Permit C ITv OF T GARD PERMIT I #: ELC96-0483
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 07/25/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 1S133AD -15200
SITE ADDRESS...: 11152 SW SUMMER LAKE DR
SUBDIVISION • SUMMER LAKE ZONING :R -7
BLOCK • LOT •33
Project Description: Instaliing one branch circuit.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS--• - --
1000 SF OR LESS : 0 0 - 200 amp ° 0 PUMP /IRRIGATION ° 0
EACH ADD'L 500SF...: 0 201 - 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY : 0 401 - 600 amp • 0 SIGNAL /PANEL ° 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 - 200 amp ° 0 W /SERVICE OR FEEDER: 0 PER INSPECTION : 0
201 - 400 amp : 0 1st W/0 SRVC OR FDR.: 1 PER HOUR • 0
401 - 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT 0
601 - 1000 amp : 0 PLAN REVIEW SECTION- -
1000+ amp /volt • 0 > =4 RES UNITS > 600 VOLT NOMINAL..:
Reconnect only : 0 SVC /FDR >= 225 AMPS. CLASS AREA /SPEC OCC.:
Owner: FEES - - - --
NOEMY BRENES MORVA type amount by date recpt
11152 SW SUMMER LAKE DR PRMT $ 35.00 CJS 07/25/96 96- 282109
5PCT $ 1.75 CJS 07/25/96 96- 282109
TIGARD OR 97223
Phone #:
Contractor: -• -. --
HONEYWELL $ 36.75 TOTAL
15495 SW SEQUOIA SUITE 100
REQUIRED INSPECTIONS -.-
PORTLAND OR 97224 Wall Cover Elect' 1 Final
Phone #: 503- 968 -3333 Elect'1 Service
Reg #..: 57824
•
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signature
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started LL
within 180 days of issuance, or if work is suspended for lore (--)-)Q, lP S Sc J r r .cQ7
than 180 days. Issued By
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 SUP R. ELEC' N : I)'I Cc 1 JC�� DATE: 06/76
LICENSE NO:
Call for inspection -• 639 -4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # ELC95' -0
vo Date Issued /as�9G
� �� I I Phone (503) 639 -4171
CITY OF TIGARD FAX (503) 684 -7297
TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: Norm - J7� 4. Complete Fee Schedule Below:
Name of Development Nocm rrne.S Moran. Number of Inspections per permit allowed
I
Address I /I "a SW vamMe -r Lake D Service included: Items Cost(ea) Sum
City /State /Zip / i n OR 97.2 .23 4a. Residential - per unit
J r' , 1000 sq. ft. or less $110.00 4
Name (or name of business) Each additional 500 sq. ft. or
portion thereof $25.00
Commercial ❑ Residential Limited Energy $25.00 1
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation
Electrical Contractor 7 o n -.t• 4 ) -./i i 200 amps or less $60.00 2
Address 1.5'/ 9 5 Sf, i .Se s6' la. 201 amps to 400 amps $80.00 2
City '} or it tan , 0 State 2 Zip 9 7,2 4 01 amps to 600 amps $120.00 2
2 q $180.00 2
601 amps to 1000 amps
Phone No. 503 - `140 g - ..1...: Over 1000 amps or volts $340.00 2
Job NO (n 77 Reconnect only
$50.00 2
contractors license NO. a ( - 2...o 7 a L 5 4c. Temporary Services or Feeders
Contractor's Board Reg. No. C) 5 7g.,z5 Installation, alteration, or relocation 2
Signature of Supr. Elec'n i.,,,,,
, a.(, 200 amps or less 2
201 amps to 400 amps $50.00
License No. 9 No. 9 Q'_33 i 401 amps to 600 amps $75.00 2
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
Each additional circuit bs $$5.00
not intended for sale, lease or rent.
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2 - Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension / $40.00 / 0. 0 6
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00 -
Per hour $55.00
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ y 0.O 0
NOTICE 5% Surcharge (.05 X total fees) $ O O
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ c?..- OD
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. verdlcomdevkieo- ❑ Trust Account #
$
prm.app
Balance Due $ 92.0o
C CITY OF TIGARD BUILDING INSPECTION DIVISIO
24 -Hour Inspection Line: 639 -4175 Business Phone: 639-41
y 9,'Jo
6
Date Requested: - 4 9? A.M. 1• P.M. MST:
Location: SU Ai ,mil e 44-,, Z .. BUP:
Tenant: � Suite: Bldg: MEC:
Contractor: a,1 e ,[,e ., vc . Phone: PLM:
Owner: NO t y (j,P o. i#4 f OQVA Phone: YZ3 •7$6, 7_ ELC: qg V4P3
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ( CA SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C U
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump
Approved Approved Approved Approv - ' Approved
Appr /Sdwlk Not Approved Not Approved Not Approved .roved Not Approved
FINAL FINAL FINAL IN FINAL
z ) — ,o, ,_‹-
K c ._),
O Call for reinspection einspection fee of $ required before next inspection O Unable to inspect () e
Inspector: Date: — Page of