Permit ,_„, CITY OF TIGARD
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DEVELOPMENT ELECTRICAL PERMIT
,,,,,„,„,,„,,.,,, . 1 1421 II m�x��m�m~��n nmnu~x�o SERVICES PERMIT #: ELC96-0689
� 7E, 13125 SW Hall 8�i��i��9������/
- - , �"-- ` - ' ' DATE ISSUED: 10/25/96
- 'm4��� PARCEL: 2S112CA-04200
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SITE ADDRESS...: 15235 SW 79TH AVE
SUBDIVISION.....: DURHAM ACRES ZONING:R-4.5
BLOCK..........: LOT.............:29
Project Description: Installing one branch circuit
_ _ ______ ____ _ _ _
---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- MISCELLANEOUS-----
1000 SF OR LESS....: 0 0 — 200 amp.......: 0 PUMP/IRRIGATION....: 0
EACH ADD 500SF...: 201 — 400 amp ^. 0 SIGN/OUT LINE LTG..: 0
LIMITED ENERGY.....: 0 401 — 600 amp.......: 0 SIGNAL/PANEL.......: 0
MANF. HM/ SVC/FDR..: 0`' 6011-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.....: IV
201 — 400 amp ^ 0 1st W/O SRVC OR FDR.: 1 PER HOUR...........: 0
401 — 600 amp....,.: 0 ` EA ADD'L BRNCH CIRCA 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 ---
JEFFERY GIBBONS type amount by date recpt
15235 SW 79TH � PRMT $ 35.00 DST 10/25/96 96-285748
5PCT $ 1.75 DST 10/25/96 96-285748
TIGARD OR 97224 •
Phone #: 684-7810 .
• .
Contractor: — — —
OWNER $ 36.75 TOTAL
• — REQUIRED INSPECTIONS -------
Wall Cover Elect'l Final
Phone #: SEE ABOVE Elect'l Service ___ _
Reg #..: .
i .
This permit is issued subject to the regulations contained in the 40
Tigard Municipal Code, State of Ore. Specialty-Codes and all other ` P= ` '. 'tee Sign- • - '
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 l80 days. ' Issued qt:et
— -- 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: DATE:
LICENSE NO ____ _ __
Call for inspection — 639-4175 •
.
^ ' ~_ M
-- CiTY`OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. R ecd By 1_.
TIGARD OR 97223 Date Rec'■■ I ,. 6
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # 'Ji -c_q6 --06S1
Fax (503) 684 7297 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) Service included: Items Cost Sum
)Address /6 c935 56'0 79' . 4a. Residential - per unit
/ 1000 sq. ft. or less $110.00 4
City /State /Zip , t A. 0 C. 9 7 , ? - 0 - Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial ❑ Residential
L imited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor Installation, alteration, or relocation
200 amps or less $60.00 2
Address 201 amps to 400 amps $80.00 2
City State Zip 401 amps to 600 amps $120.00 2
Phone No. • 601 amps to 1000 amps $180.00 2
Over 1000 amps or volts $340.00 2
Job No. Reconnect only $50.00 2
Elec. Cont. Lice. No. Exp.Date
OR State CCB Reg. No. Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Su r. Elec'n 201 amps to 400 amps $75.00 2
9 P 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No.
4d. Branch Circuits
New, alteration or extension per panel
x 2b. For owner installations: a) The fee for branch circuits with
/� purchase of service or
Print Owner's Name ie ' 171 b10 yi 3 feeder fee.
Address /S (7 - 5(.t.3 79 1 ~ Each branch circuit $5.00 2
City "Nara State 0 q... Zip Q' 7d y withou u b) The fee f prch circuits
rchas e of
Phone No. 6Y - /7/C7 service or feeder fee.
First branch circuit 1 $35.00 00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
/� (Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: h
Not required for temporary construction services. 5a. Enter total of above fees $ .5 ° d 0
5% Surcharge (.05 X total fees) $ _____L2,-
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY t # t Account % TIME AFTER WORK IS COMMENCED. Sp '7-
Total balance Due $
I: \DSTS \ELC96.APP Rev 9196