Permit ELECTRICAL PERMIT
CITY OF TIGARD PERMIT #: ELC96-0195
DATE ISSUED: 04/05/96
COMMUNITY DEVELOPMENT DEPARTMENT
PARCEL: 2S110BB-05600
13125 SW Hall Tigard, Oregon 97223.8199 (503) 639-4171
SITE ADDRESS...: 14252 SW 121ST AVE
' SUBDIVISION....: ARLINGTON RIDGE ZONING:R-3.5
BLOCK ^ LOT.............:033
Project Description: Residential to 4,000 sq ft.
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---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- . MISCELLANEOUS
16900 SF OR LESS....: 1 0 — 200 amp.......: 0 PUMP/IRRIGATION ^ 0
EACH ADD'L 500SF...: 6 201 — 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 --- -------
WILLIAM PARSONS type amount by date recpt
14252 SW 121ST AVE PRMT $ 260.00 CJS 04/05/96 9945 HAND
5PCT $ 13.00 CJS 04/05/96 9945 HAND
TIGARD OR 97223
Phone #:
r
Contractor: . — -�
THUNDERBIRD ELECTRIC INC $ 273.00 TOTAL
PO BOX 13536
REQUIRED INSPECTIONS ------
PORTLAND OR 97213 Ceiling Cover Elect'l Service
Phone #: 503-253-9934 Wall Cover Elect'l Final
Reg #..: 51888
This permit is issued subject to the regulations contained in the ��"=----� ^—^~ — •
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started �~ / x�_/
within 180 days of issuance, or if work is suspended for more �_����~ e�� .�_�h
than 18N 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: DATE:
LICENSE NO:
Call for inspection — 639-4175
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Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 9995 / /And
�� Permit # F1 C 96-0/9S
lIii1a Phone (503) 639 -4171 Date Issued y S-96
FAX (503) 684 -7297 `
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by C'�1GrlcJ Sc�i rl�; a/�
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development A. t.- I •-n o e g -r C Number of Inspections per permit allowed
Address / I / 2 S 2 S. / z I 54- A. ✓ c. Service included: Items Cost(ea) Sum
City /State/Zip - 7 - . u M at ` � 10. CI G k 4a. Residential - per unit 4
r 1000 sq. ft. or less $110.00 /1 0 o Od
Name (or name of business) Each additional 500 sq. ft or f $25.00 l 5-°` f"m 1
portion thereof
Commercial ❑ Residential VI Limited Energy $25.00
Each Manufd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
2
,C�' Installation, alteration, or relocation
Electrical Contractor • ��1 � N/J , � 13 ��D �G � . GT� � C 200 amps or less $60.00 2
Addressf2 6 135 b 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2
City ® LAto 0 State (+e ? .!j
P .� 601 amps to 1000 amps $180.00 2
Phone No. 2. S 3 - 99 30r Over 1000 amps or volts $340.00 2
Contractor's License No. G - 4-9C-.. Reconned only $50.00
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Contractor's Board Reg. No. 5 /9E; b 4c. Temporary Services or Feeders k
% Installation, alteration, or relocation 2
Signature of Supr. Elec'n ...ese-z-w 200 amps or less $50.00 2
License No.31'7' 5 Phone Nt sr-3 -99_5 r� 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
_b. For owner installations: sea •b• above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
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 tee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $35.00 2
Each additional 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:
NOTICE
5a. Enter total of above fees $ .2 6 • a°
5% Surcharge (.05 X total fees) $ Ii
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) $
?ERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal I $
JMMENCED. ❑ Trust Account # . $
Balance Due ' $ .273 ° °
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