Permit CITY OF TIGARD ELECTRICAL PERMIT
^ a DEVELOPMENT SERVICES PERMIT
ISSUED: LC98 -0217
PARCEL: 2S1O9AB -06300
SITE ADDRESS...:13O63 SW STARVIEW DR
SUBDIVISION •FORAN ZONING:R -7
BLOCK • LOT •005 JURISDICTION: TIG
Project Description : Addition or alteration of first branch circuit to SF
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
KELLY MAGETRIC type amount by date recpt
13063 SW STARVIEW DR PRMT $ 35.00 DLH 04/27/98 98- 305300
TIGARD OR 97223 5PCT $ 1.75 DLH 04/27/98 98- 305300
Phone #:
Contractor:
PREMIER ELECTRICAL CONTRACTORS $ 36.75 TOTAL
115 NICHOLAS WAY
REQUI RED INSPECTIONS
NEWBERG OR 97132 Rough —in Elect' 1 Final
Phone #: 537 -0745 Elect'1 Service
Reg #..: 001264
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 1:
days of issuance, or if work is suspended o more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Th se rules are set forth i Ji'R 952 - 181-0810 through OAR 952 -001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503 246 -1987
T / / . Issued By: 4!& 1 5 /77-4)--- “ :2---
Permittee Signature:
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 : 7 /L
,
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
'sr
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 ' � Date to DST
Inspection (503) 639 -4175 Print or Type Permit# CLe`f� 6dt /
Fax (503) 684 -7297 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) k II /ill A / i C Service included: Items Cost Sum
I
Address (5O L, 3 S 1 1 r V 1 �fr..-_ 4a. Residential - per unit
City/State/Zip �� tq r� 1000 sq. ft. or less $110.00 4
ty p Each additional 500 sq. ft. or
Commercial ❑ Residential portion thereof $25.00 1
Li mited Energy - $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy i o�urrent licenses) 4b. Services or Feeders
Electrical Contractor T v-E r^ 1 E r l Ec v'iC�'4 ) oc /. (..0 Installation, alteration, or relocation
Address I (,S N;el.r, C IS (..c.
1 364 200 amps or less $60.00 2 -
201 amps to 400 amps $80.00 2
n
City lt .,) (' air State Zip q'1 t 3 Z 401 amps to 600 amps $120.00 2
Phone No. 3'7 - n-r-IS 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. 3( - T9 C Exp.Date lob (4 R
OR State CCB Reg. No. Exp.Date I / 1 0 2 / 9 2 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n 401 amps to 600 amps $100 00 2
Over 600 amps to 1000 volts,
License No 4 / ( --/-.2 7 . Exp.Date /O // he see "b" above.
Phone Nr 641 9- 3s 0
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. o C,
First branch circuit I $35.00 3s 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. 5. Fees: �s
N
OD
ot required for temporary construction services. 5a. Enter total of above fees $ �`
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $ 3 6, . 9.5
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
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96