Permit CITY OF T ELECTRICAL PERMIT
/ \ PERMIT #: ELC1999 -00548
.44,"'t; i;'7,iII' DEVELOPMENT r o Hall SERVICES 639 -4171 DATE ISSUED: 9/9/99
13125 E/
PARCEL: 1S125DB-04100
SITE ADDRESS: 09505 SW 74TH AVE
GIN O
SUBDIVISION: BOULEVARD HEIGHTS
BLOCK: , Z R -4.5
LOT : 0 24 JUR TIG
Project Description: Add a first branch circuit to an existing dwelling. As of 9/20/99, adding a second branch circuit to this
permit for a total of 2 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/ SVCI 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: 1 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: •
ALBERTSON, GEORGE R AND BOONES FERRY ELECTRICAL
ESTHER M, CO- TRUSTEES PO BOX 628
PO BOX 1329 WILSONVILLE, OR 97070
SHERWOOD, OR 97140
Phone: Phone:
682 -4936
• Reg #: SUP 3170S
LIC 00088482
ELE 3 -223C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT GEO 9/9/99 $37.50 99- 318221 Elect'I Final
5PCT GEO 9/9/99 $2.63 99- 318221
PRMT DEB 9/20/99 $5.35 99- 318453
(additional fees not listed here)
Total $45.86
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 copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE ISSUED :Y:
• 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 e-� Q .C.7 - DATE:
LICENSE NO: r/j7C1
Cali 639 - 4175 by 7:OOpm for an inspection the next business day
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Plea3e 4-cU 75 ?ern/17
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CITY OF TIGARD PEC ec Permit Application Plan eeck
13125 SW HALL BLVD. Rec' `' 1 ��y
TIGARD OR 97223 SEP 2 0 1999 Date Rec'd 9 -Ao -97
Date to P.E. -----
Phone (503) 639-4171, x304 COMMUNITY DEVELOPMENT Date to DST e
Inspection (503) 639 -4175 Print of Type Permit # , P / -005?/
Fax (503) 598 -1960 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 of business) 6S I «r /- 117e. 5 N Service included: Items Cost Sum I
Address 95-05- S G!J '79 AV 4a. Residential - per unit
CI /StatelZi if `y ex d O R 1000 sq- ft. or less $ 117.75 4
ty P Each additional 500 sq. ft. or
� portion thereof $ 26.25 1
Commercial ❑ Residential 1 I Limited Energy $ 60.00
- -- - - - - _- -EadrManufdlHome-or Modular
2a. Contractor install 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 BOONES FERRY ELECTRIC 200 amps or less $ 64.25 2
Address P 0 Box 628 201 amps to 400 amps $ 85.50 2
W i l s o n v ill l State O R Z
97070 7 0 7 0 401 amps to 600 amps $ 128.50 _ 2
City/ P 601 amps to 1000.amps $ 192.50 2
Phone No. 503-682-4936 Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice_ No. _ 3-223 C Exp.Date 1/31/00 •
- 4c. Temporary Services or Feeders
OR State CCB Reg. No 88482 Exp.Date 2/2 3 /0 1 Installation, alteration, or relocation
COT Business Tax or t4.4:...10 No. 028511 Exp.Date 8 /1/9 9 200 amps or less $ 53.50 2
\ III 201 amps to 400 amps $ 80.25 2
'Isis® 401 amps to 600 amps . $ 107.00 2
Signature of Supr. E) - Al. ►m= Over 600 amps to 1000 volts.
see "b" above.
License No. 3170 Exp.Date 10/1/01
Phone No. 682-4936 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 Each branch circuit $ 5.35 2
b) The fee for branch circuits
Address without purchase of service
City State Zip _ or feeder fee.
Phone No- First branch circuit $ 37.50
Each additional branch circuit ) S 5.35 r O , 36
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
• panel, alteration or extension $ - 60.00
3. Plan Review section (if required):* 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
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 $ 734
* Submit 2 sets of plans with application where any of the above apply. '7 Surcharge (.05 X total tees) $ _ r $
Not required for temporary construction services. Subtotal $ j ar 73
56. 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 $ g, 73
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