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Permit CITY OF TIGARD ELECTRICAL PERMIT I VV/ I � � � DEVELOPMENT SERVICES DATE ISSUEDo PARCEL: 25111CD -01300 SITE ADDRESS...:15574 SW SUMMERFIELD LN SUBDIVISION •SUMMERFIELD NO.7 ZONING:R -7 BLOCK LOT •363 JURISDICTION: TIG Project Description : Add two (21 branch circuits to an existing single family dwelling. - -- 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: 1 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 BYRON PALM type amount by date recpt 15574 SW SUMMERFIELD LANE PRMT $ 40.00 GEO 02/20/98 98- 303461 TIGARD OR 97224 -0000 SPCT $ 2.00 GEO 02/20/98 98- 303461 Phone #: Contractor: WESTSIDE ELECTRIC $ 42.00 TOTAL 7518 SW MACADAM AVE REQUIRED INSPECTIONS PORTLAND OR 97219 Underground Cove Elect' 1 Final Phone #: 245 -3385 Elect'1 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 -8010 through OAR 952-001 -1987. You may obtain a copy of these rules or direct questions to OUNC by calling ( 246 -1987. Permittee Signature: , rr��,lJ� 7 Issued By: AOF 4 ✓',.,,,.L.t 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 54-7-0 e`'?� DATE: v� ' d - 9,. L I CENSE NO : /3 s ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ CITV,.OF 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 Print or Type Date to DST Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # � �C° g $� Fax (503) 684 -7297 Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development ► / �/ Number of Inspections per permit allowed Name (or name of business)41 -6:7 / //�� 177 / 6 /iiriDili - /7/� Service included: Items Cost Sum Address AT 7 ck) _50,17/�7P/"/' e, / (.�t A L / 4a. Residential - per unit . tY Ci /State /Zip y4 7 722f 1000 sq. ft. or less Each additional 500 sq. ft. or $110.00 4 Commercial El Residential L7 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 lice se , 4b. Services or Feeders Electrical Contractor C- C• C• Installation, alteration, or relocation 200 amps or less $60.00 2 Addres y c. 201 amps to 400 amps $80.00 2 - City of vi State g Zip 972/4f 401 amps to 600 amps $120.00 2 Phone No. 2 1 - / - / 92/ 601 amps to 1000 amps $180.00 2 Job No. 2/6 Da 7 Over 1000 amps or volts $340.00 2 Reconnect only $50.00 2 Elec. Cont. Lice. No. 26 / ?SL Exp.Date OR State CCB Reg. No. /331)6 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 2 201 amps to 400 amps $75.00 Signature of Supr. Elec'n ` ' - 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License No / Exp.Date see "b" above. Phone Nr 23/ /.f yQ 4d. Branch Circuits New, alteration or extension per panel 213. 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. First branch circuit / $35.00 2 The installation is being made on property I own which is not Each additional branch circuit i $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: L/ Not required for temporary construction services. 5a. Enter total of above fees $ Z 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 Sub al $ IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY j , / � TIME AFTER WORK IS COMMENCED. Trust Account # / 3 �? / Total balance Due $ I:\DSTS \ELC96.APP Rev 9/96 RECEIVED FEB? 91998 COmMU FY DEVELOPMENT 5/13/99 Activities for Case #: ELC98 -00082 7:49:59 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 T° Done By Disp. Level By Updated Notes ELCA001 Application received 2/20/98 GEO RECD GEO 2/20/98 ELCA003 Permit created 2/20/98 GEO DONE GEO 2/20/98 ELCA725 Underground Cover 2/20/98 GEO 2/20/98 ELCA730 Elect'I Service 2/20/98 GEO 2/20/98 ELCA799 Elect'I Final 2/20/98 4/6/99 CD PASS CD 4/6/99 hook up gas furnace & wire a/c unit ELCA500 (F) Issue permit 2/20/98 GEO PASS GEO 2/20/98 ELCA920 Miscellaneous action 3/17/99 WDJ MAIL WDJ 3/17/99 ELCA800 Case finaled 4/6/99 AKJ DONE No Hold AKJ 4/6/99 • • • • Page 1 of 1 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 qq , ,� � BUP Date Requested L - 1 -Co '' G -/ AM 2 -co " Location ISs7 �Sl/I.YYI� T-1 m We • Suite MEC Contact Person , AO _I Ph COa x)971 PLM Contractor Ph SWR p BUILDING Tenant/Owner ELC l g Retaining Wall ELR Footing Access: FPS Foundation r Ftg Drain S '.� rT'Y - LFT- 9c. — S ��• /� SGN Crawl Drain Inspection Notes: Slab 2 — � �J 4 / ( ' T19 SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing e/" /(/O/,l (1 09, y�i- Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling 60/ ri 0 C U Roof Misc: Final PASS PART FAIL PLUMBING 4/GE70 Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL Service Rough In UG /Slab Low Voltage Fire Alarm 40 PART FAIL 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 � / G Approach /Sidewalk Date ` L c 7 9 Inspector E Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.