Permit ELECTRICAL PERMIT
,C N OF T DATE I ISSUED: C 08 /06/96
COMMUNITY DEVELOPMENT DEPARTMENT PARCEL: 1 S 133DA -01400
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 .. (503 639 -4171
SITE ADDRESS...: 11095 SW SUMM LAKE DR
SUBDIVISION • AMART SUUMMER LAKE ZONING:R -7
BLOCK • LOT :36 •
Project Description: Installing two branch circuits.
- -- 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: 1 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
BOB MILLER type amount by date recpt
11095 SW SUMMER LAKE DR PRMT $ 40.00 CJS 08/06/96 96- 282559
5PCT $ 2.00 CJS 08/06/96 96- 282559
TIGARD OR 97223
Phone #:
Contract or:
SUNSET FUEL CO $ 42.00 TOTAL
PO BOX 42287
2944 SE POWELL BLVD (97202) REQUIRED INSPECTIONS
PORTLAND OR 97242 -0287 Wall Cover Elect' 1 Final
Phone #: 503 -234 -0611 Elect'1 Service
Reg #..: 2374
This periit 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 per.it will expire if work is not started
within 180 days of issuance, or if work is suspended for lore CI10 tie s -
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 SUPR. ELEC' N: DATE: R- 6- 96
LICENSE NO:
Call for inspection — 639 -4175
s.
• Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # C7t` -051 _�
,�" i , Date Issued ,c1-6-- c2(-; . 0 I• Phone (503) 639 -4171
CITY OF TIGARD FAX (503) 684 -7297
TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development ,, Number of Inspections per permit allowed
Address I 1 f 3 S � ,(n� S� b l Or Service included: Items Cost(ea) Sum
City /State /Zip -�\ Ca(:� Nd OR-- CI'i g 4a. Residential - per unit
l' 1000 sq. ft. or less $110.00 4
Name (or name of business) E- rn \ 1 Each additional 500 sq. ft. or
portion thereof $25.00 ,
Commercial I=1 Residential E-------- Limited Energy $25.00 1
Each Manurd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
c1 4b. Services or Feeders
Electrical Contractor ,."'''> � St r1S I �Q Installation, alteration, or relocation $60.00 2
1 200 amps or less
Addr ssr- -94'L '4 � 201 amps to 400 amps $80.00 2
City ti c. r ( Staten &. Zip d-O 401 amps to 600 amps $120.00 2
`r 601 amps to 1000 amps $180.00 2
Phone No. ' D i I Over 1000 amps or volts $ 340 . 00 2
Job NO Reconnect only $50.00 2
contractor's license NO. c __ 4c. Temporary Services or Feeders
Contractor's Board Reg. N... = 'syir , ,,, Installation, alteration, or relocation 2
Signature of S>,� r. Elec'n ' ���� ' 200 amps or less
License Nom'/ 201 amps to 400 am $50.00 2
� ,. ' ' Phone o. 2
401 amps to 600 amps $75.
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 without
The installation is being made on property I own which is purchase of service or feeder fee. 2
First branch circuit 1 $35.00 c - C O 2
not intended for sale, lease or rent. Each additional branch circuit T $5.00 ,. . c:DO
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
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: `I MMMM
5a. Enter total of above fees $ o w
NOTICE 5% Surcharge (.05 X total fees) $ �,
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 4-1-43. 5b. Enter 25% of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
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. word1comdev1eleo- ❑ Trust Account #
$
prm.app
Balance Due $ 4 f a- -ate
b c/-.
CITY OF TIGARD BUILDING INSPECTION DIVISION
0 ...). g .,
•
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: A.M. . . MS
Location: • ir 5 .. v /L AIL' � �I. N, A. BUP:
Tenant: / Suite: Bll MEC: • ,l9
1'
Contractor • / J " O b // PLM:` .
. �_� L . ! Phone:
Owner Phone: EL 6 /
_ ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL 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 UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
4 _,....Z. . r
•' .- / / LC 't - o 77
III
,5129
El Call for reins ion O Re' 'on fee of $ required before ext inspection O Unable to inspect
, j4 Inspector: i L Date: 4/24? 9 Page of
1 ___ _ - —