Permit '-!%111111,, CITY OF TIGARD ELECTRICAL PERMIT
,e
„ DEVELOPMENT SERVICES PERMIT #: ELC97 -0655
'�j�� DATE ISSUED: 10/07/97
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S111AC- 01300
SITE ADDRESS...:14590 SW 92ND AVE
SUBDIVISION •PINEBROOK TERRACE ZONING:R -4.5
BLOCK LOT °054. JURISDICTION: TIG
Project Description : Install a first branch circuit for an existing single family
dwelling.
- -- 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 : 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 20,0 amp 0 W /SERVICE OR FEEDER: 0 PER INSPECTION 0
201 - 400 amp • 0 1st W/O SRVC OR FDR.: 1 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
HASKETH, DUANE & HAZEL type amount by date recpt
14590 SW. 92ND PRMT $ 35.00 GEO 10/07/97 97- 299830
TIGARD OR 97224 SPCT $ 1.75 GEO 10/07/97 97- 299830
Phone #:
Contractor:
ELECTRICAL DIMENSIONS INC $ 36.75 TOTAL
PO BOX 12146 3
lv
3961 SW WILLAMS AVE REQUIRED INSPECTIONS
PORTLAND OR 97212 Elect'l Service
Phone #: 282 -7255 Elect'l Final
Reg #..: 000440
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: 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 : 07-%; eery _ DATE: it7;4;07
LICENSE NO: , 0 - S
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
f:a1 1 S39- 4179 by 7.00 p.. m. fnr an i nspart i nn naariad tha Haut hits(nass Hay
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + ++ + + + + + + + + + + ++ ++ + ++
, ..ti
Community Development �0 ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 �� Permit # � - 64,5--5-- ,....01010 Date Issued
I Phone (503) 639 -4171
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Address /(45 O SL. 9 L `"d Service included: Items Cost(ea) Sum
City /State /Zip ! tricky- - cl CD ✓- ci - 7 0L ti 4a. Residential - per unit
ii 1000 sq. ft. or less $110.00 4
Name (or name of business) H t° 5 e +1,-, Each additional 500 sq. ft. or
portion thereof • $25.00
Commercial ❑ Residential 2, Limited Energy $25.00
Each Manufd Home or Modular
• Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
�
+ 4b. Services or Feeders
( ' c '4 trt °_ 0. ( Dtim eo $t On% .6. Installation, alteration, or relocation
Electrical Contractor MG, 200 amps or less $60.00 2
Address Po 6e 17..t4/1., 201 amps to 400 amps $80.00 2
City Panr 0...d State 0 f Zip q72.( Z_ 401 amps to 600 amps $180.00 2
601 amps to 1000 amps 2
Phone No. 2.2. 7 d. t Over 1000 amps or volts $340.00 2
Job NO. 72._o Z Reconnect only $50.00 2
contractor's license NO. 24 -'/3 2. C. 4c. Temporary Services or Feeders
Contractor's Board Reg. No. ® Installation, alteration, or relocation
of Supr. nature our. ec'n ,, /�� less - }(jam t, p , r . 2
Signature p El 200 amps or e2 � 201 amps to 400 amps asf! i� ] 11:TZ) I , D50.00 2
License No. 29 y S Phone No. 2' Z x"72 5 S 401 amps to 600 amps $75.00 2
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee 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
p urchase of service or fe eder fee. 2
The installation is being made on property I own which is
o0 The
E
not intended for sale, lease or rent.
First additional circuit $$5.00 3
Each additional l branch circuit $5.00
Owner's Signature 4e. Miscellaneous •
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
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:
5a. Enter total of above fees $ 3S'
NOTICE 5% Surcharge (.05 X total fees) $ / 7 5
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. wo, comdevAeie'- ❑ Trust Account #
$
w ..app
Balance Due $ 3{ _
10
0 3 p, c_e___
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: /() -13 - A.M. P.M. MST:
Location: . ' 0 BUP:
Tenant: Suite:: a Bldg: y, MEC: q 7--D3be
Contractor: # iL. /E���� MIML�/ %� /l� 0 Phone: �5 — s 7 0 PLM:
Owner: , I/...: /I ! t - 'A / . P one:
6 39- 5463 ELC: 9 7 -C) 653
-!• ��a._. - ELR:
I V Ctak a SIT:
BUILDING BLDG (con't) PLUMBING `u I .: ► LECTRIC •. SITE
Site Post/Beam Post/Beam 'os team Cover /Service Sewer /Storm
Footing Roof . UndFl/Slab Rou -In Ceiling Water Line
Slab Framing Top Out s me Rough -In UG Sprinkler
Foundation Insulation Sewer ood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved
, 4 Approved
Appr /Sdwlk Not Approved Not Approved a; over
o , • broved te Not Approved
..
FINAL FINAL INAL I I FINAL
�_• fir A - - _--411 �- P �_ _
r / 7
. :n• . -� /L .- ___ice ` _ / -- _ _ , . L �� .i ( / . ri` .l
/ - / /
EXPIRED
a ll for reins ction O Reinspection fee of $ required before next inspection O U to ins
pe Pe q inspect
Inspector: , Date: / ® - /3 - 9 7 Page of
i (025
I tklenAta-
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: /V - /7 -q / �7 , A..M. P.M. MST: •
Location: 14590 S W 9 n� a4 BUP: / /
Tenant: ` Suite: Bldg: MEC: 97-0 3 b U
Contractor: F-- / A C.1 CX 4E-- l._- Phone: . 57 PLM:
Owner: .11 4 / A ! & 'd!.. A!) L' .I P ne: &I V3- 6 3 LC: 7 7 - 0 Co 5S
PLGASE WAIT FO LL E Ei'2L�/ LL) 1- oAAE -O (,UN•Ef2 : 6 17 - Og'
TO (SY TO TH DOD12 ' : (<i /etdi z&
BUILDING BLDG (con't) PLUMBING iZt�CTi a:1►TOfib. /• ELECTRICAL SITE
/
Site Post/Beam Post/Beam Po A= - : ' Cover /Service Sewer /Storm
Footing Roof UndFl/Slab .61' ou GO Ceiling Water Line
Slab Framing Top Out - as me _ ---- I(- 77 - f - -In UG Spriniler % , G
Foundation Insulation Sewer �' ....%' uct � � d Ionnect Vault II j
Bsmt Damp Drywall Storm
4 sa a emp Service MISC. I w
Masonry Ceiling Rain Drain •, UG Slab 1 ?
Shear /Sheath Fire Spilr /Alm Crawl/Found Dr Heat Pump Low Volt ( `
Approved Approved . • Approved Approved , `v
Appr /Sdwlk Not Approved Not Approved ,. of A..ro - - • Not Approved Not Approved ■
FINAL FINAL
�.;;_ l'.L: '; ' FINAL FINAL �, 4
a . ° ,iN
0
,9 /1 Or - - e 0 , ,
44-7-6370 / /, . (5 /e -m
--- (2___ . '
/
/9- vim/ i rit -cTX/ c q / • o rc. _ IC N6 l
/ / 1 > 1 S ///"/-, i /gce 0 d o r d 6L . dZ. c
/Ai 5779 //9 4/
zit\ 0
Call for re' .pectio O Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: Date: f Page of
•
A