Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00457
DEVELOPMENT SERVICES DATE ISSUED: 7/23/2004
"11111' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S112BC -09600
SITE ADDRESS: 08085 SW VIOLA ST
SUBDIVISION: RAZE MEADOWS ZONING: R -4.5
BLOCK: LOT : 019 JURISDICTION: TIG
Project Description: Install A/C unit.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 0 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:
SUMMERS, JAMES B + ALLISON I EVERGREEN ELECTRICAL CONTRACTOR
8085 SW VIOLA ST 23861 SE 442ND
TIGARD, OR 97224 SANDY, OR 97055
Phone: Phone: 503 - 668 -4608
Reg #: LIC 136311
ELE 3 -472C
FEES SUP 4581S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/23/2004 $46.85
[TAX] 8% State Surcharge 7/23/2004 $3.75 Elect'l Final
Total $50.60
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: I . _ 1 1� Permit Signature: _ C \p
V �
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 7:00pm for an inspection the next business day
Elestrical Per • 1' 'On FOR OFFICE USE ONLY
Received -ay ��/�J Electrical / n `, _
Date/By: T JC Pennit No. � t--e 00 � 00
City of Tigard Planning Approval Sign
J UL 2 3 1004
Date/By Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 -639 -4171 Fax -P ' . i RD WO. Post - Review Land Use
Internet: www.ci.tigard.or.JtLBIN(� I T St t '' }i: ill \
Date/By: Case No.:
Inspection Request: 503 -639 -4175 Contact wise Su See Page 2 for
24 -hour Ins
P 9 Name/Method: 1 I V Supplemental Information.
TYPE OF WORK . -- .. , PLAN REVIEW (Please checkall'that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
❑ Addition/alteration/replacement ❑Other: commercial ❑ Hazardous location
❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
• . ' CATEGORY.OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
all & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
Accessory Building 1:1 Multi - Family
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Occupant load over 99 persons 0 Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOBSITE INFORMATION - and LOCATION`- - Submit _ sets of plans with any of the above.
v i �� �� The above are not a pplicable to temporary construction service.
Job site address: %�� FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowe
Project Name: Description Qty Fee (et) Total
New residential- single or multi- family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service Included:
1000 sq. ft. or less 145.15
Each additional 500 sq. ft or portion thereof 33.40
Limited energy, residential 75.00
Subdivision: Lot #: Limited energy, non residential 75.00
Tax map /parcel #: Each manufactured home or modular dwelling
. , : ; - 'DESCRIPTION OF WORK service and/or feeder 90.90
Services or feeders - installation,
alteration or relocation:
1 -- )1Y C ( vt v y� , 200 amps or less 80.30
201 amps to 400 amps 106.85
401 amps to 600 amps 160.60
ROPERWOWNER - • 1 TENANT - . 601 amps to 1000 amps 240.60
/��,, _S Over 1000 amps or volts 454.65
� Tmt a 1Ll
Name: t Reconnect only 66.85
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85
Phone: (0 - Si r I Fax: 201 amps to 400 amps 100.30
401 to 600 amps 133.75
- CI APPLICANT I. ❑ CONTACT PERSON - - Branch circuits - new, alteration, or
Name: extension per panel:
Address: A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65
City/State/Zip: B. Fee for branch circuits without purchase of Q
service or feeder fee, first branch circuit 46.85 4(c7
Phone: I Fax: Each additional branch circuit 6.65
E -mail: Misc.(Service or feeder not included):
‘''`r` r,•' CONTRACTOR ''f '', ". . . Each pump or irrigation circle 53.40
' • ' Each sign or outline lighting 53.40
Job No: ,t - ,_,-1 p r 1 alteration, Signal circuit(s) or a limited energy panel, •
Business Name:
I✓�t t7.1 G1 E C C 1 Description: o
or extension
Page 2
Address: 33 t 1 LAt_\_ �.-% c-i
City/State/Zip: C� Si ach additional inspection over the allowable in any of the above:
p: - C ' � 1 Per inspection per hour (min. 1 hour) 62.50
Phone: ( Q ( c - (- I- (,cps, j ax: ( L S,S - c SC Investigation fee:
Other:
CCB Lic. #: I S1p 3 I I Lic. #: g- Hi a. G
Supervising electrician "7i ' ElectricalYennifFees* , - - , .
`_" Subtotal $ �tC� t S
Si: ature re wired' _ _ Plan Review (25% of Permit Fee) $
—
Print Name: 4 1 1c-, ,, Lic. #: S; \ 5 State Surcharge (8% of Permit Fee) $ S
TOTAL PERMIT FEE $ 5(T) t°°
Authorized b� �, vt. �� Notice: This permit application expires if a permit is not obtained within
Signature: �711� • Date: 180 days after it has been accepted as complete.
�! !r� *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms IcPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
? _ BUP
Received Date equested O d AM PM BUP
Location � 8 S Suite Iiic9N Iii D — De q lU
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/• _ y —Oc 4`5.7
Footing • 6 i_ _ M
Foundation ELC
Access: in 8 4
Ftg Drain U 1 ELR
Crawl Drain
Slab Inspection Note l SIT
Post & Beam - -
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear
Framing -
Insulation
Drywall Nailing
Firewall p .
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
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 FAIL
ECHANIC
Rough -In -C
Gas Line II
Smoke Dampers
T FAIL •
ECTRICAL
Ser
Rough -In
UG /Slab
Low Voltage
larm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA 6
Approach/Sidewalk Date _ Inspect ' Ext
Other:
Final DO NOT REMOVE this Inspection record rom the I site.
PASS PART FAIL