Permit CITY OFTIGARD PERMIT
Am l;,r DEVELOPMENT SERVICES ELECTRICAL PERMIT #: ELC98 -0157
!+L� = '� �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04 / 01 / 98
PARCEL: 1S133AD— 12700
SITE ADDRESS...:12621 SW SPRINGWOOD DR
SUBDIVISION -SUMMER LAKE ZONING:R -7
BLOCK • LOT •008 JURISDICTION: TIG
Project Description : Install branch circuit
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS : 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 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
1 MORRISON type amount by date recpt
12621 SW SPRINGWOOD DR PRMT $ 35.00 JSD 04/01/98 98- 304587
TIGARD OR 97223 SPCT $ 1.75 JSD 04/01/98 98- 304587
Phone #:
Contractor:
PORTLAND METRO AIRE $ 36.75 TOTAL
10010 SW BEAVERTON— HILLSDALE HWY
REQUIRED INSPECTIONS
BEAVERTON OR 97005 Rough —in Elect' 1 Final
Phone #: 626 -7818 Elect' 1 Service
Reg #..: 000612
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 lore than 180 days. ATTENTION: Oregon law requires you to fol w the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001 -0010 through OAR 952 '0 - 7. You may obtain a copy
of these rules or direct questions to OUNC by calling (5031246 -1987.
Permittee Signature: Raj Issued B .
5
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 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
1
CITY OF /TIGARD Electrical Permit Application Plan Check # .
13125 SW HALL BLVD. Rec'd
T Date Rec'd / O/
TIGARD OR 97223
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # f-z c 9 5S a
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called CyciG
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum
Address. / 2 4 c Sou SpY714 i AXJ Dr 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City/State /Zip ��11 Li Each additional 500 sq. ft. or
Commercial El Residential Residential 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 current licenses /� 4b. Services or Feeders
Pd Electrical Contractor t'd-4' If t.1A0 t1 A o - i Installation, alteration, or relocation
Address hl i £ - 1, 5 ' 614 200 amps or less $60.00 2 -
��� � 2 01 amps to 400 amps $80.00 2 -
City `� �1S�ttate O)1� Zip 0 • • 401 amps to 600 amps $120.00 2
Phone No. _ 2 - `6l g 601 amps to 1000 amps - $180.00 2
Job No. Over 1000 amps or volts - $340.00 2
Elec. Cont. Lice. No. - 6‘f C. Exp.Date /0 -/ - ?O' Reconnect only - $50.00 2
OR State CCB Reg. No. 4 1L Exp.Date 10 Zir 4c. Temporary Services or Feeders
COT Business Tax or Metro No. f ? 6 Exp.Datep-J I -5" R Installation, alteration, or relocation
ter' 200 amps or less $50.00 2
Signature of Supr. Elec'n , / ,�; 201 amps to 400 amps $75.00 2
A '
401 amps to 600 amps $100.00 2
Sn I p / O - / ^ �p Over 600 amps to 1000 volts,
License No V Ex Date 1 bb see °b" above.
Phone No 6 2.{, - S r '
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee. /,l C p)-
First branch circuit ! $35.00 J j 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(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 Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
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: , /
Not required for temporary construction services. 5a. Enter total of above fees $ /
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $
5b. Enter 25% of line 5a for / . (
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
! BUP
0 40 Date Requested AMA_A_PM BLD
Location 6 . e) soJ Sui" to MEC
7?
Contact Person h0)\. Ph 5 CQ 511 PLM
Contractor Ph SWR �r 1 7
BUILDING Tenant/Owner ELC q0 — 6 l S 1
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain �p
Crawl Drain Inspection Notes: "i SGT
-�
Slab SIT
/Jn
Post & Beam .Jr.v�t kM �.� _ q
P
Ext Sheath /Shear f J�(
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PACs, PAST FAIL
IIECHAN
Post & Beam
Rough In
Gas Line PrCi
S ' : - Dampers
Wit•
` • • ' T FAIL
CTRICAL - %, y ri 1i 'v 'p r j 7 -. - .1 - i 1_ r. - - ' - '-
Service
Rough
UG /Slab In
Low Voltage PC
Fi larm
ina
S PART FAIL
SITE
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: [ ] Unable to inspect - no access
ADA
Approach/Sidewalk
Other Date 7- Z Z Inspector .' P Ext
Other _
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.