Permit dr C ITY OF T PERMTTICAL PERMIT
PERMIT #: ELC95 -0 530
DATE ISSUED: 11/06/95
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Han Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PARCEL: 2S 104CD -10900
SITE ADDRESS...: 13652 SW TRACY PL
SUBDIVISION....: HILLSHIRE ESTATES NO. 2 ZONING :R -7 PD
BLOCK LOT °150
Project Description: 3,371 sq. ft. residential
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS....: 1 0 - 200 amp 0 PUMP /IRRIGATION : 0
EACH ADD'L 500SF...: 5 201 - 400 amp ° 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY 0 401 - 600 amp 0 SIGNAL /PANEL 0
MANF. HM/ SVC/FDR.. : 0 6014-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
BEAR ELECTRIC, INC. type amount by date recpt
P. O. BOX 389 PRMT $ • 235.00 JMH 11/06/95 95- 272579
SPCT $ 11.75 JMH 11/06/95 95- 272579
DONALD OR 97020
Phone #: 503- 678 -1355
Contractor:
CONTRACTOR NOT ON FILE $ 246.75 TOTAL
REQUIRED INSPECTIONS
Ceiling Cover Electrical Servi
Phone #: Wall Cover Electrial Final
Reg #..
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signature
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 182 days of issuance, or if work is suspended for more
than 180 days. 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 //06
LL
SIGNATURE OF SUPR. ELEC' N: i DATE: 9 J
LICENSE NO:
Call .for inspection - 639 -4175
. • Community Development ELECTRICAL PERMIT APPLICATION
r A 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 55-2 7257 9
, � }h l , , . a Permit # E-LC q3- 0530
:� ii Phone (503) 639 -4171 Date Issued 1/- OG -- 9
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by Gf I/}12C -.5
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
3, Name of Development Hiu.smaE ESf -fES . ' Number Inspections per pa
Number of Ins lions r rmit allowed
Address 06 /o 5 Z SW T/LfLY PL/¢L6 Service included: Items Cost(ea) Sum
City /State/Zip - 17& - /P/14), 04 e6 /0 9 7223 4a. Residential - per unit / 4
1000 sq. ft. or less / $110.00 / /O. 00
Name (or name of business) (t/Ni l+t- "D /lt7m 15 Each additional 500 sq. h. or
portion thereof 5 $25.00 /7 S D c 1
Commercial ❑ Residential El Lo f it 4'9 Limited Energy $25.00 - Each Manut'd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor soyz. ELEt✓T/U C, INC. 200 amps or less $60.00 2
Address Pr 0. BRA 3 95 201 amps to 400 amps $80.00 2
City Don//+ State 0/L Zip 9 ow p 401 amps to 600 amps $120.00 2
p P 601 amps to 1000 amps $180.00 2 -
Phone No. �0 7U - I355 Over l000 amps or eons $340.00 2
-
Contractor's License No. 2y - /0 7G Reconned only $50.00 -
Contractor's Board Reg. No. - 4c. Temporary Services or Feeders
_ � Installation, alteration, or relocation 2
Signature of Supr. Elec'n .07 200 amps or less $50.00 2
License No. 273" S Phon t o. G7F- /7 S c 201 amps to 400 amps $75.00 2
- 401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner installations: Bee if above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. b) The tee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $35.00 2
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2 - Each sign or outline lighting $40.00
-
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
-
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services.
5. Fees:
NOTICE 5a. Enter total of above fees $ 235.4o
5% Surcharge (.05 X total fees) $
Subtotal $ 2.4.i/... Z
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 25% of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Plan Review if required (Sec.3) $
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $ -c/75
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. ❑ Trust Account # $ X
Balance Due $ 2 "6.
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