Permit ��
ELECTRICAL PERMIT �
CITY l� OF TIGARD PERMIE-661
`m�~� � �
DATE ISSUED: 12/28/95
COMMUNITY DEVELOPMENT DEPARTMENT
1o1osaW Hall awu Tigard, o'�e*" mnouo°o�nn (503) Blvd. ' PARCEL: 2S102BB700500
SITE ADDRESS...: 10200 SW KATHERINE ST
SUBDIVISION....: GREENBURG HEIGHTS ADDITION ZONING:R-4.5
BLOCK..........: LOT ...... .......:15
Project Description: Inspection of permit originally issued at Washington County
and now expired.
--------- ____
---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 6014-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.....: 1
201 — 400 amp......: @ 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 >F4 RES UNITS. .... ... : > 600 VOLT NOMINAL..:
Reconnect only ^ 0 SVC/FDR }= 225 AMPS..: CLASS AREA/SPEC OCC. :
Owner: ------------- FEES —
KEN TOLLIVER type amount by date recpt
10200 SW KATHERINE PRMT $ 35.00 JSD 12/28/95 95-274410
5PCT $ 1.75 JSD 12/28/95 95-274410
TIGARD OR 97223
Phone #: 684-8200
Contractor: ---- --
OWNER $ 36.75 TOTAL
•
•
— REQUIRED INSPECTIONS ------
Elect' l Final __
Phone #: ----
Reg #..:
.
This perait is issued subject to the regulations contained in the ' _
Tigard Municipal Code, State of Oro and Si t
Specialty Codes and all other Permittee Signature
- applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 184 days of issuance, or if work is suspended for oore ~' _
than 18Nday». Is .ued 8v
---- OWNER INSTALLATIO' 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
Community Development ELECTRICAL PERMIT APPLICATION
A, 13125 SW Hall Blvd. / gs -o�
Tigard, OR 97223 Permit # G�
Date Issued 7.�
' ��. 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
/�' 9p ���)
Address j�A� 6') S W K $ t Service included: Items Cost(ea) Sum
l �
City /State /Zip ' / /SaI C"2' C171 4a. Residential - per unit
v I 1000 sq. ft. or less $110.00 4
Name (or name of business) He _ 2 or Each additional 500 sq. ft. or
portion thereof $25.00
Commercial ❑ Residential N. Limited Energy $25.00 1
Each Manut'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation
Electrical Contractor 200 amps or less $60.00 2
Address 201 amps to 400 amps $80.00 2
City State Zip 401 amps to 600 amps $120.00 2
y p 601 amps to 1000 amps $180.00 2
Phone No. Over 1000 amps or volts $340.00 2
Job NO. Reconnect only $50.00 2 '
contractor's license NO. 4c. Temporary Services or Feeders
Contractor's Board Reg. No. Installation, alteration, or relocation z 2
Signature of Supr. Elec'n 200 amps or less 2
License No. Phone No. 201 amps to 400 am $50.00 2
401 amps to 600 amps $
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see „b" above.
4d. Branch Circuits
Print Owner's Name 6PX) 1 ntti v kii New, alteration or extension per pane
Address a' *111 . , . / • 1 S q a) The fee for branch circuits with 2
City Tl`r� State l�R Zip ).Z3 Each h b anch Bi uit rvice or feeder fee. $5.00
Phone No. In S' '- ) b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
First additional circuit brt $$5.00
not intended for sale, lease or rent.
Each additional branch circuit $5.00
Owner's Signature /r____:_. ► /, ' 4 e . Miscellaneous
,- �>�ArJ/ (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 abo�
as described in N.E.C. Chapter 5 Per inspection 1 $35.00 jA oo
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 :-a°
5a. Enter total of above fees $
NOTICE 5% Surcharge (.05 X total fees) $ igir
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,thcomdev\eleo- ❑ Trust Account #
prm.app $
Balance Due