Permit CITY O TI G A R D ELECTRICAL PERMIT
h ��, DEVELOPMENT SERVICES PERMIT #: ELC98 -0232
f111 DATE ISSUED: 05/06/98
`- '__... 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 1
PARCEL: 25114BB -04500
SITE ADDRESS...: 10350 SW SERENA WAY
SUBDIVISION -PICKS LANDING NO.1 ZONING:R -4.5 PD
BLOCK. - LOT :022 JURISDICTION: T I G
Project Description : Installation of first branch circuit to single family
residence.
- -- 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/O SRVC OR FDR.: 1 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
MARY L WRIGHT type amount by date recpt
10350 SW SERENA WAY PRMT $ 35.00 DLH 05/06/98 98- 305528
TIGARD OR 97224 5PCT $ 1.75 DLH 05/06/98 98- 305528
Phone #:
Contractor:
JARMER ELECTRIC INC $ 36.75 TOTAL
5105 SW 45TH AVE
REQUIRED INSPECTIONS
PORTLAND OR 97221 Rough -in Elect'l Final
Phone #: 246 -5381 Elect'1 Service
Reg #..: 000069
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 1:r days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001-0010 through OAR 952- 001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: /7 /1- EIS Issued By: 4 P5 -2 gZc.rl-R—. ______
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:
CONTRACTO R INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' N : — 1/ DATE: 0/ �� —.
LICENSE NO: /
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
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CITY OF TIGARD - Electrical Permit Application Plan Check #
43125` HALL BLVD. RECEIVED Rec'd By z--/-7
/ I �` Date Recd .� /tol9�
TIGARD OR 97223 MAY 0 G 1998
Phone (503) 639-4171, x304 C. Date to P.E.
( ) �/ Date to DST
Inspection (503) 639 -4175 COMMUN �� , Print or Type Permit # CZC 94 7 /J a Fax (503) 684 -7297 IFi�o'r Mete l or illegible will . not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
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Name of Development Number of Inspections per permit allowed
Name (or name of business)1l cal r e, .1 - Service included: Items Cost Sum
Address I p?.. 'n s OJ r n... UV 4 Residential - per unit
1000 sq. ft. or less $110.00 • 4
City /State/Zip t " 1) ( ) 2 9 ) d Each additional 500 sq. ft. or
Commercial ❑ Residential portion thereof $25.00 1
' \ 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 current licenses) 4b. • Services or Feeders .
Installation, alteration, or relocation
Electrical Contractor ._was ,. ! I I .,.. 200 amps or less $60.00 2
Add, ss 5 ( b 5 r 0 Li t LLue 201 amps to 400 amps $80.00 2
City State 6 f2 Zip 9 7 as 1 401 amps to 600 amps $120.00 2
Phone No... . 9 I. - 3t I 601 amps to 1000 amps $180.00 2
Job No. I p) S Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. ekt 01 -•» 4 It. C.- Exp.Date 'MI Pi, r/ Reconnect only $50.00 2
OR State CCB Reg. No. (9 c f ay Exp.Date 5Jc3 t x79 4c. Temporary Services or Feeders
' COT Business Tax or Metro No.'a��.. _ 201 amps to 400 amps $75.00
_ �'p.Date T • Installation, alteration, or relocation
/��� 200 amps or less $50.00 2
/ 2
Signature of Supr. Elec in 401 amps to 600 amps $100.00 2
yayyS / / Over 600 amps to 1000 volts,
License No. 9 . 'S xp.Date 10 ) 9' see °b^ above. '
Phone No. . - y I. - EC I ,
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. a
First branch circuit I $35 .00 �d+
2
The installation is being made on property I own which is not Each additional branch circui
$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
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"Submit 2 sets of plans with application where any of the above apply. 5. Fees: 3 5 0
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Not required for temporary construction services. 5a. Enter total of above fees $
• 5% Surcharge (.05 X total fees) . $ l
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 , $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY 75 '
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # 3/0 -
- - Total balance Due $
I:IDSTS1ELC96.APP Rev 9/96 - /- / G + - Q/ V,3
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