Permit � ELECTRICAL PERMIT
'\//
' PERMIT #: ELC96-0544
� OF TI
DATE ISSUED: 08/22/96
� �N0MUNITYDEVEL0PMENTDEPARTMENT •
13125 Blvd. nmmm.p�u�m�o�o� 639-4171
PARCEL: 2S104CA-02500
SITE ADDRESS...: 13t SW LAUREN LN
SUBDIVISION....: HILLSHIRE ZONING:R-7 PD
BLOCK.. ... .... . : LOT. ... .. . . . . . . . :025
Project Description: Installing one branch circuit.
____________ _________________ _______________________________
---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- MISCELLANEOUS-----
1000 SF OR LESS....: 0 0 — 200 amp....... : 0 PUMP/IRRIGATION.... : 0
EACH ADO'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.: @ MINOR LABEL (10)...: 0
----SERVICE/FEEDER---- ----BRANCH CIRCUITS----- ---ADD'L INSPECTIONS---
0 — 200 amp. . ' ... : 0 W/SEAVICE OR FEEDER: 0 PER INSPECTION.....: 0
201 — 400 amp.... .. : 0 1st W/O SRVC OR FOR.: 1 PER HOUR. . ...... . . . : 0
401 — 600 amp......: 0 EA ADD'L BRNCH CIRC: 0 IN PLANT...........: 0
601 — 1000 amp.....: 0 -----------------PLAN REVIEW SECTION---- — •
16900+ amp/volt.....: 0 >=4 RES UNITS ^ > 600 VOLT NQMINAL..:
Reconnect only.....: 0 SVC/FDR >= 225 AMPS..: CLASS AREA/SPEC OCC.
Owner: -- . • • ---------- ------ FEES -----------
STELLA RICO type amount by date recpt
13599 SW LAUREN LN PRMT $ 35.00 CTR 08/19/96 96-283011
5PCT $ 1.75 CTR 08/19/96 96-283011
TIGARD OR 97224
Phone #:
Contractor: ----------- -------------------
8RF ELECTRIC $ 36.75 TOTAL
15460 SE PARADISE LN
REQUIRED INSPECTIONS -------
MULINO OR 97042 ^ Wall Cover Elect'l Final
Phone #: 503-829-4146 Elect'l Service
Reg #^.: 101543
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. 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 180 days of issuance, or if work is suspended for more
than 180 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: _MRiIed DATE:
LICENSE NO:
Call for inspection — 639-4175
•
•,
Community Development ELECTRICAL PERMIT APPLICATION
. A
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # LC96
/�x� rmlilr,�Pl��� Date Issued S'-a - q6
�� i 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 -D pm
velnei t_ Ste--/I 2 Q�. � ] ^ CC) Number of Inspections per permit allowed
T
Address ' ,, - qci Su.) VC ( te, Lei E- Service included: Items Cost(ea) Sum
City /State /Zip I I 3 C v rl�- 0 4a. Residential - per unit
f 1000 sq. ft. or less $110.00 4
Name (or name of business) Each additional 500 sq. ft. or
portion thereof $25.00
Commercial ❑ Residential I ���yyy. )(I Limited Energy $25.00 1
/ Each Manuf d Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
/ pp 4b. Services or Feeders
Electrical Contractor G �., / 7 Lf ) !yam l-- Installation, alteration, or relocation
200 amps or less g60.00 2
Address / i CL t7 S, P A r a 0 1_,. : ,,- ,.. 4, , 201 amps to 400 amps $80.00 2
City n/1 U I. i o, State MC Zip q w 401 amps to 600 amps $120.00 2
?. 601 amps to 1000 amps $180.00 2
f S Phone No. ' � c l J(f! t-LCi Over 1000 amps or volts $340.00
Job NO. c. Reconnect only
$50.00 2
t
contractor's license NO. s � - 0 4c. Temporary Services or Feeders
Contractor's Board Reg. No. ; /s _ 0 , Installation, alteration, or relocation
Signature of Supr. Elec'n '/ y / 200 amps or less 2
l Q 201 amps to 400 amps $50.00 2
License No. 0)3-5 'hone , o. r- 401 amps to 600 amps $75.00
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see „b„ above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. 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
not intended for sale, lease or rent.
First additional circuit C $$5.00 � _S
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:
5a. Enter total of above fees $ 3c,
NOTICE 5% Surcharge (.05 X total fees) $ / __ 9 ''
Subtotal $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 25% of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Plan Review if required (Sec.3)
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. wordlaamdevleiec- ❑ Trust Account #
$
prm.app •
Balance Due $ a (