Permit , CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00298
DEVELOPMENT SERVICES DATE ISSUED: 06/06/2000
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13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111 DC -04900
SITE ADDRESS: 15657 SW SUMMERFIELD LN
SUBDIVISION: SUMMERFIELD NO.7 ZONING: R -7
BLOCK: LOT : 349 JURISDICTION: TIG
Project Description: Install 1 branch circuit for can light and switch.
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: 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:
DUNLAP, MARIAN & WILLIAM OWNER
15657 SW SUMMERFIELD LN
TIGARD, OR 97224
Phone: Phone:
Reg #: ORIGINAL
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT KJP 06/06/200C $37.50 0002747 Elect'I Final
5PCT KJP 06/06/200C $3.00 0002747
Total $40.50
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- through OAR 952- 001 -0080. You may obtain copies of these rules or d ct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE /� 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: ® , - / z<jL 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
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SIN HALL BLVD. Rec'd By
•
Date Rec'd
TIGARD OR 97223 Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit #et-C, 2400 - (X.Z? 8
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below: •
Name of Development Number of Inspections per permit allowed
Name (or name of business) J.v: l l i Arn 0//14. / 4. f Service included: Items Cost Sum 4'
Address 1 5 _ 60 St.l S° ,L.••v) atf E/!1 L V 4a. Residential - per unit
� 1000 sq. ft. or less $ 117.75 4
City/State /Zip ' / , G M it n O A- Each additional 500 sq. ft. or
f portion thereof $ 2615 1
Commercial ❑ Residential EN Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation
Electrical Contractor 200 amps or less $ 64.25 2
Address 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps • $ 128.50 2
City State Zip 601 amps to 1000 amps $ 192.50 2
Phone No. Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. Exp.Date 4c. Temporary Services or Feeders
OR State CCB Reg. No. Exp.Date Installation, alteration, or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
see "b" above.
License No. Exp.Date 4d. Branch Circuits
Phone No. New, alteration,or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name i,U i (I A-vs' 4? Each branch circuit $ 5.35 2
j �"'��
Address 5 - 6 S S 5 t J p c. t(/ b) The fee for branch circuits
without purchase of service
City T;° f �D State A L Zip q n 2 24 or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, se or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
•
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
• panel, alteration or extension $ 60.00
3. Plan Review section (if required): * Minor Labels (10) $ 147-760
•
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over �90
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
5a. Enter total of above fees $ 3 7 , Sa
* Submit 2 sets of plans with application where any of the above apply. em 595 Surcharge (.95 X total fees) $ 3, CO
Not required for temporary construction services. W 11 , Subtotal / r $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS El Trust Account # I1
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ V')
i:\dsts\forrns\electric.doc
CITY OF
13125 S.W. AL BLVD. <<O
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE 4k
OWNER szTh
Electrical Signature Form
Permit #: ELC2000 -00298
Date Issued: 06/06/2000
Parcel: 2S111 DC -04900
Site Address: 15657 SW SUMMERFIELD LN
Subdivision: SUMMERFIELD NO.7
Block: Lot: 349
Jurisdiction: TIG
Zoning: R -7
Remarks: Install 1 branch circuit for can light and switch.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
•
OWNER: ELECTRICAL CONTRACTOR:
DUNLAP, MARIAN & WILLIAM OWNER
15657 SW SUMMERFIELD LN
TIGARD, OR 97224
Phone #:6 q'7 3 Phone #: 5 -O 3 -6D 39.9 7x_ 3
Reg #:
AN INK SIGNATURE IS REQUIRED ON TH . F
i
X /.� U`._ ice
S'gnature • I servis f Electrician
If you have any questions, please call (503) 639 -4171, ext. # 310
ff /
CITY OF TIGARD BUILDING INSPECTION DIVISION
Inspection Line: 639 -4175 Business Line: 639 -4171 7 • 6e/70
BUP
Date Requested 7 • AM PM BLD
Location /5 Sl4,71,(144 c:c1 L h Suite MEC
Contact Person rti C.e Ph 53, G 2,0 PLM
Contractor Ph SWR
UILDING Tenant/Owner Es, 0 _Ge) 02 9
Re • all ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
- C
gel PART FAIL J
PL BING N
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
T FAIL
ELECTRICA
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
111141, PART FAIL
SI
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Otthe�ach /Sidewalk Date 7/ Inspector / Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.