Permit CITY OF TI G A R D ELECTRICAL PERMIT
%�,�I .,; DEVELOPMENT SERVICES PERMIT #: ELC98 -0304
DATE ISSUED: 06/03/98
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
PARCEL: 25111BD -00308
SITE ADDRESS...:09915 SW PEMBROOK ST
SUBDIVISION -PEMBROOK HEIGHTS ZONING:R -3.5
BLOCK • LOT •008 JURISDICTION: TIG
Project Description:
- -- 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/0 SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 1 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
HAROLD E BOGERT type amount by date recpt
9915 SW PEMBROOK PRMT $ 40.00 JSD 06/03/98 98- 306247
TIGARD OR 97224 5PCT $ 2.00 JSD 06/03/98 98- 306247
Phone #:
Contractor:
RED'S ELECTRIC CO INC $ 42.00 TOTAL
2002 SE CLINTON ST
REQUIRED INSPECTIONS
PORTLAND OR 97202 Rough —in Elect'1 Final
Phone #: 233 -6467 Elect' 1 Service
Reg ft..: 000044
This per.it 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 per.it 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 rules are et fu in OAR 952 - 001 -0010 through OAR 952- '.'1 -1" . You may obtain a copy
of these rules or direct questions to OUNC by ! 0312 • 987.
Permittee Signature: Issued By- 411111111 0 " .
41.- 110
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 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
6 -03 -1998 3:01PM FROM RED'S ELECTRIC 503 233 1281 P. 1
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. • • • • • Planck/Rec. #
•
Tigard, OR 97223 .. . ' .
Permit # AS/A���I
•
,,w. ' 11: x'11) Phone (503) 639 -4171
Date Issued a(
FAX (503) 684 -7297 Issued by
CITY OF TIGARD TDD No. (503) 684-2772
Inspection (503) 639 -4175 •
1. Job Address: 4, Complete Fee Schedule Below:
Name of Development + ! Number of Inspections per permit allowed —
Address 9 el 1 5 . P0inb /'00 /S�I Service included: Items Cost(ea) Sum
•
/i
City /State/Zip �/ . ei� 922 L7 4a. Residential - per unit • 4
1 000 ti $110.00 -__
Each addiioral SOO sq. It. or t
Name (or name of business) • portion thereof $ 2500
Commercial ❑ Residential ® wed Energy $25.00
Each Mane d Home or Modular
pweltng Service or Feeder 888.00
2a. Contractor " stallati only: 4b. Services or Feeders
//" Installation, alteration, or relocation 2
Electrical Contractor X. S 1: [- 200 amps or less sa0.00 2
C 201 amps to 400 amps Sao,00 2
Addf = SS i O �+ 401 amps to 800 amps $120.00 2
City State AP _ , Zip 801 amps to Iwo amps snow 2
Phone No. 1 -74 Yd 7 over to0o amts or vats s340.00 2
Contractor's License No. 4 24-- - /57.2. L Retvnned only $50.00
Contractor's Board Reg. No. h e-' !' I 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Si nature of Sur. Elec' = -im .._...� / Z 1_4_, 200 or less $50.00 2
9 p 201 amps to 400 amps 575.00 2
License No. 5 5 5 Pho ; O. !!Trams 401 amps to 800 amps $ 100A0
Over A00 amps to 1000 volts
2b. For owner installations: see "le above.
ad. Branch Circuits
Print Owner's Name • New. alteration or extension par panel .
Address a) The fee for brarch circuits side
perches el..raar a larder fee. 2
Each City • State Zip branch circuit 55.00
Phone No. _ b) The lee for branch circuits wril!tout
The installation is being made on property I own which is patch. at a. m. e. a seder toe. ., � 4,0 2
First branch circuit 535,00
not intended for sale, lease or rent. . Each additional branch circuit _j 55.00
Owners Signature • de. Miscellaneous
(Service or feeder not included) 2
Each pump or irrigation circle $40.00 2 - 3. Plan Review section (if required): Each sign or outline lighting 2
Signal ctrouit(a) or a limited energy 2
Please cheek appropriate kern and enter fee In section 513. panel, attention or extension S40.00
4 or more residential units in one structure Minor Lab* (19) 5100.00
Service and (seder 225 amps or more a t additional inspection over •
System over 600 volts nominal the allowable in any of the above
special occupancy
Classified area or structure containing spepancy •
Per inspection 535,00
d in N.E.C.
as described Chapter 5 P hou $55.00
• In. Plant $55.00
Submit 2 sets of plane with application where any of the above
apply. Not required for•temporery construction services. 5. F ' 0
Sa. Enter total of above fees $_,
NOTICE 5% Surcharge (.05 X total lees) $ �v��
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ .
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
Plan Review if required (Sec.3) $
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR
Subtotal $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. ,,Host Account* $
. Balance.Due $
............,....p q ct, , 36 (Q-2((?-