Permit OF T ELECTRICAL EPERMI0586
ERMIT #: DATE ISSUED: 09/09/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PARCEL: 251 13AD 700
SITE ADDRESS...: 16920 SW 72ND AVE
SUBDIVISION • ROSEWOOD ACRE TRACTS ZONING:C -G
BLOCK LOT..... ........ :30
Project Description: Installing six sign or outline lighting
- -- 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..: 6
LIMITED ENERGY ° 0 401 - 600 amp 0 SIGNAL /PANEL ° 0
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
BORDERS BOOKS type amount by date recpt
16920 SW 72ND AVE PRMT $ 240.00 B 09/04/96 96-283561
SPCT $ 12.00 B 09/04/96 96- 283561
TIGARD OR 97224
Phone #:
Contractor: -• ----------
MEYER SIGN CO $ 252.00 TOTAL
7340 SW LANDMARK
REQUIRED INSPECTIONS
TIGARD OR 97223 Ceiling Cover Elect'l Service
Phone #: 503- 620 -8200 Wall Cover Elect' 1 Final
Reg #..: 64014
This permit is issued subject to the regulations contained in the /
Tigard Municipal Code, State of Ore. Specialty Codes and all other P ^m i t t e e 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
l� �^-
than 180 days. Issued 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: DATE:
•
CONTRACTOR INSTALLATION ONLY • - - - --
SIGNATURE OF SUPR. ELEC'N: _ _ ( t��1) DATE: _ _
LICENSE NO: _
Call for inspection - 639 -4175
trre'A 9 -q 4,
• Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec #
• I lyr I Permit # kLE`(Io - Qr-,�1)Lt
� 1 Phone (503) 639 -4171 Date Issued
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development $O2DEQS '3n0K5 Number of Inspections per permit allowed
Address l 3.O s
�a '�
G, q Service included: Items Cost(ea) Sum
City /State/Zip T I CAP 02 6 17 2 z 3 4a. Residential - per unit 4
r 1000 sq. ft. or less $110.00
Name (or name of business) I3 0 21> � 1
S Each additional 500 sq. ft or
portion thereof 825.00
Commercial RI Residential ❑ Limited Energy $25.00
Each Manufd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders
Installation, alteration. or relocation 2
Electrical ContractorMf :qEQ S (C (i) OF Of. 1 1 200 amps or less $60.00 2
Address" `-I l) 5.0 L.A ri M A R. K LN , 201 amps to 400 amps $60.00 2
t 401 amp to 600 amps 8120.00
CityT 1 G A tZD State n(2 Zip en 2,23 601 amps to 1000 amps 8180.00 2
Phone No. 679-0 O Over 1000 amps or volts $340.00 2
Contractor's License No. a n - 19 n G L S Reconnect only 850.00
Contractor's Board Reg. No. .L4 �� 4c. Temporary Services or Feeders
Installation, alterat or relocation 2
Signature of Supr. Elec'n .ticA.Iffr _ - 200 amps or less $50.00 2 -
201 amps to 400 amps $75.00 2
License No. .0.- Phone No. . a0 - ; _ 64 401 amps t 600 amps $100.00
• Over 600 amps to 1000 volts
2b. For owner installations: see 'b' above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The tee for branch circuits with
City State Zip purchase of service or feeder fee. 2
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 vice or feeder fee. 2
not intended for sale, lease or rent.
First additional circuit brt $5.00
Each addAional branch circuit $ $00
5.
Owners Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle T $40.00 2
Each sign or outline lighting aB $40.00 ;y ip
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension 840.00 - 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 $35.00
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:
NOTICE 5a. Enter total of above fees $ Z4i 6
,o
5% Surcharge (.05 X total fees) $ _IL' • i' .
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. ❑ Trust Account # $
Balance Due $ 2 _-.O
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