Permit 4, CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00234
I r* DEVELOPMENT SERVICES DATE ISSUED: 5/6/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S133AD -06600
SITE ADDRESS: 10895 SW SUMMER LAKE DR
SUBDIVISION: AMART SUMMERLAKE ZONING. R -7
BLOCK: LOT : 110 JURISDICTION: TIG
Project Description: (2) branch circuits for AC and gas furnace.
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 HMI 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: 1 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:
LANGE, TERRY E SHARPE ELECTRIC INC
10895 SW SUMMER LAKE DR 22605 SW RIGGS
TIGARD, OR 97223 BEAVERTON, OR 97007
Phone: 503 - 649 -1271 Phone: 642 -7937
Reg #: LIC 81518
SUP 3344S
FEES ELE 34 -217C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/6/2004 $53.50
[TAX] 8% State Surcharge 5/6/2004 $4 Rough -in
Elect'I Final
- Total $57.78
•
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 -800-3 344.
Issued By: Permit Signature: /J'I ,r1 J 60I'
OWNER 1-
INSTALLATION ONLY 7�
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: � 3 1 -/y C�
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY
Received
City of Tigard
Received S ( Q ! Permit j/� h�f_ �ja
I 3.;25 SW I;all Blvd., Tigard, OR 97223 Plan Reviess - -vv�wv
Phone: 503.639.4171 Fax: 503.598.1960 l Date'By: I Other Permit
Inspection Line: 503.639.4175 �y. r.•'fl � Date Ready: By: Sur' 'flu Sec Page for
Internet: www.ci.tigard.or.us Notitied :\Ielhod: /g pplemental Inl'unnation
TYPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply:
❑ Demolition Other: ['Service over 225 amps. comm'I ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft..
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
Al I and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
Buildin over three stories ['Feeders, 400 amps or more
❑ Multi family 0 Master builder ❑ Other:
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job site address: S S w k-,0/1/41 � O 9 3 esiL. 01-care facility ❑Other:
I� Submit 2 sets of plans with any of the above.
City /State /ZIP: / j O p-_,___. op__ The above are not applicable to temporary construction ser ice
Suite /bldg. /apt. no.: Project name: FEE* SCHEDULE
Description Qty. I Fee. Total I -
Cross street/directions to job site: ' hc) JJS Qt^ qV. New residential single- or multi- family dwelling unit.
Includes attached garage.
I ,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 _
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 1 2
A/C, [ i /e ti{of. /ws/ NEv 6,1s e,v Services or feeders installation. alteration, acid /or relocation
200 amps or less 80.30 I '-
�p 201 amps to 400 amps 106.85 2
S° PROPERTY OWNER ❑ TENANT
1_19 � � 401 amps to 600 amps I60.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: / Q 9 VI..) Over 1,000 amps or volts 454.65 '_
Reconnect only . 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration• and /or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 I
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 1 33.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ dpe II CAN' ( 4 ti ❑ CONTACT PERSON A. Fee for branch circuits with
�
^ /�� ieF• EL. I IC re./ C JA /( branch or feeder fee, each 6.65 2
Business name: C i > J branch h circuit
B. Fee for branch circuits
� ^ f
Contact name: �� A without service or feeder fee, I 46.85 /7/4 it 2
Address: '2 ,, 5 ,(2 .I each branch circuit
v �+ Each add branch circuit J 6.65 4 � 2
City/State /ZIP: 5 70D Miscellaneous (service or feeder not included)
S n Pump or inigation circle 53.10
2
Phone: ) F /2- 7937 Fax:: ( ) 9Z , 2
Sign or outline lighting
53.40
E -mail: Signal circuit(s) or limited- .
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: A 'n� Address: / Iii".. additional inspection over allowable in any of the abuse
Per inspection 62.50 i r I
City /State /ZIP: Investigation per hour (t hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 15 t Electrical Lic.��� —Z) 7 u pr Lic�� _ , Subtotal
Suprv. Electrician signature, required: , P lan revicss (25 °4. of permit fee) .7„1 9
Print name. �.a p,4, A AD Kw ' / State surcharge (8% of permit fee) - • 4 D ated .
f TOTAL PERMIT FEE I
Authorized signature: This permit application expires if a permit is not obtained ssithin 1511
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry See ice Board `/
•• Number of inspections per permit allowed. 5�, �/
I .Bu ilding ' Permits \ELC•PermnApp doc 1103 440.4515T110 03 - / COxt WEB
Electrical Permit Application - City of Tigard -
V
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other: •
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑
•
Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ .Other
Total number of commercial systems:
*No licenses are required. Licenses are required •
for all other installations
i. 'Duilding \ELC•PcrmitApp doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested „ / a1--- AM PM BUP
Location / SZ4 ems►. Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR /
BUILDING Tenant/ - . --AA t S 7 - 0 ��� ELC l" - ' D_3 z
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam ._
Shear Anchors //�� ��►► � �J ' o o
Ext Sheath/Shear .(/111 I ) oV
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm �� rJ'A L, ELg 2V 2 L <(--
Susp'd Ceiling
Roof kf p 2oV lA L--.
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
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
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
CD Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE fl Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA D 311 2 n l. Ins Inspector te N68 � Ext
Approach/Sidewalk 1 p
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL