Permit - CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES P ERMIT #: ELC98 — @�48
���'�� ° �''�'����I DATE ISSUED: @5/11/98
:-!l+� _.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
PARCEL: 2S1 @1AD — @�6 @@
SITE ADDRESS...:1�6�5 SW 69TH AVE
SUBDIVISION •WEST F�ORTLAND HEIGHTS ZONING:MUE
BLOCK LOT • @31 JURISDICTION: TIG
p'ro j ect Description : Teaporary service for new dental office.
- -- RESIDENTIAL UNIT - - -- -- -TEMP' SRVC /FEEDERS - - -- MISCELLANEOUS
1 @ @@ SF OR LESS @ @ — 2 @@ amp 1 PUMP /IRRIGATION @
EACH ADD'L 5 @ @SF...: @ � @1 — 4 @@ amp @ SIGN /OUT LINE LTG..: @
LIMITED ENERGY @ 4 @1 — 6 @@ amp @ SIGNAL /RANEE @
MANF. HM/ SVC /FDR..: @ 6 @i +amps -1 @ @@ volts.: @ MINOR LABEL (1 @)...: @
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
@ — � @@ amp @ W /SERVICE OR FEEDER: @ F'ER INSPECTION @
2 @1 — 4 @@ amp @ ist W/O SRVC OR FDR.: @ F'ER HOUR @
4 @1 — 6 @@ amp @ EA ADD'L BRNCH CIRC: @ IN pLANT @
6 @1 — 1 @ @@ amp @ PLAN REVIEW SECTION
1 @ @ @+ amp /volt @ > =4 RES UNITS > 6 @@ VOLT NOMINAL..:
Reconnect only @ SVC /FDR >= 2�5 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
JOHN MCCROSKEY, DR type amount by date recpt
14125 SW FARMINGTON RD PRMT 'b 5 @. @@ DEB @5/11/98 98 -3 @5646
BEAVERTON OR 97 @ @7 SpCT $ 2. 5@ DEB @5/11/98 98 -3 @5646
phone #:
Contractor:
DDN RIFE RIFE ELECTRICAL CONTRACTORS $ 5�.5@ TOTAL
1901 NE 134TH PL
REQUIRED INSPECTIONS
G�ORTLAND OR 9783@ Elect'1 Service
Phone #: X93 -8E43 Elect'1 Final
Reg #..: @@ @723
This per�it is issued subject to the regulations contained in the Tigard Municipal Code, State of Dregon Specialty Cades and all other
applicable laNS. All cork Mill be done in accordance with approved plans. This per�it sill expire if work is not started pithin 1����
days of issuance, or if work is suspended for yore than 180 days. ATTENTION: Dregon law requires you to follow the rules adopted by
the Dregon Utility Notification Center. Those rules are set forth in �R 95Z�1 -0010 through OAR 952 1 -1987. You aay obtain a copy
of these rules or direct questions to �JNC b calling (503)246 -1987.
Permittee Signature: �C Dx- �'� Issued B � �, t. iL� .l .�• ,
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:
CONT OR INSTALLATION ONLY
�,n � _
SIGNATURE OF SUF'R. ELEC' N : X �-dC � ' '� DATE :J '��`�
/�`
LICENSE N0:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7: @@ p. m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY O�TIGARD Electrical Permit Application Plan Check -
13125 SW HALL BLVD. Recd By
TIGARD OR 97223 Date Recd 5 // �
Date to P.E. ��
Phone (503) 639 -4171, x304 �-
Print or Type Date to DST
Inspection (503) 639 -4175 Permit# FLCS�f" 0 ��/�
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name f us e ) �r: CR 0 S /�Ey Service included: Items Cost Sum
� � �
Address - S �✓ � � 4a. Residential -per unit
1000 sq. ft. or less $110.00 4
City /State /Zip Each additional 500 sq. ft. or
Commercial ❑ Residential ❑ portion thereof $2s.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 curre licenses) _ 4b. Services or Feeders
Electfical Contractor � � � � �L � GT� r rG Installation, alteration, or relocation
200 amps or less - $60.00 2
Address 90/ �/E J � � �L_ 201 amps to 400 amps $so.00 2
Clt)/ /�L,L7 State �� Zlp_ ���.:.� d 401 amps to 600 amps $120.00 2
Phone No. 972 � �� �3 601 amps to 1000 amps $180.00 2
JOb No. Over 1000 amps or volts - $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. � to - 7�7C.�Exp.Date /or���'
OR State CCB Reg. No� � d2 � �3 Exp.Date !r � ,� 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date f/ /�� Installation, alteration, or relocation / s- c O
200 amps or less / $50.00 � 2
Signature of Supr. Elec'n �'�. �'� 401 amps to 600 amps � $100.00 2
Over 600 amps to 1000 volts,
License No -- �J �.� Exp.Date �� 1�� see "b" above.
Phone N� j 7�2 �- �7� y�
4d. Branch Circuits
New, alteration or e�dension per panel
Zb. For owner installations a) The tee for branch circuits with
purchase of service or
Print Owner's Name /seder fee.
Address Each branch circuit � $5.00 2
b) The fee for branch circuits
Cit)/ State ZJp without purchase of
Phone No. serv/ce or feeder tee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. ae Miscellaneous
(Service or feeder not included)
Owners SlgnatUre Each pump or irrigation circle $40.00 2
Each sign or outline lighting - $40.00 2
3. Plan Review section (if required):'` Signal circuits) 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. J Fees: O
Not required for temporary construction services. 5a. Enter total of above fees $
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 Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑Trust Account # �a • �
Total balance Due $
1:1DSTS1ELC96.APP Rev 9/96