Permit CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
PERMIT #: ELC96 -0763
!+� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1 / 05 / 96
PARCEL: 2S1O2DC -02300
SITE ADDRESS...: 09265 SW MCDONALD ST
SUBDIVISION • EDGEWOOD ZONING:R -4.5
BLOCK • LOT •15
Project Description:
- -- 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
MERHEATHER type amount by date recpt
9265 SW MCDONALD PRMT $ 70.00 JSD 12/05/96 96- 287320
5PCT $ 3.50 JSD 12/05/96 96- 287320
TIGARD OR 97223
Phone #:
Contractor:
ROBERT HAUSER ELECTRICAL INC $ 73.50 TOTAL
1410 NE 106TH
REQUIRED INSPECTIONS
PORTLAND OR 97220 Ceiling Cover Elect'1 Final
Phone #: 256 -1599 Wall Cover
Reg #..: 13476
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 188 days of issuance, or if work is suspended for more.
than 180 days. I ued 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 : DATE:
LICENSE NO:
Call for inspection — 639 -4175
12/04/96 10:31 '$`503 684 7297 CITY OF TIGARD EZ1 002002
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By ' �-
TIGARD OR 97223 Date Rec'd (0
Phone (503) 639 -4171, x304 Date to P.E.
Inspection (503) 639 -4175 Print or Type Date to DST
Permit # ti-9 6-B7 -
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_ g r; c s _ w Mrrir)na . 4e, Residential - per unit f
City/State/Zip T i ga rd f car 9 7 22.4.___ 1000 sq. K or less $110.00 4
t=ech additional 500 sq. ft. or
Commercial ❑ Residential
Ea Limited thereof $25.00 - 1
Limned Energy $25.00
Each Manuld 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 FC1ber * r-a a re s r E 1 prat ,Inc _ Installation, alteration, or relocation
Address 200 amps or less $80.00 6 0 _ 0 0
1 41 0 Di _ E .1 C ti t h 201 amps to 400 amps $80.00 2
City P ort State fir Zip 9 7 2 2 0 401 amps to 600 amps $120.00 2
Phone No. a5 6 - t 5 a a
- 601 amps to 1000 amps $180.00
Job No. Over 1000 amps or volts $340.00 2
2 -
Elec. Cont. Lice. No 2 6 4 0 2 c Exp -Date 1 0- 9 7 Reconnect only 4.50.00 2
OR State CCB Reg. No.1_3,42.6 Exp.Date 4/t5/q7 4c. Temporary Services or Feeders
COT Business Tax or Metro • A , . Ex p ate 3 _ q 7 Installation, alteration, or relocation
'
200 amps or less $50.00 2
Signature of Supr. EIeC'n i,; ,a'►f /i / ‘..,/,,...,, 201 amps to 400 amps 575.00 2
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 1 5 S lc Exp.Datel 0 - 1 - 9 8 see "b" above.
Phone No 2 5 6 1 5.9 3
4d. Branch Circuits
2b. For owner installations: New, alteration or extension per panel
a) The lee for branch circuits with
purchase of service or
Print Owners Name _ feeder fee.
Address Each branch circuit 2 $5.00 1 0_ n n , 2
- b) The lee 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 circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
Owner's Signature (Service or feeder not Included)
Each pump or Irrigation cIrcle $40 -00 - 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuits) 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 41, Each eddldonal 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 S in Plant $55.00 - -
* Submit 2 sets of plans with application Where any of the above apply. 5. Fees: 70.00
Not required for temporary construction services. 55. Enter total of above fees $
5% Surcharge (.05 X total fees) $ - 3 - 5 0 -
NOTICE Subtotal $
5b. Enter 25% of fine sa for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if reauired (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. 0 Trust Account # °.4 56
Total balance Due $ 1