Permit CITY OF TIGARD
/tot � i � ;A\ DEVELOPMENT SERVICES ELECTRICAL
EP
=- PERMIT I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERM ISSUED: 11 E 1 / 06 06
PARCEL: 251O4CD -10300
SITE ADDRESS...: 13633 SW TRACY PL
SUBDIVISION : HILLSHIRE ESTATES NO. 2 ZONING:R -7 PD
BLOCK LOT •102
Project Description: ADDING IRRIGATION PUMP
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION 1
EACH ADD'L 50OSF...: 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/0 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
WINDWOOD HOMES type amount by date recpt
13633 SW TRACY PL PRMT $ 40.00 TAT 10/22/96
5PCT $ 2.00 TAT 10/22/96
TIGARD OR 97223
Phone #:
Contractor:
CEDAR LANDSCAPE $ 42.00 TOTAL
14375 SW PATRICIA
REQUIRED INSPECTIONS
HILLSBORO OR 97123
Phone #: 503- 628 -3411
Reg #..: 5843
This eruit is issued subject to the regulations contained in the
P subject 9
Tigard Municipal Code, State of Ore. Specialty Codes and all other P e r m i t t -ee S i g n a -
applicable laws. All work will be done in accordance with (J
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. Ad 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: DATE:
LICENSE NO:
Call for inspection — 639 -4175
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, ( ) , x Date to DST
Inspection (503) 639 -4175 Print or Type Permit # ICLCq�- c)Io70
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: �� / 4. Complete Fee Schedule Below:
Name of Development /5r/ 5 iA ES Es Number of Inspections per permit allowed
Name (or name of business) 14/1/ d Lclod /107 1 eS Service included: Items Cost Sum
Address /3633 St / 7,4C' P1. 4a. Residential - per unit
i• 1000 sq. ft. or less $110.00 4
City /State/Zip //r ✓ . Each additional 500 sq. ft. or
Commercial ❑ / Residential Limited Energy W $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 CEZa4 -k LANDScnPE Installation, alteration, or relocation
Address /4375 S W P/1r is /A 41/E 200 amps or less - $60.00 2
201 amps to 400 amps $80.00 2
City Wilk-iv/2o State OR Zip 7/.23 401 amps to 600 amps $120.00 2
Phone No. (o a8 31 /1 601 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. Exp.Date
OR State CCB Reg. No. J"843 Exp.Date 6 - 96 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 � e LtJ 201 amps to 400 am $75.00 2
401 amps to 600 amps $100.00 2
- 9�
Over "b" amps to 1000 volts,
License No. /a 3 Exp.Date 6
see "b" above.
Phone No. 6 .2g" - 34/(
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
-
b) The fee for branch circuits
City State Zip 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) � 1
Owner's Signature Each pump or irrigation circle I $40.00 7 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:
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ 2
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 Q�
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ 1:2
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96