Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC97 -0621
DATE ISSUED: 09/18/97
J.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2911ODD -14000
SITE ADDRESS...:1O65O SW SUMMERFIELD DR
SUBDIVISION •SUMMERFIELD ZONING:R -7
BLOCK • LOT •O0B JURISDICTION: TIG
Project Description : Add seven (7) branch circuits to existing club house
facilities.
- -- 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/O SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp : 0 EA ADD'L BRNCH CIRC: 6 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
SUUMERFIELD CIVIC ASSOCIATION type amount by date recpt
10650 SW SUMMERFIELD DRIVE PRMT $ 65.00 GEO 09/18/97 97- 299387
TIGARD OR 97223 5F'CT $ 3.25 GEO 09/18/97 97- 299387
Phone #:
Contractor:
WESTSIDE ELECTRIC $ 68.25 TOTAL
7518 SW MACADAM AVE
REQUIRED INSPECTIONS
PORTLAND OR 97219 Ceiling Cover Underground Cove
Phone #: 245 -3385 Wall Cover Elect'l Service
Reg #..: 000133
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 requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling l 46 -1987.
/
Permittee Signature: Issued By: d
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 : 0 DATE: C
LICENSE NO: ! ✓ �
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
COY OI: TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit itFZZ
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development / /' /% �yJ Number of Inspections per permit allowed
Name (or name of business) . U'M 2 r�`ieY /U /C 1, Service included: Items Cost Sum
Address /06SYj SG,' i r/aarrfie7t:/A: 4a. Residential - per unit -
CI /State /ZI / 4 6 � r f �� / 1000 sq. ft. or less $110.00 4
ty p 1 / / Each additional 500 sq. ft. or
Commercial Lam] Residential 1=1 Limited 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 yce es /� 4b. Services or Feeders
Electrical Contractor ' , % "C/ / c Installation, alteration, or relocation
- r - r 4 200 amps or less $60.00 2
Addres /J a r 4h 201 amps to 400 amps $80.00 2
City r Gsc State 9/2 Zip 9 72/9 401 amps to 600 amps $120.00 2
Phone No. 4. Z Y - 601 amps to 1000 amps $180.00 2
Job No. '9/0 - l)/)/ Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 2 _ 3S Exp.Date
OR State CCB Reg. No. Exp.Date 4c. 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 Sur. Elec'n 201 amps to 400 amps $75.00 2
g p 401 amps to 600 amps $100.00 2
( / Over 600 amps to 1000 volts,
License No .f (G7_ Exp.Date see "b" above.
Phone Nr Z- V..S 3 & S
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. / $35.00 3 2
First branch circuit
The installation is being made on property I own which is not Each additional branch circuit b $5.00 30 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 $ t 3 s--- 5% Surcharge (.05 X total fees) $ r
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 Subtot $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY / �/ 2.
TIME AFTER WORK IS COMMENCED. IIL���JII Trust Account # �,, b
Total balance Due $
TA r
I:\DSTS \ELC96.APP Rev 9/96
RECEIVED
SEP 181997
COMMUNITY DEVELOPMENT
y ieer'r 0`31 � G-8gAm. ITY OF TIGARD BUILDING INSPECTION DIVISION cAP -i
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171 .3 — e,44._ . '
Date Requested: (' 13 /C/ ( A.M. P.M. MST:
Location: A Ti _ _ �4J III /J_, . t / 1 .......1 BUP:
Tenant: f p ,. Suite: Bldg: , MEC:
Contractor: L d 11 Phone: 3/ —, S PLM: 3 - 8 ran., 4,
Owner: Phone: ELC: 0 7= - 7
S4 less 1 Xi- Hic ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling ater Line
Slab Framing Top Out Gas Line Rough -In S rinkler
Foundation Insulation Sewer Hood/Duct Reconnec Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved %pprov - • Approved
Appr /Sdwlk Not Approved Not Approved Not Approved _ . id . • ved Not Approved
FINAL FINAL FINAL - FINAL
1 ,e,//LH ..e- LAJt Pa/14-
/_*
C4JeD
O Call for reinspectio O Reinspection fee of $ required before next inspection 0 Unable to inspect
Inspector: _ Date: CL/ --s' 9.a p Page of