Permit •
CITY OF TIGARD
jj ELECTRICAL PERMIT
A %; DEVELOPMENT SERVICES CATEIISSUEDLrO4 /0399?
PARCEL: 15136CA -01600
f'SITE ADDRESS...:11655 SW PACIFIC HWY
,,"SUBDIVISION ZONING:R -12
BLOCK LOT JURISDICTION: TIG
Project Description: Installation of 1 feeder and 50 branch circuits.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS-- - --
i 1000 SF OR LESS • 0 0 - 200 amp • 0 PUMP /IRRIGATION : 0
EACH ADD'L 50OSF...: 0 201 - 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 - 600 amp • 0 SIGNAL /PANEL • 0
MANE. 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: 10 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
60) - 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 - -
RAZ type amount by date recpt
11655 SW PACIFIC HWY PRMT $ 110.00 DRA 04/03/97 97- 292672
TIGARD OR 97223 5PCT $ 5.50 DRA 04/03/97 97- 292672
Phone #:
Contractor:
DICKINSONS ELECTRIC $ 115.50 TOTAL
A449 SW BARBUR BLVD
REQUIRED T. PECTIONS
PORTLAND OR 97217
Phone #: 503 -246 -3550 -- le
Reg #.. : 65534
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permitt-ee Signature
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started i '
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
male, lease, or rent.
OWNER'S SIGNATURE: DATE:
- - - CONTRACTOR INSTALLATION ONLY
STGNAT11RE OF SUPR. ELEC'N: DATE:
L.Tr "ENSE NO
Call for inspection - 639 -4175
. .
i
P lan Check:
egy OF TIGARD Electrical Permit Application
13125 SW HALL BLVD. Rec'd By .
TIGARD OR 97223 Date Recd - - 9 7 -
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # , 67---e.--5 7 - 0/9/
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
4-7_, Name (or name of business) Service included: Items Cost Sum
I
Address 1/6 S srA) vuye= 1 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State/Zip Each additional 500 sq. ft. or
Commerci 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 curve t licenses) /
• 4b. Services or Feeders
Electrical Contractor i C--Id. 4 i / Installation, alteration, or relocation $60.00 GO dt/
Address r ' ' 5 i - / - _ i _ r 200 amps or less
201 amps to 400 amps $80.00 2
City /•' i �. _.•' State (SW Zip 4 2 1' 401 amps to 600 amps $120.00 2
Phone No. to '3 .5-75-1-2 601 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. a b-/go C- Exp.Date
OR State CCB Reg. No. b?s-S'-3 V 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' �� ��-* -« 401 amps to 600 amps $100.00 2
$� 2
Exp.Date Over 600 amps to 1000 volts,
License No. p.Date see "b" above.
Phone No. itafg <- / 5 3 S'' 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
im
Print Owner's Name feeder fee. /`v
Address Each branch circuit /9 $5.00 J 2
City State Zip b) The fee for branch circuits
�l p 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
(Service or feeder not included)
Owner's Signature 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. S. Fees: / /.7 '!c
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ S X50
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 # 6p
I / .
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96