Permit , rITY OF .TJGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00147
;I n DEVELOPMENT SERVICES DATE ISSUED: 3/20/03
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134CB-00300
SITE ADDRESS: 12125 SW SUMMER ST
SUBDIVISION: SUMMER HILLS PARK ZONING: .R-4.5
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Change service from 100 amp to 200 amp, refeed existing circuits and sub panel.
Job No. 2816
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: 1 W /SERVICE OR FEEDER: 25 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
WASHINGTON FEDERAL SAVINGS STW, INC
425 PIKE STREET • P 0 BOX 1629
SEATTLE, WA 98101 SANDY, OR 97055
Phone: Phone: 503 - 668 -7757
Reg #: ELE 3 -502C
LIC 145981
FEES` SUP 3155S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/20/03 $326.85
[TAX] 8% State Tax 3/20/03 $26.14 Rough -in
Elect'l Service
Total • $352.99 Elect'l Final
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 mor= . : • • = . ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
fo in OAR 952 - 001 -0f • through O' ' • 2 -0f •100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
800 - 332 -2344.
Issued By: � !� J 14(/ L"� Permit Signature: k 1/14.4.
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: ,C DATE:
LICENSE NO: A4
Call 639 -4175 by 7:00pm for an inspection the next business day
Electc,,1 Permit Application FOR OFFICE USE ONLY
Received Electrical P
Date/By: 5 ®� Permit No.: �ls� ior�•r e Q /V
City of Ti and Planning Approval Sign
g Date/By: Permit No.:
13125 SW Hall Blvd. • Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503-598-1960 ii Post - Review Land Use
Ft Date/By:
Case No.: •
Internet: www.ci.tigard.or.us _ , 7u� el I Contact J uris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 - -" Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial III Other: Other: SeService rvice ❑ ivl ❑ Hazardous
over 320 amps - rating of Building Building over er 10 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
K C 1 & 2- Family dwelling Ell Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ ❑ Building over three stories ❑ Feeders, 400 amps or more
Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: / 2.1 Z $ S GJ S c.i fsi yi S'f FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total 1
Cross street/Directions to job site: New residential- single or multi - family per
l dwelling unit. Includes attached garage.
!
1 . / S Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 l
Limited energy, residential 75.00 2
Subdivision: I Lot #:
Limited energy, non residential 75.00 . 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
e Services or feeders - installation,
ChA-Al 7 c Sezvice ,eo" l /00 /tM/O alteration or relocation:
p 2 DO 4-M /e E- - t 45(14 C k f$. 200 amps or less 106.85 bo.1o� 2 2
2
201 amps to 400 amps
S P4 401 amps to 600 amps 160.60
P ROPERTY OWNER 0 TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: LL/ft$ #0N � / ' Reconnect only 66.85 2
Address: { 2 gr ` - v/AIf> Temporary services or feeders - installation,
P i S' "" - ' alteration, or relocation:
City /State /Zip: 5 04 -/}-/ / c , ) ,4- / S1DN 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps _ 100.30 2
❑ APPLICANT ❑ CONTACT PERSON Branch 1 circuits h amps 133.75 2
Bn c -new, alteration, or
Name: 5 tjc) i . /&JC extension per panel:
�%
A O 80 /6 21 A. Fee for branch with purchase w
Address: Or r0 service e feeder feededer fee, each branch circuit 1 t zs 6.65 j41/ 2
City/State /Zip: 5 4iit, S y i 04_ 91o5 13. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone 6ta $q?' —) 977 I Fax: 01)3) 6 S2- 9Z, Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Z $ /6 Signal circuit(s) or a limited energy panel,
Business Name: 6 1 J C Description:
or extension Page 2 2
r Description:
Address: )'O. ' /1.1
Cit City/State/Zip: r q 6,rs Each additional inspection over the allowable in any of the above:
y p S�fn./d i / l'- 7 7 Per inspection per hour (min. 1 hour) 62.50
Phone: (cg) t'/9' 14∎79 Fax: 6'03) 8'52— 92 6 4 Investigation fee:
CCB Lic. #: IL-ISIS I Lic. #: 3 -Soz G Other:
. Electrical Permit Fees*
Supervising electrician Subtotal $ 32 ( .$5
signature required: Plan Review (25% of Permit Fee) $ a ,,{
Print Name: 11A-1 go tMSAc/f Lic. #: �l065/S Statc Surcharge (8% of Permit Fee) $ A-( ,If'f
TOTAL PERMIT FEE I $ s ... 4 19
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information .
