $239.39 Elect'l Service Elect'l Final 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 a (503) 246-6699 or 1 -800- -2344. Issued By: Permit Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intende• for sale, lease, or rent. OWNER'S SIGNATURE: i_.i j / //� 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 , Electrical P • • FOR OFFICE USE ONLY ,� � �� j i City Tigar f o I3y� g/ 0>/�t/ A. Permit N/r�<,Y� •-• O Q � i 13125 SW Hall Blvd., Tigard, OR 97223 h Plan Re vies s•ie Phone: 503.639.4171 Fax Other Permit: Inspection Line: 503.639.4175 , I rtT I Date Ready /By: J uns 0 See Page 2 for Internet: www.ci.tieard.q�tl'Y OF TIGARD Notired'Mtethod: 1 ■ O I Supplemental Information BUILDINta I PE WORK PLAN REVIEW ❑ New construction e Addition /alteration /replacement Please check all that apply: ❑ Demolition ❑ Other: ❑Service over 225 amps, comm'I ['Hazardous location OService over 320 amps - rating ❑ Buildng o%er 10.000 sq. t1.. CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more nee% residential Q 1 and 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 ❑ Multi family 0 Master builder ❑ Other. ['Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park Job no.: Job site address: /� ['Health-care facility ['Other: 0 r 8 -. S U- 5 0AAMar Dr Submit 2 sets of plans with any of the above. City /State /ZIP: T;,.., o ta 9 7 z. a The above are not applicable to temporary construction service Suite /bldg. /apt. no.: Project name: FEE* SCHEDULE Description Qty. I Fee. Total Cross street/directions to job site: SGlo / /S ) ((11 Ld'! / -to $L)nit / New residential single - or multi- family dwelling unit. vv I nc lud es attac gar S,_ i -. 61 s _ = s '_l " , •hv.N•.,.. ,, e 1,000 sq. n. or less 145.15 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I Tax map /parcel no.: Limited energy, residential I 75.00 7 S 2 L energy, non - residential 75.00 DESCRIPTION OF WORK Each manufactured or modular dwelling, service and /or feeder 90.90 2 LE w t'r' NI r� 00�I e -. I C) 0 ,4-... -a n - n p - I Fa.*1 . I Services or feeders installation, alteration, and /or rcloruiou tv i•t-t It. L1n_e.w er"y- f,„1/4.1 ✓a a, lNS7¢dia r ri.v',4o2wO 200 amps or less 80.30 O PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 401 amps to 600 amps 1 60.60 2 Name: 1e, 6r>ti P /4-0 • 601 amps to 1,000 amps 240.60 2 Address: 2,539 / S I - /� L N Over 1,000 amps or volts 454.65 // '(T� Reconnect only 66.85 City /State /ZIP: - ©K - civ 7011 Temporary services or feeders installation, alteration. and /or Phone: ( 5 p t relocation amps ` 7 � � O e � � Fax: ( ) 200 amps or less 1 66.85 (, 485 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 intended for sale, lease, rent excha• • e, ac•. • ■ ing to ORS 447, 449, 670, and 701. - 401 amps to 600 amps 133.75 _ Owner signature: �J / ,Aa • Date: Branch circuits - new. alteration, or extension, per panel Er APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with v�C� service or feeder fee, each !V 6.65 Business name: branch circuit Contact name: r--• 6 / B. Fee for branch circuits tvrrhour service or feeder fee, 46.85 2 Address: each branch circuit Each add'I branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 I 2 Phone: ( 503) 7 70_0ei/ I Fax::( ) Sign or outline lighting 53.40 _ ' E - mail: r 0 i . k 69 2 V p__ ® 5 GL fYYI- w 11,,9 . C Oypi Signal circuit(s) or limited - CONT'RACTOR energy panel, alteration, or extension. Describe: Page 2 I _ ' Business name: Address: Each additional inspection over allowable in any of the above Per inspection 62.50 I City /State /ZIP: Investigation per hour (I lir min) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lie.: Electrical Lie.: Suprv. Lie.: Subtotal ' i Suprv. Electrician signature, required: Plan review (25% of permit fee) � State surcharge (S% of permit fee) / 7 .71 Print name: Date: TOTAL PERMIT FEE 39 . 3`j Authorized signature: This permit application expires if a permit is not obtained nithin I811 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Sets ice Board •• Number of inspections per permit allowed. 1 Building •Permits \ELC- PermitApp doc 1303 4.L045 15Ti i0,02CO ?t. sEB Electrical Permit Application - City of Tigard • Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined .. S75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: H Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation H Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations ' Budding , Pernuts'ELC- PermitApp doc 04'03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION _ Business Line: (503) 639 -4171 MST BUP Received / /�' e- 3 Date Requeste -// — 4 / AM PM BUP Location l a 7 _wt jte MEC Contact Person .r1 . _ ) 976 — 0c / / 7 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner EL / Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler J� .A /Q L f412.e 2 /.4 Fire Alarm Susp'd Ceiling Roof Other: Final , / 7v ,4 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 ICAL _ Service Rough -In UG/Slab Low Voltage Fire arm PA S S PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for reinspection RE: Unable to inspect – no access Fire Supply Line ADA / C� Approach/Sidewalk Dat> /' ( Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL