Permit ELECTRICAL PERMIT
SIN OF T PERMIT 5
•
DATE ISSUED:
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL: 2S 101 AA - 09001
SITE ADDRESS...: 12585 SW 68TH AVE
SUBDIVISION • WEST PORTLAND HEIGHTS ZONING:C —P
BLOCK LOT •29
Project Description: Service to 400 amps & 34 branch circuits.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION : 0
EACH ADD'L 500SF...: 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: 34 PER INSPECTION : 0
201 — 400 amp • 1 1st W/0 SRVC OR FDR.: 0 PER HOUR : 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 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
PRECISION IMAGESETTING type amount by date recpt
12585 SW 68TH AVENUE PRMT $ 245.00 JSD 06/27/96 96- 281105
PLCK $ 61.25 JSD 06/27/96 96- 281105
TIGARD OR 97223 5PCT $ 12.25 JSD 06/27/96 96- 281105
Phone #:
Contractor:
DON RIFE RIFE ELECTRICAL CONTRACTORS $ 318.50 TOTAL
1901 NE 134TH PL
REQUIRED INSPECTIONS
PORTLAND OR 97230 Ceiling Cover Elect'1 Service
Phone #: 293 -8243 Wall Cover Elect'1 Final
Reg #..: 072343
This permit is issued subject to the regulations contained in the ,A'
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signature
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 18® days. I sued By
OWNER INSTALLATIO 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 for inspection — 639 -4175
to e E. 1,--18-q4' flOT.-1S1'96 « c - t/ 'p /(S G
• Community Development ELECTRI P(E9LI(TCAPPFIC
LI CATION
• 13125 SW Hall Blvd. o�
Tigard, OR 97223 Permit # et-C., l % - t 3/D
�" �, � Date Issued 0(0:75
el ii Phone (503) 639 -4171
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: ( 96- etc `7 4. Complete Fee Schedule Below:
Name of Development ,P4L C) S ' J Number of Inspections per permit allowed
Address �v o5 s !� 'l Service included: Items Cost(ea) Sum
City /State /Zip / / r 3 !911°,1, T R ? 7;2,43 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) � �� � ° J Each additional 500 sq. ft. or
portion thereof $25.00
Commercial )g Residential Limited Energy $25.00 1
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
R e 6 � � d N j I NC Installation, alteration, or relocation 2
Address
Electrical Contractor i re .L 200 amps or less $8000 2
201 amps to 400 amps $12000
.2.c- (p Oa � ? 3 i"��� al. 9 � 401 amps to 600 amps 2
City Pi �-l� State d Zip 9 7, A4 601 amps to 1000 amps $180.00 2
Phone No. Z1 _? ~ PA 4 /3 Over 1000 amps or volts $340.00 2
Job NO. Reconnect only
$50.00 2
contractor's license NO. 0 - 7 G 4c. Temporary Services or Feeders
Contractor's Board Reg. No. . AM la g r Installation, alteration, or relocation
Signature of Supr. Elec'n "..;72 WINE, -ct 200 amps or less _ 2
License No. 3 r71 y 5 Phone No. ,,,?1,..?,-J-2243 201 amps to 400 amps • r. r • A 2
0 0
401 amps to 600 amps $75.
Over 600 amps to 1000 volts 5100.00
. 2b. For owner installations: see „b„ above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with 2
purchase of service or feeder fee.
City State Zip Each branch circuit $5.00 110-c°
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
First branch circuit $35.00
not intended for sale, lease or rent. Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal circuits) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
-
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ ro
NOTICE 5% Surcharge (.05 X total fees) $ _
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for i
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $ [p �`
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. wwdlcomdevleko ❑ Trust Account #
$
prm.app
Balance Due $ ` �j )