Permit •
ELECTRICAL_ PERMIT
.CITY OF TI GARD PERMIT
12 /2
COMMUNITY DEVELOPMENT DEPARTMENT
PARCEL: 1 s 1 `5DC- 015Q10
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
SITE ADDRESS...: 07145 SW VENTURA DR
SUBDIV,ISION....: WASHINGTON SQUARE ESTATES ZONING:R -4.5
BLOCK ° LOT °5
Project Description: One branch circuit.
- -- 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 - - - --
PHOENIX ELECTRIC type amount by date recpt
7379. SW TECH CENTER DR PRMT $ 35.00 CJS 12/20/95 95- 274117
5PCT $ 1.75 CJS 12/20/95 95-274117
TIGARD OR 97223
Phone # : 503 -246- -8874
Contractor: •- • --
PHOENIX ELECTRIC CO $ 36.75 TOTAL
PO BOX 1432 •
REQUIRED INSPECTIONS
TUALATIN OR 97062 Ceiling Cover Elect'1 Service
Phone #: Wall Cover Elect' 1 Final
Reg it..
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm i tt ee Signature
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started L
within 180 days of issuance, or if work is suspended for more _ C /1G�/'1nf
than 180 days. Issued By .
-- - - - - -- - -- OWNER I_NSTALLAT I ON 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 SUP R. ELEC' N : _ ?'7I)&/ ____^ _ DATE : _/2 ?O- 9s _
LICENSE NO:
Call for inspection - 639 -4175
•
- -- * Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # ELCQS- 0693
,���, �. Date Issued /1 A6- S�`
povi 6∎ II Phone (503) 639 -4171
CITY OF TIGARD FAX (503) 684 -7297
TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below: ,
Name of Development ta.,. x Number of Inspections per permit allowed
Address _\ � `�� \�,� \t XC_ \"y . Service included: Items Cost(ea) Sum
City /State /Zip (0,110r G .2a: 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) Each additional 500 sq ft or
portion thereof $25 00
Commercial ❑ Residential Limited Energy $25.00
Farh Manu'.1 u....,..... RA...+••
-- ia. contractor installation only:
4b. Services or Feeders
Electrical Contractor h • - % . ) Installation, alteration, or relocation $60.00 2
200 amps or less
Addressl3 `F1.5�J 7;2.8/ o"'\ k.,-, - r • 201 amps to 400 amps $80.00 2
City Tq, State ZI C(1 401 amps to 600 amps $120.00 2
`r ' r � 4IL _ KO 4 p� 601 amps to 1000 amps $180.00 2
Phone rJ Over 1000 amps or volts $340.00 2
Job NO. 30\" -lea Reconnect only $50.00 2
contractor's license NO. 3 Q- 4c. Temporary Services or Feeders
C
Contractor's Board Reg. No. 7 ae Installation, alteration, or relocation
Signature of Supr. Elec'n 200 amps or less 2
License No. 4// hone No. robs/ -, j4e,0 201 amps to 400 amps $so 00
401 amps to 600 amps $75 00 2
Over 600 amps to 1000 volts $100 00
2b. For owner installations: see „b„ above
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. G t7 - 2
First branch circuit / $35.00 ��./
not intended for sale, lease or rent. 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 imgation circle $40.00 2
Each sign or outline lighting $40 00
Signal circurt(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:
5a. Enter total of above fees $ , 1.5*
NOTICE 5% Surcharge (05 X total fees) $ / r j5
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. rmd\comdeNeieo- ❑ Trust Account #
$
pm, app
Balance Due $ c--