Permit , CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00125
� DEVELOPMENT SERVICES DATE ISSUED: 2/17/2006
.4 61j1. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 110 D C -01000
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SITE ADDRESS: 11240 SW MEADOWBROOK DR 2 ZONING: R -25
SUBDIVISION: WILLOW BROOK FARM LOT : 014 JURISDICTION: TIG
Project Description: Unit 2, install service for washer and dryer.
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: 1 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:
SUMMERFIELD ASSOCIATES, LLC JET ELECTRIC INC.
% HSC REAL ESTATE PO BOX 20765
1500 SW 1ST SUITE 1020 PORTLAND, OR 97294
PORTLAND, OR 97201
Phone: 503 - 546 -5712 Contact #: PRI 503 - 258 -1715
FAX 503- 258 -1716
FEES
Description Date Amount Reg #: ELE 26 - 1068C
[ELPRMT] ELC Permit 2/17/2006 $24.25 LIP 141920
[TAX] 8% State Surcharge 2/17/2006 $1.94 SUP 4517S
Total $26.19 REQUIRED ITEMS AND REPORTS
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 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: JUL) Permittee Signature: 4142 .�Qt (�
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:
LICENSE NO:
Call 503- 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
02/10/2006 11:49 FAX 5035981960 CITY OF TIGARD a 002
t
Electrical Permit Application FOR OFFICE USE ONLY •
City of Tigard o en3 : , ri rmimi PermitNo.: tL4 D p0(
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review In
n > ..; 9
Phone: 503.639.4171 Fax: 503.598.1960 ut i ,! iI� : i i Daffy, Oth Permit:
Inspection Line: 503.639.4175 ,! .,.! ''' I Date Ready/By: El Scc Page 2 fur
Internet: www.tigard- or.gov Nodfed/Method: • ' Supplements' Inrormution
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.• .
. :,TYPE, OE;:WORK._ ,
.. .. • ' � .� • ��.: �PLAN�•RE'yIEW:.' '.:
Q New construction ❑ .A &tion/alteration/replacement Please cheek all that apply.
- ❑Service over 225 amps, comnt'l DHazardous location
El Demolition Outer_
. CATEGORY' O CONSTRUCTION . :: l,' • : ❑ of 1 -t 320
and 2-family dw dwellings 4 or more n residential
❑System over 600 volts nominal units in one structure
DI 1 d 2-family dwelling ❑ Commercial/industrial 0 Accessory building ❑Building over three stories ❑Feeders, 400 amps or more
ulti family ❑ Master builder ❑Oth ['Occupant load over 99 persons QManufactured structures or
• BOB SITE INFORMATION AND LOCATION . ,.. ' .: • ❑Egness/lighting plan RV park
• 00 [Wealth facility []Other.
Job no.: Job site addre ^ boct) r 71eD 0 �Q ,
l 1 d t) � . •-� - S ubmit 2 sets of plans with any of the above. •
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City /State /ZIPt --ri& i ) (rg� c 7 UZ _4 The above arc not applicable Co temporary construction service.
•
` - • FEE". SCHEDULE :.. •
Suite/bldg. /apt. no.: Up tT Z Project name_ , 1,4) Descriodefl Qa• T"Wt .
Cross street/directions to job site: Vu �, , A, „tA0,,,,a e '�' „` New residential single - or multi- family dwelling unit
Includes attached garage.
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G CF qg WC - _ 1,000 sq. R or less 14 5.15 4
Subdivision: Lot no.: Ea. add'l 500 a4. ft. or, portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non-residential 75.00 2
. D ESCRIPTION OF WORK • • • Each manufactured or modular
i dwelling, service and/or feeder_ 90,90 2
GI C.�_1Z-C r }
l }O0¼-'f vim- I 1 t? 5 i'113- Services or feeders Installation, alteration, sndior relocation
200 amps or less 8030 2
2 01 amps to 400 am 106.85 2 .
p ROPERTY: OWNER . ❑ TEN.ijNT .• • ' ::: 401 amps to 600 amps i 160.60 2
Name: n.tE t,�'yp ,t,* . M . L .C.� P' i.W 4 ' " 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
�5�� �� �� + Vi= ' .. ��� Reconnect only 66.85 2
City/ State/ZIP: •w C%i � ' . AI ' ` 72.0 I Temporary services or feeders installation, alteration, and /or
relocation q 100.30 Phone: (t3) 6 a , - r� 7 2 � . Fax: Gl) - . ' . C) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not . 201 amps to 400 amps 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 _ 2
Owner signature: _ : Date: Branch circuits - new, alteration, or extension, per panel
APPLICANT : CON.TAC.T: PERSON • A, Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: 5 (V, 40,1, 1) CD1.1 -rp-..., U te::4 1 ••• branch circuit
�L��, B. Fee for branch circuits
=,
Contact name: � T11,� �C. 2_ without service or feeder fee, ( 46.85 2
first branch circuit
Address: 15 go?, Nv ip AN a . Each add'I branch circuit ' 6.65 2
City/ State/ZIP: tz4 s , i 9 • 4-2. Miscellaneous (service or feeder not Included)
Pump or irrigation circle I I 53.40 2
Phon ( ) 2....,5 Fax:: xs) 4. - it,' 2 ,C, Sign or outline lighting 53.40 2
E -mail: C l-.. e ` 5 yd; (, 1 e4 0:)n 1.5"fir - -t&c4v . C oak. Signal circuit(s) or limited-
CONTRACTOR: energy panel, alteration, or
- extension. Describe: Page 2 2
Business name:
Each additional Inspection over allowable In any of the above
Address:
1). v • 'boy., Qo 7 5 _ Per inspection 62.50
City/State/ZIP: S L. 0 4 1 2. - 4 Investigation per hour (1 hr min) 62.50
A s i 7 (� ) 25 > _ ` 7 i 4 Industrial plant per hour 73.75
Phone: roc Fax: • ELECTRICAL :PERMIT 'FEES' • •
CCB Lit:.: I y i e i ac, I Electrical Lic.: 2( •- jot, • , Suprv. Lic.: 1,1 5 1 • s _ Subtotal A , aCj
Suprv. Electrician signature, required: ®° • Plan review (25% of permit fee)
State surchurge (8% of permit fee) I
Print name L Date:a 1p 0 4 , �E(i - TOTAL PERMIT FEE 4 .
Authorized signature: This permit application expires If a permit it not obta t ied within I
days after It hoe been accepted as complete
Print name: Date: • Pee methodology set by Tri•County Building Industry Sn-riee Board
Number of inspections per permit allowed.
I:\euiIdius1 Permit \ELC•PenrlitAep.40e 12/30/05 444-0615T(IO/02/COMIw8n
CITY OF TIGARD
ELC
BUILDING DIVISION PERMIT #: 42606, — po /,z 5
13125 SW Hall Blvd., Tigard, OR 97223 r : ' DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
t - �I tvE4Aimi .
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: T ( I 6 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 —( Ce Pour Time:
Code # Inspection Descr' tion Confirm # Contact # Message
l'tG L= '� , 3 0— /(87
- • rreccttions /Com = 4 truc • :. s:
A
f
p PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: &' 1'J 6 W Date: Phone #: (503) 718- 1-if(A)