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Permit
1 . a 1 1 CITY OF TIGARD �/ DEVELOPMENT SERVICES ELECTRICAL PERMIT , n u 011 1 141ii PERMIT #: ELC98 -0274 ,_„_410- =:_.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 _ DATE ISSUED: 05/26/98_ PARCEL: 2S1O3CB -02000 SITE ADDRESS... :12220 SW JAMES ST SUBDIVISION.... :WILLAMETTE ZONING: R -4. 5 BLOCK. LOT .............: JURISDICTION: URB Project Description: Add 2 or less service /feeder and two branch circuits. - -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS 1000 SF OR LESS - 0 0 — 200 amp ... ° ° „.: 0 PUMP /IRRIGATION - 0 EACH ADD'L 5O0SF...: 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: 2 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 CROUCH, FRED & KAREN type amount by date recpt 12220 SW JAMES ST PRMT $ 70.00 GEO 05/26/98 98- 305977 TIGARD OR 97223 SPCT $ 3.50 GEO 05/26/98 98- 305977 Phone #: Contractor: OWNER $ 73.50 TOTAL . REQUIRED INSPECTIONS. Elect'l Service Phone #: Elect'l Final Reg #.., • 000000 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-P: . You may obtain a copy of these rules or direct questions to OUNC by calling (503) -1987. d :'� , Fermittee Signatur es Issued By: ` „ • OWNER INSTALLATION ONLY The installation is being made on pro y I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: _ - DATE: 5 - - ..74 " ONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ t � CITY OF TIGARD Electrical Permit Application Plan Check # 13125 SW HALL BLVD. Rec'd By TIGARD OR 97223 - - - -- - - Date Rec'd Date to P.E. Phone (503) 639 -4171, x304 Date to DST Inspection (503) 639 -4175 Print or Type Permit # c 9$ -0 a -7,/ 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 / 2 Z 3 D LI3 J/ . 4a. Residential - per unit Ci City/State/Zip % � g.� Each additional 500 sq. ft. or 1000 sq.ft.orless $110.00 4 ty p /f % 72 Z Commercial El Residential portion thereof $25.00 1 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 $60.00 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 $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 Supr. Elec'n 201 amps to 400 am $75.00 2 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License Na Exp.Date see "b" above. Phone Nc 4d. Branch Circuits New, alteration or extension per panel 2b. For owner installations: a) The fee for branch circuits with purchase of service or _-__- Print Owner's Name eei feeder fee. / Address /2- Z 2-4 ,c" ,/ 7-q -n-Le_c S Each branch circuit $5.00 / 2 - 7 - ? -7r� State r r Zip ' 2 b T he fee for branch circuits City P }' without purchase of Phone No. 5 ) 9 -7 '74 3 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 - i 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: ' '.---- 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 #3 Total balance Due $ I: \DSTS \ELC96.APP Rev 9/96 Ni Permit #: f 7 V O F O �, Address: / � F ; e ms :1 c� I ssued by: C/ Date: -' �a - 9 1 8 5 9 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 1 - q/ -- 1 - . I own, reside in, or will reside in the completed structure. n 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. ri 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Co ,uction Responsibilities on the reverse side of this form. -S 2 6 -1 g ,,,, ________ Fr (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) R l Dana o ©ru Moto ©e o Prr ©pert' Owner PAheM! Cons ruc ton Res pofsbMes • Note: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by l eing aware of the following responsibilities and areas of concern. agPi!_O T7',R nsnetY'aiGs EA LIMES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: Oregon's with..: ©iSi g tax law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945 -8091. • Unernpl©yemeri:' i> <5v. ar ce fixx: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources at 378 -3524. Won eLs' c ©a erusa ©nn insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation i'isura.nce for your employees. If you fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945 -7888. U.S. dntezi nal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1-800-829-1040. OTHER r ESPOfi SM.JIMS AND AREAS OF CONCERN: R4' : Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention through inspections. Liability and properly damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re -done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough -in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309 -5052, 503/378 - 4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop- own.pm4 1/94