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-ECTRICAL P'LRMI'1
t-RMIT #: ELCI)604(�7
CITY OF TIGARD DA1'E ISSUED: 07/23/96
COMMUNITY DEVELOPMENT DEPARTMENT 1"ARCEL : IS133L)P-0411.4',
13125 SW Hall Blvd.Tigard.Oregon 97223*8190 (603)639.4171
LIR
SUBL)1 V I S I ON. . . . AMART 5LjL1MME9LAKE ZONINCS:R-7
81-CA"K. . . . . .. . . . . LU I.. . . . . . . . . . . . . :6.t
V)ro,ject Description : Installing two brancl CirCUit -B.
UNI'f------- ---TEMPI SRVC/FE_EDE1`?S-----
1000 SVOR LESS. . . . : 0 0 - r00 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . :
LACH ADD' L 500SF. . . : 0 201 - 400 amp. . . . . . . a 0 SIGN/OUT LINE LTG— :
LIMITED L"NERGY. . . . . : 0 40! -- 6_00 amp. . . . . . . : 0 S I GNAL/P,ANF I_. . . . . . . : V)
MAW'. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : IZA MINOR LWSFL ( 10) .
- - !.,;ERV I GL/FEEDER------ CIPC'LJITS,--- -- -- .. ---ADD' L INSP'E(:'111JN
0 200 amp. . . . . . : 0 W/GERVICE OR FEEDER: 0 PIER INSPECTION. . . . .
201 400 ramp. . . . . . : IP I st WIQ SPVC OR FDR. . 1 PIER HOUR. . . . . . . . . . . .
401 600 amp. . . . . . :, 0 EA ADD' L SRNCH CIRC: I IN PLANT.. . . . . . . . . . .
C,0 1 1000 amp. . . . . : 0 R17 V IF W FiE:CTIE]lu---.__-__--_-.-___-_-_....
1000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : > 600 VOLT NOMINAL. . :
pecofinect 01,1%,. . 0 SVC:/!-1)R c.25 AMI�'S. . CLAS"F-3 AREA/SPF[,:
Owner-: ........... FEES
RUFFONIEf-1-0 type_ amov.nt by date re pt
le'.-)40 SW ULACILR LILY C.'13CLE P,RMT $ 40. 00 CJS 07/23/96 96-26,1. ,-
5P,CT t 2. 00 CJS 07/23/96
TIGARD OR
PItIone #:
Uontractor*
Tf--'C fELLUIRICAL SE-HVIGE'-) I N%', 00 rO'TPI-
140 BE INTERNATIONAL WAV
---- IREQUIRED INSPIE.C.'TIONb
LWOUKIL. UN Wall (.'QV9 ' Llectl I Final
,one #- '5'713-64-3325 Elect' l Service
,q #. . - 913774
is permit is issued subject to the regu.'ations contained in the
lard Kinicips.1 Logo, State of Ore, Specialty Cadet and all ott,'- Pler-mittee 7i gnat�.rre
,licabie la-,s. All work will be dont it, accordance with
orovea pla"s. This permit will expire if work is not started
*;hin 18@ days of issuance, of if worl, it suspended for more --Ate
.kn 18@ days. 15c;Lted by
INSTALLATION ONLY .. ...........
ie installatior, is being made an property I own vif-� t,,Ji is not intencled for
,,,Ie, 1p,.�se, ri tent.
�)NE R I S'3 91 CYNA I URE- -------- DATE'.:
CMIT PAC 7 0 R I NS71LLA T I ON ONI_Y
ELLLIN: 'P17
tall fLlr iT,sp' ction 639-41
Community Development ELECTRICk,L PERMIT APPLICATION
1312:: 1;VV Hall Blvd.
Tigard, OR 97223 PlancwRec.
