Permit CITY OF TIGARD
„
1 1 DEVELOPMENT L SERVICES ELECTRICAL PERMIT —
.411 11. 13125 RESTRICTED ENERGY
PERMIT #: ELR97 -0287
DATE ISSUED: 10/14/97
PARCEL: 25113AB -00300
SITE ADDRESS...:16O75 SW UPPER BOONES FERRY RD
SUBDIVISION •FANNO CREEK ACRE TRACTS ZONING:I —L
BLOCK • LOT •036 JURISDICTN: TIG
Project Description: NN Landscape
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM • BOILER LANDSCAPE /IRRIGAT..:
GARAGE OPENER CLOCK ° MEDICAL
HVAC • DATA /TELE COMM..:X NURSE CALLS
VACUUM SYSTEM • FIRE ALARM OUTDOOR LANDSC LITE:
OTHER: .• HVAC PROTECTIVE SIGNAL..:
INSTRUMENTATION.: OTHER..:
••
TOTAL # OF SYSTEMS: 1
Owner: FEES
NORTHWEST LANDSCAPE INDUSTRIES type amount by date recpt
16075 SW UPPER BOONES FERRY RD PRMT $ 40.00 JSD 10/14/97 97- 300024
TIGARD OR 97224 SPCT $ 2.00 JSD 10/14/97 97- 300024
Phone #: 684 -1450
Contractor:
AMERICAN TELECOM INC $ 42.00 TOTAL
1225 SE WATER AVE
REQUIRED INSPECTIONS
PORTLAND OR 97214 Ceiling Cover Low Voltage Insp
Phone #: 236 -8991 Wall Cover Elect'l Final
Reg #..: 007723
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 mo,e than 180 days. ATTENTION: Oregon law requires you to follow rule adopted by the '
Oregon Utility Notification Center. Those es are set forth in OAR 952-001 -0010 through OAR 952- 001 -0080. You may obtain copies of
these rules or direct questions to -' )246-1987.
Issued by _ `: 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:
LICENSE NO:
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
+++++,++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
r ■,
CITY OF TIGARD Electrical Permit Application Plan Check # ��
13125 SW HALL BLVD. Rec'd By G2
TIGARD OR 97223 Date Rec'd l U)(J - i
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Permit # 6 2 .,
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
.71
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) 1V /4 . e - 41`4)5C Service included: Items Cost Sum
Address . 1400 -*5 s ' & ' . ' OffAge. a #' 72.) 4a. Residential - per unit
'Y-9- 1000 sq. ft. or less $110.00 4
City /State /Zip 11 (7k1 / OR/ 2i2-1 Each additional 500 sq. ft. or
Commercial P Residential El portion thereof $25.00 1
Limped 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 4 - 171:92.1&n/ rafeeefri /NC_ Installation, alteration, or relocation
Address /225 6 &m4-7442.- X44,- 201 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City State tsvz Zip 9? Y 401 amps to 600 amps $120.00 2
Phone No. 503- 2 -3 - S 9'1 / 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 24 / 1 -18 Reconnect onl $50.00 2
OR State CCB Reg. No. 0 Exp.Date Jo - 2 -T 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
201 amps to 400 amps $75.00 Signature of Supr. Elec'n 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No.
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.
First branch circuit $35.00 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 Q C ,
panel, alteration or extensi n J
0 $40.0 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 inspe tion over
Service and feeder 225 amps or more the allowable in any oft e 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: gp
Not required for temporary construction services. 5a. Enter total of above fees $ -, - n
exc.I
5% Surcharge (.05 X total fees) $ z-,/
NOTICE Subtotal $ 14 2, On
5b. Enter 25% of line 5a for �„.
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Revie if required (Sec.3) $ 42 000
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 Acco nt # $ 1 00
Total balance e
, \ k , 6
I• \DSTS \ELC96 APP Rev 9/96
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