Permit ' CITY' OF T ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC99-0122
��m~�m~u~�~n n�nu~u�u ��m~»x�o~�m~�� DATE ISSUED: 03/03/99
6 11. /3/25SN/ Hall 0hut, Tigard, ORg7223(503)639-4/71
PARCEL: 2S111CA-04400
SITE ADDRESS...:09700 SW LAKE SIDE DR
SUBDIVISION ^SUMMERFIELD NO.12 ZONING:R-7
BLOCK ^ LOT........ ..... :664 JURISDICTION: TIG
Project Description: Installation of 1 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/O 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
WILLIAMSPEAR type amount by date recpt
9700 SW LAKESIDE DR PRMT $ 35.00 DEB 03/03/99 99-313401
TIGARD OR 97224 5PCT $ 1.75 DEB 03/03/99 99-313401
Phone #: 624-2122
Contractor:
WEST SIDE ELECTRIC CO INC $ 36.75 TOTAL
1834 SE 8TH AVE
REQUIRED INSPECTIONS
PORTLAND OR 97214 Elect'l Service
Phone #: 231-1548 Elect'l Final
Reg #..: 13306
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 r-' es you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in DAR 952-m1-001 rough OAK -m1-1987. You may obtain a copy
of these rules or direct questions to OUNC by lli 503)246-1987.
���� .
Permittee Signature : U� 1 Ma(� » '' /) � Issued B. ^ ^� ���" 'N�' Ai ^�� 0 _^
/ / •
— 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 INSTA ATIC4 ONLY
. �� '
SIGNATURE OF SUPR. ELEC'N: t J��'. ` ���~� . �4 DATE: •
LICENSE NO: ~L55.��
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
MAR -02 - 99 04:40 PM WEST SIDE ELECTRIC 503 736 0677 P.01 '
A
CITY OF TIGARD Electrical Permit Application Plan Ch ItT� z /
'13125 SW HALL'BLVD. Rec'd e A a 145
TIGARD OR 97223 08 to Date Rec'd _� °` ',P ^.,.. tit
Phone (503) 639 -4171, x304 Dale to P.E.
Date to DST
Inspection (503) 839 - 4175 Print or Type � '�'� Permit N EGC q ? '
•
Fax (503) 684 -7297 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) �y i JD Service Included: Items Cost • Sum
Amm
%
Address 700 S4. 40Z2, r 1c4 . 4a. Residential - per unit
City/State/Zip 7/:90b o 9 v y woo sq. ft, orless ., $110,00
/ Each additional 500 sq, ft. or
Commercial ❑ Residential 12--- portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all cu rent Ice • es / 4b. Services or Feeders
Electrical C n : ctor a A / /C f %? / C/ C. Installation, alteration, or relocation
Addres - . ` . 20o amps or less • $60.00 2
r I �� 201 amps to 400 amps 580.00 2
City Or 0/r - , State I � Zip AW 401 amps to 600 amps $120.00 2
Phone No. .2 / - / SV ' 601 amps to 1000 amps _ 5180.00 2
Job No. 70/ - 002- Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 26 ' /JS`� Exp.Date Reconnect only 550.00 _ 2
OR State CCB Reg. No. /3306 , Exp.Date sr .Temporary Services or Feeders `
COT Business Tax or Metro No. . Exp.Date installation, alteration, or relocation
200 amps or less $50.00 _ 2
Signature of Supr. Elec'n 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
LlcensA No Over 600 amps to 1000 volts,
CSC Exp .Date see "b" above.
Phone Nr 23/ /'S`
4d, Branch Circuits
2b. For owner installations: New, alteration or extension per panel
a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder 1st •
Address Each branch circuit �_ $5.00 2
City State Zip b) The lee for branch circuits
ty p without purchase of •
Phone No. service or feeder fee.
' First branch circuit / $35.00 3S 2
The installation is being made on property I own which is not Each additional branch circuit $6.00 2
intended'for sale, lease or rent. 4e..Misceltaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 - 2
• Each sign or outline lighting $40.00 • 2 •
3. Plan Revi section (if required):* Signal clrouit(a) or a limited energy _ alteration or extension $40.00 2
Minor labels (10) $100,00
Please check appropriate Item and enter fee In section 66.
4 or more residential units In one structure 4f. Each additional Inspection ever
� • Service and feeder 225 amps or more the allowable In any of the above '
System over 600 volts nominal Per Inspection $35.00 • Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
._-
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: 3S-
.
Not required for temporary construction services. 6e. Enter total of above fees $
5% Surcharge (,05 X total fees) . $
NOTICZ Subtotal -
Sb. Enter 26% of line Se for
PERMITS VOID IF WORK OR CONSTRUCTION-AUTHORIZED-IS - - P_Ian.ReviewI1 r (Sec.3)
$
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Sub ! ,, $
'. IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY Trust Account q
3)Lo A
TIME AFTER WORK IS COMMENCED. tr
Total balance Due leafT
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 3 - 3. -q9 AM y PM BLD
Location q 7 n L P. t - Y9Y Suite MEC
Contact Person aQfQ,C irkA l` Ph '-g44 -Z03 PLM / t0-
Contractor T 4
r po A - -c Ph SWR
BUILDINGAtiA ,., : = Tenant/: L.O ?( jV) � Y ELC 9 7 10/ 7 Z
Retaining Wall 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
Fire wall
Fire Sprinkler
Fire Alarm -
Susp'd Ceiling
Roof Ja
Misc: `
Final
PASS PART FAIL �(
cPLUMBIRG:=?
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
n3
G 't?} PART FAIL
Post&
Rough In
Gas Line
Smoke Dampers
Final
P PART FAIL
LECTRICr
Service
Rough In
UG /Slab
Low Voltage
Fi - larm
:
• S PART FAIL
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: F . 7 ] Unable to inspect - no access
ADA
Approach /Sidewalk Q
t Ext
Date / I 9 Inspector �iic /� —
Other D VaLi !
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.