Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00418
Mill DEVELOPMENT SERVICES DATE ISSUED: 7/13/99
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S113AC -00101
SITE ADDRESS: 16655 SW 72ND AVE I • 1-.4
SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING:. I -P
BLOCK: LOT : 029 JURISDICTION: TIG
Project Description: Installation of 5 branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 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: 4 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:
PACIFIC REALTY ROBERTS ELECTRIC INC
15350 SW SEQUOIA PKWY 5759 SW 48TH
SUITE 300. PORTLAND, OR 97213
TIGARD, OR 97223
Phone: Phone: V -244 -7754
Reg #: SUP 3886S
LIC 9388
ELE 34 -23C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT DST 7/13/99 $58.90 99- 316810 Elect'I Final
5PCT DST 7/13/99 $4.12 99- 316810
Total $63.02
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain co • rules or direct questions to OUNC at (503)
246 -1987.
/
Permit Signature: Iss ed By: , 1� (
OWNER INSTALLATION ONL
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SU R. ELEC'N: k . DATE:
LICENSE NO:
CaII 639 -4175 by 7:OOpm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Chet
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 � e , ' Date Recd 7 - l 3 47
Date to P.E.
Phone (503) 639 -4171, x304
b
C(c1 9 Date to DST
Inspection (503) 639 -4175 Print of Type P I Permit# Fc-e1999-O0Ya
Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called
1. Job Address: n ,. 4. Complete Fee Schedule Below:
Name of Development PA 7 % Number of Inspections per permit allowed
Name (or name of business) FL( 6 74 T' Ofiv 4#'i. cC$ Service included: Items Cost Sum 4 '
Address j (vss S. Li-, . ') 2. 6 14 4a. Residential - per unit
- ,�,�n 1000 sq. ft. or less $ 117.75 4
City /State /Zip / U (J Each additional 500 sq. ft. or
portion thereof $ 26.25 1
Commercial El Residential ❑ Limited Energy $ 60.00
Each Manufd 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 j t S _-e-vsR LC 200 amps or less $ 64.25 2
Address 7S 1 5 • .- 4 e 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
City /°A7 State dR Zip 5' 72 z l 601 amps to 1000 amps $ 192.50 2
Phone No. c - 7134 Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. .SW-23C. Exp.Date 4c. Temporary Services or Feeders
OR State CCB Reg. No. R Exp.Date Installation, alteration, or relocation
COT Business Tax or Metro No. f WV Exp.Date 200 amps or Tess $ 53.50 2
A 401 amps to 600 amps $ 80.25 2
Signature of Supr. Elec'n �/� 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
, . � .& ( S Exp.Date see "b" above.
License No. ' 1 D p.Date � �
Phone No. cl({+'-7 ,c4 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 Owners Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee. 0
Phone No. First branch circuit ( l $ 37.50 3 .�
�
Each additional branch circuit T $ 555
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
if required):* panL alteration or extension $ 60.00
3. Plan Review section
( Minor Labels (10) $ 107.00
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
Service and feeder 225 amps or more Per inspection $ 50.00
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 $,
* Submit 2 sets of plans with application where any of the above apply. 71p. vo Surcharge (.05 X total fees) $ i /, /
Not required for temporary construction services. Subtotal $
5b. 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 # 2-
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 603
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