Permit CITY OF T ® . ELECTRICAL PERMIT
, i„„ , DEVELOPMENT SERVICES PERMIT #: ELC97 -0430
��"� �h � � l�� DATE ISSUED: 07/02/97
-! :_.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S101BC -01000
SITE ADDRESS...:08485 SW HUNZIKER ST
SUBDIVISION - KNOLL ACRES ZONING:R -4.5
BLOCK LOT -5 JURISDICTION: TIG
Proj ect Description : Installing a 200 amp service
- -- 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 - 200 amp - 1 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
ROBERT CLICKENER type amount by date recpt
AND PATRICIA CLICKENER PRMT $ 60.00 B 07/02/97 97- 296729
13855 SW PACIFIC HWY 5PCT $ 3.00 B 07/02/97 97- 296729
TIGARD OR 97223
Phone #:
Contractor: --
FARWEST ELECTRIC INC $ 63.00 TOTAL
7402 NE 189TH AVE
REQUIRED INSPECTIONS
VANCOUVER WA 98682 Ceiling. Cover Underground Cove
Phone #: 360- 892 -1022 Wall Cover Elect'1 Service
Reg #—: 000623
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 -.! -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling 703)246 -1987.
Permittee Signature. ■ 1 ,. Wimu. ' , .' ssued 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: ,� , i(.dv . ■ - DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + ++ + + ++ + + ++ + ++
Call 639 -4175 by 6:00 p.m. far an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY .OF TIGARD Electrical Permit Application Plan Check •
r
- 13125 SW HALL BLVD. Rec'd By ?I �/ /... .
TIGARD OR 97223 Date Rec'd -7-2,--1-7
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # aati1 -tt{O
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 businessi - DA-Y Se..'4400L Service included: Items Cost Sum
I
Address Sli 8S S all ...t.,._ S77 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip - 1 - 7.1_ - .CA-A- - 7 1 O R7-2-7-3 Each additional 500 sq. ft. or
P M 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 - AF.-- W e= "t` - EC -tG = Installation, alteration, or relocation ( `�' D °D
Address I L+ lV G 0 2- 1 bQ 41 '` Akt: 200 amps or less � . $60.00 2
201 amps to 400 amps $80.00 2
City VA NcoUJi Z.. State t.4/A-- Zip q $ 6A2 401 amps to 600 amps $120.00 2
Phone No. . O - gc?2 - t 0Z2 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
- �� Exp.Date Reconnect only $50.00 2
Elec. Cont. Lice. No. Z p.Date
OR State CCB Reg. No. 37 - 7-17 G Exp.Date l 0-1 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 5-7-57105 Installation, alteration, or relocation
���I�ML� 200 amps or less $50.00 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 2
/ ` /� i - p O ver 600 amps to 1000 volts,
License No. /49 S Exp.Date 0 o see "b" above.
Phone No. / -- ....36o - S 9.- - 10 � 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee forbranch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. 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
(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: n' �
Not required for temporary construction services. 5a. Enter total of above fees $ V
5% Surcharge (.05 X total fees) $ ?1 •■5
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 FORA PERIOD OF 180 DAYS AT ANY /
TIMEAFTER WORK IS COMMENCED..' ❑ Trust Account # (0 (/ �� /'1
t Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION ------7
24-Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: ` / / / 7 A.M. P.M. MST:
1
Location: , ' p� � ,�� �
/J ' , BUP:
1 / rj
Tenant: 1 I i / Suite: Bldg: MEC:
Contractor: — 77/P/62 _ / 4-4.0 ` 4 fries s Phone: — 5d/'L PLM: • Owner: r ` L . . ./ '' _ A. ' Phone: (Q .3?—* / 1 7 7 - 0
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cov Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace 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 Approved App> ov) Approved
Appr /Sdwlk Not Approved Not Approved Not Approved -• •• ed Not Approved
FINAL FINAL FINAL FINAL FINAL
_
14 E) - --- cr'l
I re
7
------,
- ,/--", --/------"-')
____----:----
O Call for reinspection O Reinspection fee of required before next inspection 0 Unable to inspect
Inspector: /44 ; c 4 . , ® � )R ( Date: - / Page / of