Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00453
4"f - ' = DEVELOPMENT SERVICES DATE ISSUED: 8/9/00
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 1 S136AB -00200
SITE ADDRESS: 10006 SW 72ND AVE
SUBDIVISION: METZGER ACRE TRACTS ZONING: R-4.5
BLOCK: LOT : 003 JURISDICTION: TIG
Proiect Description: Temporary service.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: • 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:
CLAY HARRINGTON OWNER
14182 SW NORTHVIEW DR
TIGARD, OR 97223
Phone: 579 -8109 Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT BLD 8/9/00 $64.25 0004356
5PCT BLD 8/9/00 $5.14 0004356
Total $69.39
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty 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 -0080. You may obtain copies of these rules ordirect questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE � % ISSUED BY:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not i,t)nded for sale, lease, or rent. G�
OWNER'S SIGNATURE: > "O��L DATE: 1.— — 6)
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
•
Call 639 -4175 by 7:OOpm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Che #
13125 SW HALL BLVD. Recd By G. /7
Date Rec'd eP, 9,
TIGAKD OR 97223
� Date to P.E.
Phone (503) 639 -4171, x304 l� Date to DST
Inspection (503) 639 -4175 Print of Type Permit # &2 a tran d0 VSO
Fax (503) 598 -1960 Incomplete or illegible will not be accepte Called
1. Job Address: /000K - 5-.7 .7O 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) /1G 67 re/ , , m ),-1 ,-f Service included: Items Cost Sum
Address f_!I <Tit�> /1111 4a. Residential - per unit
�� A , .1 0 1000 sq. ft: or less $ 117.75 4
City /State /Zip L � - : Each additional 500 sq. ft. or
El portion thereof $ 26.75 1
Commercial ❑ Residential ICJ Limited Energy $ 60.00
Each Manned Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation
Electrical Contractor 200 amps or less I $ 64.25 6 y 25 2
Address 201 amps to 400 amps $ 85.50 2
City State Zip 401 amps to 600 amps $ 128.50 2
ty p 601 amps to 1000 amps $ 192.50 2
Phone No. Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. Exp.Date 4c. Temporary Services or Feeders
OR State CCB Reg. No. Exp.Date Installation, alteration, or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or Tess $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 100.00 2
Over 600 amps to 1000 volts,
• see "b" above.
License No. Exp.Date
Phone No. 4d. Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
/ feeder fee.
Print Owner's Name L . , My /�L /j dGl Each branch circuit $ 5.35 2
Address / C6/^Y` J/� t',t• b) The fee for branch circuits
I without purchase of service
City �, i State 2r + '- 7 b Zip / ? -/ 7� or feeder fee.
N
Phone o. �7- 1l Of AT f �j dl 7/ First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous •
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
w section if required):* panL alteration or extension $ 60.00
3. Plan Revi
Minor Labels (10) $ 100.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Per inspection $ 50.00
Service and feeder 225 amps or more
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
5a. Enter total of above fees $ Z S
* Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ /
Not required for temporary construction services. Subtotal $ -�
Sb. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 69, .3 g
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