Permit CITY OFTIGARD
%r_ , DEVELOPMENT SERVICES ELECTRICAL PERMIT
�i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT #: ELC96 -0703 3
DATE ISSUED: 11/01/96
$3"1(0 , , '
F.� / PARCEL: 1S136CC —CH001
SITE ADDRESS...: SW r; FF' 15, d C : ST
SUBDIVISION • CARRIAGE HOUSE APARTMENTS ZONING:R -12
BLOCK • LOT •
Project Description: TEMPORARY SERVICE FOR CARRIAGE HOUSE APARTMENT SITE
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 1 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/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
ANDREWS MANAGEMENT LTD type amount by date recpt
4000 SW KRUSE WAY #270 PRMT $ 50.00 JMH 11/01/96 96- 286030
5PCT $ 2.50 JMH 11/01/96 96- 286030
LAKE OSWEGO OR 97035
Phone #: 639 -3645
Contractor:
JARMER ELECTRIC INC $ 52.50 TOTAL
5105 SW 45TH
REG!UIRED INSPECTIONS
PORTLAND OR 97221 Underground Cove Elect' I Final
Phone #: 503- 246 -5381 Elect' 1 Service
Reg #..: 6924
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Per mitt e S ' t �_�r e
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 v r
than 180 days. I s s • d By
OWNER INSTALLATION 'NLY
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. qI `_
Tigard, OR 97223 P lanck/Rec. # 1.1�J - )41Q v X12 J0
;proA� w' I', a Permit # �i t�g(o -(-f C� Z
.� I Phone (503) 639 -4171 Date Issued (- 0 1- R
CI OF
1 TIGARD FAX (503) 684 -7297 Issued by I ?-9141-
TOD No. (503) 684 -2772
9 a 3y Inspection (503) 639 -4175
1. Job Address: �,-,r� 4. Complete Fee Schedule Below:
Name of Development C%'�A - � Number of Inspections per permit allowed
,
Address %3✓I Qv .5 P Service included: Items Cost(ea) Sum
/� ,(�
City/State2ip 4 �/ c l 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
-
Name (or name of usiness) Each additional 500 sq. ft. or 1
portion thereof $25.00
Commercial ❑ Residential ❑ Limited Energy $25.00
- Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor A , . • ._4 0 • - 200 amps or less $60.00 2
• ddress �_ g" . � 66 !:lam v 201 amps to 400 amps $80.00 2 -
Ci t,. , _07.,T�1! State Olt Zip Q� 401 amps to 600 amps $120.00 2
p ) sot amps to 1000 amps $180.00 2 -
Phone No. C.- 34g Over 1000 amps or volts $340.00 2
Contractor's License No. ato - 1 z /)./ C Reconnect only $50.00
Contractor's Board Reg. No. (0 d V 4c. Temporary Services or Feeders JI) iPj SH e_ ___. 2
Installation, alteration, or relocation 00
Signature of Su • r. Elec'n ,/` 200 amps or less I $50.00 50 2
License No. • b Phone No. EOM.- , 201 amps to 400 amps $75.00 2
- 401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner installation': see •b• above.
Print 4d. Branch Circuits
rint Owner's Name
New, alteration or extension per panel
Address a) The lee for branch circuits with
purchase of service City State Zip
Each branch p «, or far $5.00 2
1 0'7 Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $35.00 2
Each additional 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 $40.00
-
• 4 or more residential units in one structure Mi nor 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
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
-
In Plant $55.00
Submit 2 sets of plans with application where any of the above
ii apply. Not required for temporary construction services. 5. Fees:
NOTICE 5a. Enter total of above fees $ 50
5% Surcharge (.05 X total fees) $ c2 5�
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.
$
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED.
-gy ❑ Trust Account # $
16136 d / �{ � l Balance Due $ a
m `r
Page No. 1 CASE HISTORY FOR CASE NO.: ELC96 -0703
ANDREWS MANAGEMENT LTD
08376 SW PFAFFLE ST
04/25/98
Action Description Reg/ Schd/ 'End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
ELCC003 Permit created / / / / 11/01/96 RECD JMH 11/01/96 DST
ELCC500 (F)Issue permit / / / / 11/01/96 PASS JMH 11/01/96 DST
ELCC725 Underground Cover 11/01/96 / / 11/01/96 11/01/96 DST
ELCC800 Case Finaled / / / / 11/05/96 PASS HW 11/06/96 MJR
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