Permit ,
TY OF T PERMIT I #: ELC96-0364
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 06 / 1 1 / 96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: `S 104PP -04500
SITE ADDRESS...: 14133 SW LIDEN DR
SUBDIVISION • CASTLE HILL ZONING:R -12 PD
BLOCK LOT •022
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 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 • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION 0
201 — 400 amp • 0 1st W/O SRVC OR FDR.: 1 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
TROY CHRISTIANSEN type amount by date recpt
14189 SW STARDUST LN PRMT $ 35.00 CJS 06/11/96 96- 280444
5PCT $ 1.75 CJS 06/11/96 96- 280444
TIGARD OR 97223
Phone #: 579 -9332
Contractor: —
PHOENIX ELECTRIC CO $ 36.75 TOTAL
PO BOX 1432
REQUIRED INSPECTIONS
TUALATIN OR 97062 Wall Cover Elect'1 Final
Phone #: 503 -692 -5882 Elect'I Service
Reg #..: 52288
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 dr; r- /es , c/7' -
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: 00 Ctnp /ire, fthn DATE: A
LICENSE NO: / ///
Call for inspection — 639 -4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # E/-e.35'
, ��r� l l�j ('` Date Issued G -ii- 96
,,'' � �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 Development b.c 9 -0 7 Number of Inspections per permit allowed
I
Address I LA1, 35 sw .--\ / ^7 (( Service included: Items Cost(ea) Sum
City /State /Zip 1 OG4�I ne `7 3 4a. Residential - per unit
L 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 Limited Energy $25.00 1
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor "I stallation only:
4b. Services or Feeders
Installation, alteration, or relocation
Electrical Contractor Ax • 0 . 200 amps or less $60.00 2
Address 1 3 7 -- , N\ .1( 201 amps to 400 amps $80.00 2
CI State • r' Zip 3 401 amps to 600 amps $120.00 2
City p 601 amps to 1000 amps $180.00 2
Phone fV(/ -- ?76 Over 1000 amps or volts $340.00 2
Job NO. ,--15.502.3z- Reconnect only $50.00 2
contractor's license NO. 3y -d c/7e- 4c. Temporary Services or Feeders
Contractor's Board Reg. No. Installation, alteration, or relocation 2
Signature of Supr. Elec'ne 200 amps or less
201 amps to 400 amps $50.00 2
License Nol f /G/OS' Phone No. G� eF��l�(J 401 amps to 600 amps $ 2
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
• City State Zip purchase of service or feeder fee. 2
y 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 ofserviceorfeederfee. / W 2
First branch circuit $35.00 35�
not intended for sale, lease or rent. 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: c,
5a. Enter total of above fees $ ?-�'
NOTICE 5% Surcharge (.05 X total fees) $�
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) $
7
A PERIOD OF 180 DAYS AT ANY TE AFTER WORK IS Subtotal -- - - - - - -$
COMMENCED. wordtcomdMeiec- ❑ Trust Account # $
prm.app
Balance Due l -
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: a -- Z'_ 91. :.M. ,',M. Entry:
Address: / 33 57-c) .._ ..1.A 1
Tenant: Ste: MST:
/� BUP:
Con /Own: egGL p�Z4 /MEC:
6 84'' 36 oc ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
4 f C r Zile. _. rs C ce/
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it " % �- tl
Ins ector: Dat `�
APPROVED _DISAPPROVED /CALL FOR REINSP. CO
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