Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC97 -0424
DATE ISSUED: 07 /02/97
�.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 251O2CB -06801
SITE ADDRESS...:1O475 SW PARK ST #NEW
SUBDIVISION • ZONING:R -4.5
BLOCK • LOT • JURISDICTION: TIG
Project Description: Hess
- -- 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: 0 PER INSPECTION • 0
22 — 400 amp • 0 1st W/0 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
PHILLIP HESS type amount by date recpt
10475 SW PARK PRMT $ 60.00 JSD 07/02/97 97- 296699
TIGARD OR 97223 5PCT $ 3.00 JSD 07/02/97 97-296699
Phone #: 684 -8833
Contractor:
GARNER ELECTRIC $ 63.00 TOTAL
21787 SW TUALATIN VALLEY HWY #L
REOUIRED INSPECTIONS
ALOHA OR 97006 -1248 Elect'l Service
Phone #: Elect'l Final
Reg #..: 001167
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
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. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those ules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -1987. . _may obtain a copy
of these rules or direct questions to 1 b: calling )246 -1987.
Permittee Signature: Issued By• O`
F
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 639 -4175 by 6:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
.CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By -4
TIGARD OR 97223 Date Rec'd IS Air
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit #__E- rs(cZ�
Fax (503) 684 -7297 Called CO C'
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
I
Address /a 97 r S. 4/. Pa e 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip ' 7- 5 i CU/Z Each additional 500 sq. ft. or
t i portion thereof $25.00 1
Commercial ❑ Residen
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 reent licenses) `>; 4b. Services or Feeders //
Electrical Qo tractor A'V `e Y / Installation, alteration, or relocation /n v
i1 v_ 200 amps or less r $60.00 L 2
Address t! tI " 5 ,4 I. / 1 201 amps to 400 amps $80.00 2
City P • f f / 6 State €./t Zip 97 401 amps to 600 amps $120.00 2
Phone No. c Y -Vert- 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. - 7.#17 r Exp.Date • -a
OR State CCB Reg. No. /Z// ( Exp.Date / 7 4c. Temporary Services or Feeders
COT Business Tax or Metro No. L� /0 Exp.Date 4// 199 Installation, alteration, or relocation
200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec'n alliff 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 316/1 Exp.Date / 4 /,J�v see "b" above.
Phone No. (,( / g - f
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee 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
(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:
Not required for temporary construction services. 5a. Enter total of above fees $ 4 k---
5% Surcharge (.05 X total fees) $
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 $ fl /
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due $
1q7-96
I: \DSTS \ELC96.APP Rev 9/96