Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00333
ce . , DEVELOPMENT SERVICES DATE ISSUED: 6/4/99
l l 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 114BB -01400
SITE ADDRESS: 10265 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT : 028 JURISDICTION: TIG
Project Description: First branch circuit
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
CHRISTOPHE JABLONSKY WEST SIDE ELECTRIC CO INC
10265 SW SERENA WAY 1834 SE 8TH AVE
TIGARD, OR 97224 PORTLAND, OR 97214
Phone: Phone:
Reg #: x - 15 06
SUP 1556s
ELE 26 -135c
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT BON 6/4/99 $37.50 99- 315900 Elect'l Final
5PCT BON 6/4/99 $1.87 99- 315900
Total $39.37 ORIGINAL
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Permit Signature: otik_ ( . ij14 Issued 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: evrl r( DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
JUN -03 -99 05:41 PM WEST SIDE ELECTRIC 503 736 0677 P.01
;CITY I0P TIGARD Plan Che r
:1312 SW HALL BLVD. RECEIV Electrical Permit Application Recd By I
TIGA 67 OR 97223 Date Recd - = 0 NI
Phone (503) 839 -4171, x304 0 3 1999 Date to P.E.
Date to DST
Inspection (503) 839-41
LAMUNITY DEVELOPMEN Print of Type Permit d 1A -eX73
Fax (503) 598 -1960 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
Name (or name of business) Service Included: Items Cost Sum S
Address j rysD S AO. Residential - per unit
(`iiryJSta;e/Zip'r: 1000 ad ft. or less s 117.75 4
Each sddltlonal 500 sq. ft. or
�.�/ portion thereof 5 26.25 1
Comme'ciel Residential L� Limited Energy _ S 60.00
Each Manufd Home or Modutar
fa. C Dntrector Installation only: Dwelling Service or Feeder S 72.75 2
(Prior to permit Issuance, applicants must provide contractor license lb. Services or Feeders
Information for COT data base). . [_ Installation, alteration, or relocation
Electrical Contractor % ♦ Ex L- y . "1 U 200 amps or leas 8 64,25 2
ddre6 ���� t e 201 amps to 400 amps $ 86.60 2
� Ity rJ/ *ii *7e/ 401 amps l0 600 amps 126.50 2
p 601 amps to 1000 amps $ 192.50 2
Phone o. _ Over 1000 amps or volts $ 363.75 2
4ob No. , III • _ Reconnect only $ 53.50 2
elec. C. nt. Lice. No. - - / Exp.Date 4c, Temporary Services or Feeders
OR State CCB Reg. No. ' h Exp.Date Installation, alteration, or relocation •
COT B4 slness Tax or Metro No. Exp.Date 200 amps or less 5 53.50 _ 2
201 amps 10 400 amps $ 60.25 2
Signatu 'e of Supr. Elec'n 401 amps to 600 amps S 107.00 2
Over 800 amps to 1000 volts,
aes' "above, t,iCense No. FS �i Exp.Date ad. Bench above, Phone No. - yX New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder foe.
Print Owners Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
tity _ State Zip or feeder fee.
phone No. First branch circuit 1 $ 37.50 3'7, 519
Each additional branch dreult 5 6.35
The Installation Is being made on property I own which Is not Ie. Mlsesllsneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or Irrigation circle _ $ 42.75 •
Owner'F Signature Each sign or outline lighting $ 42.76
61gna1 circuit(;) or a limited energy
3. P'an Review section If re uiredl: * panel, alteration or extension - 5 60,00
4 / Minor Labels (10) $ 107.00
Please check appropriate item and enter fee In section 6B. df• Each additional inspection over
4 or more residential units in one structure the allowable In any of the above
Service and feeder 225 amps or more Per Inspection $ 60.00
Per hour $ 60.00 •
System over 600 volts nominal In Plant $ 59,00
Classified area or structure containing special occupancy as
described In N.E.C. Chapter 5 5. Fees:
6a. Enter total of above fees $
Aig
'; Subm 12 sets of plans with application where any of the above apply. 6% Surcharge (.05 X total fees) $
Not required for temporary construction services. Subtotal $
• 6b, Enter 25% of line Si for
tI OTICE • • Plan Review )f required (Sec. 3) 5
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR '
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS Trust Account* ,
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due 1 $ 9, 3 7.
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