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
0 Audio and Stereo Systems
0 Burglar Alarm
JJ Garage Door Opener
Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
El Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
Clock Systems
0 Data Telecommunication Installation
0 Fire Alarm Installation
n HVAC
Instrumentation
0 Intercom and Paging Systems
Landscape Irrigation Control
0 Medical
n Nurse Calls
Outdoor Landscape Lighting
El Protective Signaling
IT Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Fotms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639 -4175
.
INSPECTION DIVISION - - Business Line: (503) 639 - 4171 MST
/ Q� BUP
Received Date Requested L- v AM PM BUP
Location -_■u 44L J Suite MEC
Contact Person Ph ( ) 8 — ( 419 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC � - / 9 ` 6 a y
Foundation Access:
Ftg Drain ELR
Crawl Drain 1- )Q/n1;; , (3
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
H/2_7 Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ALI& LI Please call for reinspection RE. ❑ Unable to inspect - no access
Fire Supply Line
ADA • ,
Approach/Sidewalk Date / i Inspe or fi Ext
Other:
Final DO NOT • EMOVE this inspection record rom - e Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour -
BUILDING • Inspection Line: (503}09.4175
INSPECTION DIVISION • -- Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 3 -a T , / AM PM BUP
Location /.2` a —� �t _ � � uite / / MEC
Contact Person Ph ( ) I f - / L -N PLM
Contractor Ph ( ) SWR t
BUILDING Tenant/Owner ELC 3 z / 7
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing \
Firewall c\ 1 i J C\
Fire Sprinkler ��+� f w 111
Fire Alarm bey. \ 1\., \'\ 1� ly. 1�1 �.�) � 15 c 1
Susp'd Ceiling
Roof
Other:
Final
PASS
PLUMBINGRT FAIL c `i , c j T o P\V ` i / I c 0 c r ,
Post & Bea
Under Slab IY . \e) �S +1J' 0 \Q F ,
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
ervice.,
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final leo ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
•
Fire Supply Line
ADA ll
Approach/Sidewalk Date -5 — . Inspector C.e Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour •
•
BUILDING ' c=P \�^ Inspection Line: (503)-63175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
-Z BUP
Received Date Reque d J AM PM BUP
Location P- / a - . � Suite MEC
Contact Person Ph 65____) gqi — / L t7 r PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3 - 6/q7
Footing
Foundation ELC
Access:
Ftg Drain 1 3 /8 ELR
Crawl Drain 1
Slab Inspection Notes:n w mG - SIT
Post & Beam l
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear t% \\,) k� 4 < 1_ A9 -
Framing �( w � (7
Insulation D\ 1 ' �•� (4-- (� % K ftA Ic(N '1)
Drywall Nailing , V� J C I
Firewall � P . - 4 � L �Y S � \"
Fire Sprinkler 1 �\ i
Fire Alarm 3 _ ' fig 01 � \" t'\6-.t n_ �\ 1 S
Susp'd Ceiling \ ^`
Roof ID � .1.- CAC* 1qC j 1 ZE Mk
Other: m
Final C � � D(V1)1��(.� 7f (41`10 �0 vc� �"1VR-414(-
PASS PART FAIL )
PLUMBING lay cd4 p N , �'"� E L 3 i V -1 (�
Post & Beam y
Under Slab ,(/ �, / ,�� `1/c
Rough -In (,(4/ 4 G /" y �s i. f t !/� T °G
Water Service r / `1
Sanitary Sewer ..5E a- U i ( t REc ()e) �yQEkr"'
Rain Drains
Catch Dra in / Manhole C C l c t tiqv y n Storm Drain / /✓
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA Date C7 - 2 I - •
Approach/Sidewalk I nspecto � W Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL