Permit A CITY OF TIGARD ELECTRICAL PERMIT
z .14,00 DEVELOPMENT SERVICES PERMIT #: ELC97 -0621
1 L 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 29/03 /97
PARCEL: 1S135DB -04100
SITE ADDRESS..•:11330 SW 92ND AVE
SUBDIVISION °.••:DOGWOOD RIDGE ONING:R -4 °5
BLOCK • LOT •14 ISDICTION TIG
Project Description: Insatlling service or feeder to 200 asps
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS : 0 0 — 200 amp • 1 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 — 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
JOSEPH H BUI type amount by date recpt
11330 SW 92ND PRMT $ 60.00 B 09/03/97 97- 298908
TIGARD OR 97223 SPCT $ 3 °00 B 09/03/97 97- 298908
Phone #:
•
Contractor: .
OWNER $ 63.00 TOTAL
REQUIRED INSPECTIONS
Rough —in Elect' 1 Final
Phone #: Elect'1 Service
Reg #..: 999999
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 sore 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 Si nature: —�.,,_ ./, ,�, ' Issued B : U.��l %�..
9 Y 40 /
•
-- -OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for
sale, lease, or rent. DATE•
OWNER'S SIGNATURE: ' ∎ a —
'IN - ACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. EL ' N: DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the net business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + ++
CITY OF TIGARD Electrical Permit Application Plan Check .
13125 SW HALL BLVD. Rec'd By .� v
TIGARD OR 97223 Date Recd miry
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Permit # �j
. wD
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 11 `j1A) C 14 • 4a. Residential - per unit
�- G► Z y 1000 sq. ft. or less $110.00 4
City /State /Zip Lk rA €C� (7 Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial ❑ Residential
Limited 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
Address 200 amps or less t d
$60.00 O 2
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
Job No. Over 1000 amps or volts $340.00 2
Reconnect only k $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
201 amps to 400 amps $75.00 Signature of Supr. Elec'n 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
2b. = For owner installations: a) The fee for branch circuits with
, r �-t purchase of service or
- s - 05E-144-
Print Owner's Name �llA�� feeder fee.
Address (( S 0 S.t.t.J /9- b) Each branch circuit $5.00 2
_ U b The fee for branch circuits
City Lx .d , State k____ Zip 7..-2-7-, , without purchase of 7 c, Phone No. � t service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
q 4, (Service or feeder not included)
Owner's Signature -.or mi / AiltA _rd Each pump or irrigation circle $40.00 2 • Each sign or outline lighting $40.00 2
3. Plan Revi= se •' i o on required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check a • pro •riate item and enter fee in section 5B.
4 or more resi.ential 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: CO �L
Not required for temporary construction services. 5a. Enter total of above fees $ , ,
5% Surcharge (.05 X total fees) $
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
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # � / � 0
$ . IJ
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96