Permit ELECTRICAL PERMIT ✓✓
Cliv OF TIGARD DATE PERMIT ISSUED: CO5/02/96
COMMUNITY DEVELOPMENT DEPARTMENT PARCEL: 1 S 1 33DA -01400
S I T 1311��5g".d Tigard f •8?a, 1 ( F39- 417��E DR
SUBDIVISION • PMART SUUMMER LAKE ZONING:R -7
BLOCK • LOT •36
Project Description: Installing one branch circuit for an air conditioner.
- -- 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
BOB MILLER type amount by date recpt
11095 SW SUMMER LAKE DR PRMT $ 35.00 CJS 05/02/96 96- 278897
5PCT $ 1.75 CJS 05/02/96 96- 278897
TIGARD OR 97223
Phone #:
Contractor: --
SUNSET FUEL CO $ 36.75 TOTAL
PO BOX 42287
2944 SE POWELL BLVD (97202) -- REQUIRED INSPECTIONS --
PORTLAND OR 97242-0287 Elect'1 Service
Phone #: 503- 234 -0611 Elect'1 Final
Reg #. ° : 2374
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Dre. Specialty Codes and all other Perm i t t e e Signature
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 188 days of issuance, or if work is suspended for more (7icr /e 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: (7/'7 `.) l i cciti on DATE: S- 96
LICENSE NO:
Call for inspection — 639 -4175
- • . Community Development ELECTRICAL PERMIT APPLICATION
Aat 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # eM a7gR97
+;� Permit # 11696-0277
'_ � 1 I Phone (503) 639 -4171 Date Issued 5- a -96'
CITY OF TIGARD FAX (503) 684-7297 Issued by Ch.r/ s��» df
FAX
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 1 1 O_1 ± ,3LLD SLA( \('A)S \\ c0(12 Or Service included: Items Cost(ea) Sum
City /State/Zip `T■ �f� 02- ° t - 10-0-3 4a. Residential - per unit 4
+ 1000 sq. ft. or less $110.00
Name (or name of business)
Each additional 500 sq. ". or
portion thereof $25.00 1
Commercial ❑ Residential ❑ Limited Energy $25.00 - Each Maned Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders
n CA) 2rles or relocation 2
�
Electrical Contractor�� �
� "- 200 0 amp ps or or less $60.00 2
Addr s==. C N l 1 vv�.Q .X 1 201 amps to 400 amps $80.00 2 -
City Vr StateC CC Zi ' f a 401 amps to 600 amps $120.00 2
Phone No. c 1� p 601 amps to 1000 amps $180.00 2
V� Over 1000 amps or volts $340.00 2
Contractor's License No.- Reconnect only $50.00
- Contractor's Board Reg. No. ra -7`-i- 4c. Temporary Services or Feeders
` Installation, alteration, or relocation
200 a mps or less $50.00 2
Signature of Supr. Elec'n . , i 2
? -
License No.,�� - _ i , r �iJ
$ ' Phone No. 201 amps to 400 amps $75.00 2
- 401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner installations: see 'b' above.
Print Owner's Name 4d. Branch Circuits
New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip Purchase of service or feeder fee. 2
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
not intended for sale, lease or rent. First branch circuit 1 E35.00 OO 2
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Pla Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal or a limited energy 2
al a
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Mi nor Labels (10) $100.00
Service and feeder 225 amps or more .
System over 600 molts 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: G �
NOTICE 5a. Enter total of above fees $ c3J.
5% Surcharge (.05 X total fees) $ '1
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $Th
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. ❑ Trust Account # $
Balance Due $ 3toT13
w.....am ,oa
31%
t ,/ co -. •
CITY OF TIGARD BUILDING INSPECTION DIVISION
0
24 -Hour Inspection Line: 639-4175 Business Phone: 639 -4171
Date Requested: A.M. . . MS •
Location: • # . ��L //`' - 4 �.: - %
N BUP: U
Tenant: � Suite: Bldg: MEC: •. A 9
Contractor - I . : A A .4_' ' L : ! 1 //
Phone: .7,3e/-- Q b j! PLM:
Owner: Phone: ELC 0 _
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
A _ �
•
•
,l , e -.44.41/ ' .17 - _ � / fir " �-'' . I /
1 ' S / 29
•
O Call for rein ion O Rein on fee of $ required before ext inspection O Unable to inspect
Inspector: i u-C Date: 4/24:7 9 Page of
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing Lelg�
PIbg.Und /Flr /Slab Plbg. Top Out Insulation lec
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk /�_ ,,Reins.
Other: Cr itlj
Date: Z�t A.M. P.M. Ent :
Address: —.._—,4i4...114 4 / , -0 , bp
Tenant: Ste: MST:
U P'
Con /Own:
PLM:
ELC: & x).."11
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Ac �� - i C /
� _. l C - Ar L, l� _; ■■
/
r /
Inspecto
r /�� Gh v.Q ( �1.��� Date: 5/2,
APPROVED DISAPPROVED /CALL FOR REINSP. CO
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