Permit CITY OF TIGARD
4 6, „
1 � DEVELOPMENT SERVICES ELECTRICAL PERMIT
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT #: E LC96 -0643
DATE ISSUED: 10/15/96
56 60 4" zi[ PARCEL: 2511ODB -00600
SITE ADDRESS...:-1S340 SW PACIFIC HWY
SUBDIVISION • WILLOW BROOK FARM ZONING:C —G
BLOCK LOT •10
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 : 1
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
2O1 — 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
SECURITYLINK FROM AMERITECH type amount by date recpt
5110 NE SANDY BLVD PRMT $ 40.00 TAT 10/09/96 96- 284933
5PCT $ 2.00 TAT 10/09/96 96- 284933
PORTLAND OR 97213
Phone #: 228 -3430
Contractor:
CONTRACTOR NOT ON FILE $ 42.00 TOTAL
REQUIRED INSPECTIONS
Ceiling Cover Underground Cove
Phone #: Wall Cover Elect'1 Service
Reg #..
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permit S i g n at ur :
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started A61-1/C_Y—'
within 180 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
. Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. a //
Tigard, OR 97223 Permit # Cte 96 -Ov
�'
4 I i Date Issued
Ai- A I I Phone (503) 639 -4171
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 44-
Inspection (503) 639 -4175 -G `D r �s��
1. Job Address: 4. Complete Fee Schedule Below:
Name of Dev lopment 2 ' � Number of Inspections per permit allowed
/56
Address r S4i P. & COAST 1 Service included: Items Cost(ea) Sum
City /State /Zip 7i &A-4-0 OR, i 9'72?-54 4a. Residential - per unit
r
1000 sq. ft. or less $110.00 4 -
Name (or name of business) /JOAIK 8iYGCLs Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial IZI Residential 111 Limited Energy $25.00
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Electrical Contractor ScC(.0 "TYLl N!L From AptuiYcc Installation, alteration or relocation 2
200 amps or less $60.00
Addre s57 /o Nr Sflxroy 2L•vA 201 amps to 400 amps $80.00 2
0.00 2
City r1t 3-io Statet,2,, Zip 92.2./g 401 amps to 600 amps $12 0.00 2
601 amps to 1000 amps
Phone No. CS -3 Over 1000 amps or volts $340.00 2
Job NO. Reconnect only $50.00 2
contractor's license NO. agirpt 210-V y CLE 4c. Temporary Services or Feeders
Contractor's Board Reg. No O SO 4 Installation, alteration, or relocation
Signature of Supr. Elec' 17-1 200 amps or less 2 2
License No. l02-3JLE Phone No. So " p 201 amps to 400 amps $50.00 2
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
Each additional branch circuit $5.00
not intended for sale, lease or rent. First 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 I $40.00 442.
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
Chapter 5 Per inspection $35.00
as described in N.E.C. Cha
p 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 $ 747 •DD
NOTICE 5% Surcharge (.05 X total fees) $ 2. DO
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. wordknmdMeko- ❑ Trust Account #
prm.epp
Balance Due $ 642 -DD