Permit A . CITY OF TIGARD
„„„, ELECTRICAL PERMIT
DEVELOPMENT ������N����
m�m�� m�u���n nwou�n� w SERVICES PERMIT #: ELC97-0081
.�gy ' I' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 02/13/97
PARCEL: 2S101AA-09800
SITE ADDRESS...: 12570 SW 69TH AVE
SUBDIVISION ^ MLP95-0013 ZONING:MUE
BLOCK ^ LOT.............:001
Project Description: Installing temporary service
___ _____
---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- MISCELLANEOUS
1000 SF OR LESS....: 0 0 — 200 amp.......: 1 PUMP/IRRIGATION....: 0
EACH ADD' L 5090SF. . . : 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 6014-amps-1000 volts.: 0 MINOR LABEL (10)...: 0
----SERVICE/FEEDER---- ----BRANCH CIRCUITS----- ---ADD'L INSPECTIONS---
G — 200 amp • 0 W/SERVICE OR FEEDER: 0 PER INSPECTION : 0
201 — 400 amp......: 0 1st W/O SRVC OR FDR. : 0 PER HOUR...........: 0
401 — 600 amp • 0 EA ADD'L BRNCHCIRC: 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
J T ROTH JR type amount by date recpt
12540 SW 68TH AVENUE #B PRMT $ 50.00 B 02/13/97 97-290362
5PCT $ 2.50 B 02/13/97 97-290362
TIGARD OR 97223
Phone #: 639-2639 x
Contractor:
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DON RIFE RIFE ELECTRICAL CONTRACTORS $ 52.50 TOTAL
1901 NE 134TH PL
REQUIRED INSPECTIONS
PORTLAND OR 97230 Elect'l Service
Phone #: 293-8243 Elect'l Final
Reg #.. : 072343
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This permit is issued subject to the regulations, contained in the �� W~~� �0
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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 �*�^ �» ��W����J�� ,_
than 180 days. Issued By
---------- ---OWNER INSTALLATION ONLY--------
The installation is being made on property 1 own which is not intended for
sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
---- CONTRACTOR INSTALLATION ONLY —
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SIGNATURE OF SUPR, ELEC' N: � , ~�
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LICENSE NO:
Call for inspection — 639-4175
--- Community Development ELECTRICAL PERMIT APPLICATION
� 13125 SW Hall Blvd. r"
Tigard, OR 97223 Permit # IE
La, 7 o I
,��,iq� . �, Date Issued 2 e t 7
� i 1 Phone (503) 639 -4171
`'� FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development ell 4 5 PI EA 0 /59c Number of Inspections per permit allowed
Address /a S 7 t2 EL EL) 6 7 Service included: Items Cost(ea) Sum
City/State /Zip 2/ t2 /NCO ek Y 3 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) Each additional 500 sq. ft. or $2500
portion thereof 1
Commercial Residential El Limited Energy $25.00
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation
Electrical Contractor A Fk. ELECT CeNr, 200 amps or less 560.00 2
Address /PI/ A/E j 34‘ PL f 201 amps to 400 amps $80.00 2
City /a
401 amps to 600 amps $120.00
GD State 4/e Zip 9 7 3Q 601 amps to 1000 amps 5180.00 2
Phone No. A 7 3 - ,P. 2 Over 1000 amps or volts $340.00 2
Job NO. Reconnect only
850.00 2
contractor's license NO. al 6 X 76 / 7 C 4c ovary Servicer Feeders
Contractor's Board Reg. No. 0 7 '
2. 3 4 2 Installation, alteration, or reioc ion
Signature of Supr. Elec'n ' i%lais 200 amps or less T 0 .b0 2
201 amps to 400 amps 850.00
2
License No. 3 7/f S Phone No. 02 9 3 -.p./ y3 401 amps to 600 amps 575.00 2
Over 600 amps to 1000 volts $100.00
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
C i State Zip purchase of service or feeder fee.
City Each branch circuit $5.00
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 2
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 circuit(s) 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 535.00
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 J 0 O C
NOTICE 5% Surcharge (.05 X total fees) $ 1 '5
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. wmdUmmdeNebf. ❑ Trust Account #
prm.epp i-..
Balance Due $ S1 .517