Permit •
C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00297
,rl� DEVELOPMENT SERVICES DATE ISSUED: 5/23/03
'�" .,� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S111 DC -05000
SITE ADDRESS: 15671 SW SUMMERFIELD LN
SUBDIVISION: SUMMERFIELD NO.7 ZONING. R -7
BLOCK: LOT : 350 JURISDICTION: TIG
Project Description: Move (1) 220, add (1) 220 and (2) 110's.
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:
•
GARY NELSON OWNER
15671 SW SUMMERFIELD LN
TIGARD, OR 97224
Phone: 503 - 639 -9539 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/23/03 $66.80
[TAX] 8% State Tax 5/23/03 $5.34 Rough -in
Elect's Final
Total $72.14
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be gone-in -ac or dance 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. ENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in AR 952-001-0010 { 'rough OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions UNC at (503) 246 -6699 or
1 -80 32 -2344.
Issu d By: • : ,, /i Permit Signature:
OWNER INSTALLATION ONLY
The installation is being made on pr•Jwn which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE: 5/ 62-3 � 43
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
•
„ _ w
Electrical Permit Application
Date received: 6 d3 Permit no.: -cr 3- e60
.„,, ,, I City of Tigard Project/appl. no.: ' e date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By:. Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
. JOB SITE INFORMATION .
.
Job address: /5 S ' _ um/71er / e, . Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: IBlock: (Subdivision:
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: w !� � Fee Max
Business name: 0 Description Qty. (ea.) Total no. insp
N ew res - s or mu family per
Address: dwelling unit. Includes attached garage.
City: I State: I ZIP: ' Service included:
Phone: Fax: I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: I Elec. bus. lic. no:
Limited energy, residential 2
City /metro lic. no.: Limited energy, non - residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 6110 - Iffe; 201 amps to 400 amps 2
/ n 401 amps to 600 amps 2
Mailing address: /6'&7/ ��i(/ n ei�G' 601 amps to 1000 amps 2
City: ,14(,� I Sta I ZIP: 77. Over 1000 amps or volts 2
Phone: 0� qJ Fax: I E -mail: Reconnect only i
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale lease, rent, or exchange according to installation, alteration,orrelocation:
200 amps or less 2
ORS 447, 455, 479, 67 !
s' 201 amps to 400 amps 2
Owner's signature: �-7 Date 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of //
Address: service or feeder fee, each branch circuit 7 7� 85 2
City: I State: I ZIP: B. Fee for branch circuits without purchase &
Phone: Fax E -mail of service or feeder fee, first branch circuit: ./ 19.95 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
0 Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension' 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection I I
Submit sets of plans with any of the above. ° Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ W • d
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number. / / within 180 days after it has been State surcharge (8 %) .... $ ' 3
Expires accepted as complete. TOTAL $ � � /
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6M00 /COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System"
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑ Vacuum Systems'
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see "b" above. Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
•
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy .
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control`
Minor Labels (10) - $125.00
n Medical
Each additional inspection over
the allowable in any of the above n Nurse Calls
Per inspection $62.50
•
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee licenses are required. Licenses are required for all other installations
See "Plan Review" section on $
front of application.
Fees: .
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts \foms \elc- fees.doc 10/09/00
r ,
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received Date 'quested AM PM BUP
Location _.. ` ' i f .d Suite MEC
Contact Person 2 Ph ( ) PLM
Contractor 0 Ph ( ) SWR
BUILDING Tenant/Owner ELC -zoA q7
Footing ELC
Foundation
ef:Cess•
Ftg Drain g ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam / h&
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire wall v P OC -C.)�
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 _ FAIL
� 'E ECTRIC
Service
Rough-In
UG /Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Date b � 30 rj Inspector G t r )� Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL