Permit ELECTRICAL PERMIT
� ��� � � ��'�� PERMIT #: ELC96-0579
��w� � � � �m�r� ny�n��m�' ��-'ITi DATE ISSUED: 09/05/96
COMMUNITY DEVELOPMENT DEPARTMENT
1o1omaW Hall Blvd. Tigard, Oregon 97223°8199 (503 mom~u�v�
' PARCEL: 26113AD-01700
SITE ADDRESS...: 16920 SW 72ND AVE
SUBDIVISION....: ROSEWOOD ACRE TRACTS ZONING:C-G
BLOCK : LOT ^30
Project Description: Installation of 3 signal circuits or a limited energy panel
---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 • 3
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: 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 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 -----
BINGHAM INVESTMENT CO
3939 SW ST HELENS RD type amount by date rec9t
PRMT $ 120.00 D*A 09/04/96 96-283583
5PCT $ 6.00 D*A 09/04/96 96-283583
PORTLAND OR 97210
Phone #:
Contractor:
TELEPHONE & ALARM SUPPLY $ 126.00 TOTAL
ACTION TECHNOLOGY
835 SE 17TH AVE REQUIRED INSPECTIONS
PORTLAND OR 97214 Ceiling Cover Elect' Service
Phone #: 231-1992 • Wall Cover Elect'l Final
Reg #..: 079136
This permit is issued subject to the regulations contained in the _
Tigard Municipal Code, State of Ore. Specialty Codes and all other P' `mittee Signature
applicable laws. All work will be done in accordance with
d plans. This it will expire if work is not started
approve p an,. , perm w rxp ry wo ^ no / ,
dzi
within 180 days of issuance, or if work is suspended for more _ '~��~� . atini
than 18N thays. ssued By
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for
sale, lease, or rent.
OWNER'S SIGNATURE: ~ AQAL DATE:
- CONTRACTOR INSTALLATION ONLY -
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: _ ________
Call for inspection - 639-4175
- - - - - ' - - - --' - - - - ---- - -
—
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
./.., Tigard, OR 97223 Permit # CL . - % j ((Q57
Date Issued
..,,� t .., l Phone (503) 639-4171 ' .' ± � FAX (503) 684 -7297
CITY OF TIGARD TOD No. (503) 684 -2772 .. .
Inspection (503) 639 -4175 .
1. Job Address: 4. Complete Rio Schedule Below:
Name of Development Zowle,N,s egi 5 Number of Inspection per permit allowed
Address 16Pt a,o SL) - 6-) ` - Service included: !terns CbSt(ee) Sum
CityIState/Zlp T= OVP-- 4a. Residential - per unit
1000 66. R Or bs, sumac 4
Name (or name of business) Each addelon.nSOOso. n. or
portion thence MOO _
Cornmercial tte�rr t Energy S25.0o
Jam. Residential ❑ '
Egon Merwrrd Rorer or Mocker
Dw11np Sreviceor Feeder 160.00 2
—
2a. Contractor installation only:
t honQ A l�v�t
`
411 services or Feeders
Electrical Contractor � C�t 44 T w retsr
err�coLADce ---k i' ' � "°" 560.00 2
Address 233 sue_ t'YM yews 201 Moe 10 400 snipe 1110.00 2
City Povur wert•�� State Ova Zip a'l2ly, 4ot ovate= Nape 1120.00 2
Phone No. 2. — 2 • lot ."p' 001000 *n°' 8140 .03
2
Over loan ewe v vole $340.00 2
-
Job NO. necovIedante 1150 2
contractor's license NO. 2 6 -1"1 S C. k, Temporary Services or Platers
Contractor's Board Reg. No._(7 _ ■ rnsnu.Itow en«esbn or re4cnlon
Signature of Su r. Eiee n 7:4 y •..c--4- . 200 wen or leas 2
License No. J LE Phone No. 23 t - t °I°l2 tot ""pe to 400 orris 560.00 2
401 WOO to 600 WOO G7S 00 2 —
Herg0 909 1C9 over 600 amps to 1000 vole stoo.ao
2b. For owner ens lotions: GM'D a we.
4d. Branch Circuits
Print Owner's Narne New amnion er extension per ace
Address s) tyro nee for trance amity 'WO
2
put raw of a.wlas et foods( re&
City State Zip Each warm chili 15.o0
Phone No. bl The tee sr Irma &milts withO rr
The installation is being made on property I own which is pa/avfreoreal, T
tseh.a s lb
First brevet d s1S.00 2
act
not intended for sale, lease or rent. Each egaeiaw Winch c> 1503
Owner's Signature 40. Mlevellansous
(Service or feeder not inchded) 2
3. Plan Review section (if required): Est' °' m ar I"i''la' 340.00 2
Emit Woo Or ormlo MOntlno 340 00
Please check appropriate item and enter foe in section 513. $ atteneton onen oo lalo•�.o
`
4 or more reeidenUol units in one structure Mary Lank ( - 3 0. stn0.00
Service and feeder 225 amps or more
System over 600 volts nominal 41. Each additional inspection over
Classified area or structure containing special occupancy the allowable In any of the above
as described in N. t?.C. Chapter 5 as inspection S:16.00 Per hour 31S 00
In Ptorrt spy.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construcdon services. 5. Fees:
NOTICE 5a. Enter total of above fees 3 ( .L • 00
5% Surcharge (05 X total fees) s X00
Subtotal $ t 26. oz.
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5t,, Enter 25% of fine A for •
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OR IF
Plan Review if required (Sec 3I g
CONSTRUCTION OR 1M)RK 15 SUSPENDED OR ABANDONED FOR Subtotal
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK 15 S
COMMENCED. -•em m.1.- ❑ Trust Account li
ww.ev 3
Balance Due $ 2 .1. 6:z) .