Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00123
DEVELOPMENT SERVICES DATE ISSUED: 2/15/2006
r 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 2 S 110 D D -06600
SITE ADDRESS: 10650 SW SUMMERFIELD DR ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.4 LOT : F JURISDICTION: TIG
Project Description: Replace exit sign.
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: 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 CIVIC • ROSENDIN ELECTRIC
ASSOCIATION 1300 NE 48TH #1200
10650 SW SUMMERFIELD DR HILLSBORO, OR 97124
TIGARD, OR 97224
Phone: Contact #: FAX 503 - 615 -0689
PRI 503 - 615 -8189
FEES
Description Date Amount Reg #: LIC 103939
[ELPRMT] ELC Permit 2/15/2006 $46.85 ELE 3071S
[TAX] 8% State Surcharge 2/15/2006 $3.75 SUP 37 -692C
Total $50.60 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: Permittee Signature: 91 `4 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: 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.
Electrical Per _ LE: '„y„, o i FOR OFFICE USE ONLY
'' ' City of Tigard Received / r
13125 SW Hall Blvd., Tigard, OR 9.7,2
Date/B ., — /t• L -
g Plan n Review
Phone: 503.639.4171 Fax: 503508 0 (NU / p ,' 1 Date/B : Other Permit:
Inspection Line: 503.639.4175 ■ y e Date • ReadyBy: El See Page 2 for
Internet: www.ci.tigard.or.us CITY OF T CARD Notified/Method: Supplemental Information
Bu D WORK O R ��
WORK PLAN REVIEW
❑ New construction . Addition/alteration/replacement Please check all that apply:
❑Demolition ❑Other: ['Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps - rating DBuildng over 10,000 sq. ft., • • CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling p'Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB.SITE INFORMATION AND LOCATION DEgress/lighting plan RV park
Job no.: J s ite a ddress: / ❑Health -care facility
['Other: PI ��6 yo 5 w S ; %� dr t < /� Submit 2 sets of plans with any of the above.
City/State /ZIP: 77 yt/r d,q q7:2-11 The above are not applicable to temporary construction service.
FEE*" SCHEDULE
Suite/bldg. /apt. no.: Project name: / g %- Cif' /T
• i. Description I Qty. I Fee. I Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. R. or less 145.15 1 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 2
ge l4 e rx; i77h.J /_/�. .0;7/ ;; t.-4,-- ,: 5 ' 7 5 /-2e Services or feeders installation, alteration, and/or relocation
�-,� / 200 amps or less 80.30 2
rROPERTY OWNER 0. TENANT 201 amps to 400 amps 106.85 2
A 401 amps to 600 amps 160.60 2
Name: y 4 ( G i • , amps to 1,000 am 60 am s
C. h�in / , f > C !�!G ./ 5JC �i "� K « �7 amps 240.60 2
Address: l y � Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: .-- 7 i7rve - e 7 o z2 y/ Temporary services or feeders installation, alteration, and/or
Phone: ( .& 3) 6 Z tj _U`j/ Fax: ( rpJ) 6 7� e y/ _ / 2 am ion
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 100.30 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 I . ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name.: B. Fee for branch circuits
without service or feeder fee, / 46.85 zf� s 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
o extension. Describe: Page 2 2
Business name: g ,7S , E /E'. b--/ e__ Zh c
Each additional inspection over allowable in any of the above
Address: /,-30 /71, ,4 •fr /,ZQQ -
�y / • �'� Per inspection 62.50
City/State /ZIP: HA /7,9„_, (7w I74z /f Investigation per hour (1 hr min) 62.50
/ Industrial plant per hour 73.75
Phone: (r0) 6, . � f Fax. ( 6/5 ,I :_r '._ ELECTRICAL PERMIT,. FEES *.
CCB Lic.: /17,3 �7 Electrical Lic.: 37 -‘,,g C Suprv. Lic.: S Subtotal , ,, ;ff
Suprv. Electrician signature, required: ;✓ �j�� Plan review (25% of permit fee)
Print name: - r{ K 7 ,- n ,, �,..- , rzt Date: a7/74,44 State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name: Date: • Fee method set by Tri -County Building Industry Service Board
• • Number o inspec per perm all owe d .
i:\ Building \Permits\ELC- PermitApp.doe 12/03 • 440.4615T(10 /07/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: kL(:.�iJOf-00
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/15.1200,; Phone: (503) 639 -4171 ; , iii
Inspection Requests (24 Hrs.): (503) 639 -4175 �+�- p_
INSPECTION WORKSHEET FOR DATE: 2/16/2006 TIME: 7:07AM PAGE: 76
SITE ADDRESS: 10660 SW CUMMERFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMERFIFLD NO.4 LOT #: F TYPE OF USE: •
PROJECT NAME: SUMME:RI CIVIC Af3 OCIAT1ON
DESCRIPTION: 12eplace exit sign.
OWNER: SUMMERFIELD CIVIC, PHONE #:
CO TRACTOR: ROSENDIN ELECTRIC PHONE #: 50:1 - 615 -81119
Inspection - -quest Scheduled For: Date: 211612006 Pour Time: .
Code # spection Description Confirm # Contact # Message
199 F , •tiical final 026972 -01 503615 -6189 `t
Corrections /Comme s /Instructio s: Ra\
)
- 2 , `r o N c), ch e\ m1,__NO
) PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
7 n
Inspector: 7 N Q g • Date: 4_4__________i 0 b Phone #: (503) 718 -2