-4Permit # AL -
Phone (5;?� �;a-4171 Date Issued �x
FAX (503) 684-7297 Issued by Ch& ,� le-v Schrrl;u(t
CITY JF TIGARD TDD No. (503) 684-2'772
InspPrtion (503) 639-4175
4. Complete Fee $ched�Ile Below:
1. Job Address:
Name of Development _ __ Number of Inspecti line per permit allowed —
Address Ia5 y� S w �-�A�' /���"//"\� Nice included Items Cost(ea) Sura
l 4
;,itylstate/Zip�/ +� Olic— `F 7 03 3 4a. Residential- per unit �—$110 00
—
1000 aq 11 or lose
n
Name (or name of business) Each additional 500 sQ II or ,
K�<FSO dL t I portion thereof $25 00 —
Limited Energy E25 00 r
Commercial❑ Residential Each Manurd Horne or Modular
[)walling Service or Feeder EBB 00
2a. Contractor installation only: 4b.Services or Feeders
Installation. ,Iteration.or relocation 2
Electrical Contracto ELEt^ r�P�CA� 200 amps irless $6000
too 00 2
01 am{xs 1,400 amps 2
Address''-i/.)(J F l^ -�/tTi c -, 401 amps to Boo AP-Ps $12000 n
City��i j-Lu 0`1111.t 2c i C State &e- Zip ct UQ--j F0, a r,ps to Inco amps $t60 00 _ 2
7A Cher 1000 arTmA 0,volts $34000
Phone No.�s r - 3 3 J 5 FAV471`� reconnect wily $5000 —
Contractor's License No. 34- 3 7,3 C
Contractor's Board Reg. No. _U43 7y 4c.Temporary Set to or Fenders
Installation alteration n wcation
loss $50 00
Signature of Sup►. Elec' mss` sr 201 amps or 400 mo
201 amps l0 400 pe: $7500
License No 3J �^ 401 amps to 600 amps t,0000 _---
rNer 600 amps to 1000 Volts
2b. For owner Installations: as•b•nbcva
4d. Branch Circuits
Print Owner's Name New,she, lion or extension per panel
Address e)The lee for branch circuits With 2
pu►eheaa of aarvfea or Hadar Na.
City _ State zip__ Each branch circuit $500
Phone No. b)Thr lee for branch circuds Wfthm 2
The installation is being made on property I own whish is purchaser of"tyke or N.dK Na. 2
FirstDO :3�
st branch rucuit �_ $35
not inte riled for sale, lease or rent. Each Wddroral brar6i c m �_ $5 DO
Owner's Signature __-_-_ 4e. Miscellanvuus
(Se(vice or feeder not Included) 2
Each pump or irrigation circle t40 On
3. Plan Review section (if f )quired): Each sign or outline Ighbng $4000 _
2
Signal ctrcud(s)o a lim fled energy
Please check appropriate item and enter tee in section 5B. panel,09ratron v extension t 40 00
4 or more residential units in one structure Minor Labels(10)
Service and feeder 225 amps or more 4t. Each additiorxal inspection over
_system over f3o0 volts nominal the allowable in ar-v of the above
I Classified area or structure containing specie,occupancy Per mspachnn $35 D0 _
as described in N E C Chapter G {,r,r ho,,, —� $5500 _
in plant 55500
Submit 2 sets of plans with application where any of the above
apply. Not requited for temporary construction servicej. 5. Fees:
5s. Enter total of above tees $ O.QO
NOTICE 5%Surchargb(05 X total fees) $
Subtotal $ "
PERMITS BECOME VOID IF WORK OR CONSTRU^TIC'N 5b. Enter 25%of lire A for
AU r140RIZED 18 NOT COMMENCED WITHIN 180 DAYS,OR;F Plan Review it required(Sec 3) $
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEC, FOR Subtotal $
I A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
1
COMMENCED. nest Accor,nt# $ —
Balance Due $
eErdY.Vr1A1NdItjfT•a
CITY ®F TIGARD DAtFM1T ,� ,. . , M� 96_0='3�
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW hall Blvd.Tigard,Oregon 97223.8100 (503)834.4171 PARCEL: i 5 1 33UA--QlA 100
i ,
_ILII)I V L S I ON,. . . . : AMAR T SUUMMF.RLAKE Z UNI NCS; R-7
..00K. . . . . . . . . . . . . . . . . . . . . . . . :63
A:iS OF WORK. . :ADD FLOOR f LJF?P•t. , . , lel EVAP UIOO _L.RS: 0
1PL OF U:'E. . . , :CiF UNIT HEATERS. . : 0 VENT FANS. . . : 0
VENT'.' W/0 ADPL: 0 VENT' `.3'(S"EMS: 0
I ORIE:S-3. . . . . . . . : 0 SOILERS/COMPRESSORS HOODS. , . , . . . : 0
A-A.- TYPES._,_ ....- _. 0-3 HV. 1 DOMES. INC IN: 0
3-15 HP. . . , 0 COMhIL. I NCI N: 0
)X JNC)ILIT : o LiFIJ 15 30 111'. . . . 0 REPAIR UNITS: til
RE DAMF'EFkS9. , : 30-50 }TF'.. . . . : 0 WOODS-FOVE:S. . : 0
lea F='RE:. ,SURE::. . . 510+ 15'. . . , : 0 CLO DRYERS- - 0
A. OF UNITCI' -- - -- AIR HANDLING UNI IS OTHER UNITS. : 0
'1RN S 1000 BTU: Vl ( : 1001110 f m : 10 GA5 OU 1'L.E.TS. : 0
1 PN wrU: 0 > 10000 c f m : 0
Install ir.11 one to 31-11:x.
