Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00091
1 4, DEVELOPMENT SERVICES �n DATE ISSUED: 3/29/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -41 `7 / G/ N PARCEL: 2S102BA -00302
SITE ADDRESS: 09898 SW TIGARD ST
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: I -P
BLOCK: LOT : 022 JURISDICTION: TIG
Project Description: Electrical service or feeder 601 to 1000 amps
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: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: 1 PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: X CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD INDUSTRIAL LLC • • DICKINSONS ELECTRIC
11336 SW BULL MOUNTAIN RD #103 8449 SW BARBUR BLVD.
TIGARD, OR 97224 PORTLAND, OR 97217
Phone: Phone: 246 -3550
Reg #: LIC 00000655
SUP 3100S
ELE 26 -140C
FEES Required Inspections
Type By Date Amount Receipt
Ceiling Cover
PRMT DEB 3/29/00 $192.50 0001010 Wall Cover
5PCT DEB 3/29/00 $15.40 0001010 Elect'I Service
PLCK DEB 3/29/00 $48.13 0001010 Elect'I Final
Total $256.03
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -s - ay obtain copie hese ru - • or direct questions to OUNC at (503)
246 -1987.
r
PERMITTEE'S SIGNATURE d� ISSUE 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 IN 4 01 : r0 " ONLY
SIGNATURE OF SUPR. ELEC'N r/ DATE:
LICENSE NO io06
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY, OF TIGARD Electrical Permit Application Plan Check # vZ -((o
13125 SW HALL BLVD. Rec'd By
Date Rec'd - - vim "
TIGARD OR 97223 Date to P.E. _Z - ZED
Phone (503) 639 -4171, x304 Date to DST .3 - I V - -aD
Print or Type
Inspection (503) 639 -4175 Permit # X b - 7
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called -� /v - w 5. O«k
1. Job Address: s tel 7' 4. Complete Fee Schedule Beldam:
L.2
a
Name of Development 9l.1 / Number of Inspections per permit allowed
Name (or name of business) R0/7 l � i11 (� 41D Service included: Items Cost Sum
I
Address 4a. Residential - per unit
O lJ 9 ? � Z - 3 1000 sq. ft. or less $110.00 4
City/State/Zip r r7 �C- / 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
Electrical Contractor Ar t ced,j_S w gkebi `C_ Installation, alteration, or relocation
200 amps or less $60.00 2
Address _ � _ " ..... 1= 201 amps to 400 amps $80.00 2
City i/ '_.F State 4 0 7 -z_ Zip . - Z 401 amps to 600 amps $120.00 2
Phone No. Li b c s^ c7 l 601 amps to 1000 amps I 4 D .
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 02 d-/ a‘-- Exp.Date /U/ c2 2 - J Reconnect only $50.00 2
OR State CCB Reg. No. �S'.3 Exp.Date Agr 2 oP=' ; Pd l 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 5 99 ZZ Exp. a ate / z rrx, Installation, alteration, or relocation
200 amps or less $50.00 2
amps to 400 amps $75.00 Signature of Supr. Elec'n .. _ _ _� 2 07 amps to 600 amps $100.00 2
/ U 1 32' / 2 Over amps 1000 volts,
3/‘0- License No. �� 5 Exp.Date ! "b
see "b" above.
Phone No) -a _577 7/ 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 circ $5.00 2
City State Zip b) The fee for branch circuits
ry p without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 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.
r 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: 142. 5o A i ` �
o
Not required for temporary construction services. 5a. En total of above fees ar // L tSy
Surcharge (.p81( total fees ) D / M ir Q
NOTICE ubtotal $ WIW 6 Alow.
ter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS an Review if required (Sec.3) y8.13 .� $ AI 00
'
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 # 25 q
` )-3 �1 n 1, 0
Total balance Due\
I: \DSTS \ELC96.APP Rev 9/96