filter". L=EES
0.FON 11=:L.1_.IJ tyP'? -imol.!nt by !Date re;_pi:
'40 SW GLACIE'ft 1_...11..Y 0114(71-L PRMI $ E,5. 00 C�.JC) 07/23/96 96---c::6189F,
//�� (( 137-1213
) 5CG"'1' $ 1. ��", +:::,J'r2 0'ttC': !' (w `a6 -2�J 1?.:
Ione #:
(Fti1Ci C31�FF I AI.. :1 111Fvr
O NE HAL_UEY
'.)RI LFaND OR 97' L't r
10ne tl': $ :-'6. 25 TOTAL_
056628
REUU 1 RE.1) 1 Ncjr`Fc-r J ON;;
is perwit is Issued subject to the regulations contained in the Mec.:hanicAl Insp _._•_..__...
gard Muricipal Cade, State of bre. Specialty Codes and all other Misc. 1 nspect i ran _......____...___.._._____.._.__...._.
,tllcable laws. All work will be done in accordance with Fina 1 I n s p : i o n
or.,Ved pians. ihls persit will expiry if work is not startea
thin W days of issuance, cr if wvk 15 Suspended fir care
an 18® a:Vis.
mi.tt9w 1:ii1:)n�x;:
(_:all far inspecticltl — 6:.—
SINEW
City of Tigard MECHANICAL PERMIT Planck/Rec. # _
13125 sw Han Blvd. APPLICATION Permit
Tigard, OR 97223
(503) 639-4171
Table 3A V*zhanical Code QTY PRICE AMT
'X;= _
Job -7,10 i «. iE. L+ ly 1) Permit fee -0- -0- 10.00
Address ----�-T--—
i �< < 2) Supplemental Permit
300
urnace to
1) incl. ducts " vents 6.00
Owner . . 2) incl. ducts &yr is 7.50
-oor urnance
r 1 .72
z •� 3) incl. vent 6.00
Suspended eater, wail eater
4) or floor mounted heater 6.00
"0 "' ""• ent not inc. in
Occupant 5) apphanre permit 3.00
Rep au oTFeatmq, re fig.
6) cooling, absorption unit 6.00
Boiler or comp, neat pump, air con .
ac <.-!,; r 7) to 3 HP; absorp unit to 100K BTU 600
oiler or comp,W. heat pump, air con -
�J`r: ,A L..�< 8) 3-15 HP; absorp unrl to 500K BTU 11.00
COtltraGfOr ,. " w -- offer or Comp, eat pump, airCon --
( 121c"+ 9) 15-30 HP; absorp unit .5.1 mil BTU 15.00
oiler or comp, Feat pump, air cond,
'7< 10) 30-50 HP; absorp unit 1-1.75 mil NTU 22.50
areoy ac now edge that I nave rea t application, that Me of er or comp,neat pump, air con .
information given is correct, that I am the owner or authorized 11) > 50 HP; absorp unit 1.75 mil BTU 37.50
agent of ,ne owner, that plans submitted are in compliance with a ana rng unit to
State laws, that I am registered with the Construction Contractor's 12) 10,000 CFM 4.50
Board, that the number given is correct. (It ex?mpt from Stale Air handling unit
registration, please give reason below.) 13) 10,000 CTM + 7.5U
Non po le
_ 14) evaporate cooler 4.50
en�an connec ed
15) to a single duct 3 00
Ventilation system not
16) incieded in appliance permit 4.50
1 ) mechanical exhaust 4.50
Describe worK new 0 a ition C3 alteration 0 repair Commercial or inaustria --
to be done residential 0 non-residential p 18) type incinerator 30.00
Existing Use o ter i.e., w000stove, water
building or property _ 19) heater, solar, clothes dryers, etc. 4.50
Proposed use of 20) Gas piping one to four outlets 2.00
building or property r --
Type of fuel -oil O natural oas Q LPG Q electric 0 21) More than 4-per outlet —
NOTICE
Minir.uim Fee $25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION - - -
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 51:SURCHARGE
IF CONSTRUCTION OR WORK IS SUSPENDED OR - —
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PI-AN VIEW 25% OF SUBTOTAL
AFTER WORK IS COMMENCED.
TOTAL
Special Conditions — — -
— Date issued by
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