Permit CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00582
, DEVEL Tigard, o
SERVICES 639 -4171 DATE ISSUED: 9/28/99
13125 SW
PARCEL: 1S125DA-02900
SITE ADDRESS: 06607 SW WALNUT TERR
SUBDIVISION: KINGS VIEW p PRIewAs ZONING: R -4.5
BLOCK: LOT : 0 JURISDICTION: TIG
Project Description: Installation of two branch circuits.
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: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
DEIBELE, CURTIS DEAN + DANA D • OWNER
6607 SW WALNUT TERR
TIGARD, OR 97223
Phone: Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT DEB 9/28/99 $42.85 99- 318700 Elect'l Final
5PCT DEB 9/28/99 $3.00 99- 318700 -
Total $45.85
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 m ore than 180 days. ATTENTION: Oregon law requires you to follow rules as optes by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtai •• pies of these • -s or direct questions to OUNC at (503)
246 -1987 /
PERMITTEE'S SIGNATURE I SUED BY: .. J/ , ,
OWNER INSTALLATION • '
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: Jc DATE: 9 -7 --- 2 ) -- 9 9
((( CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
l
CITY / 0,F TIGARD Plan Ch -------
Electrical Permit Application
13125 SW HALL BLVD. Recd B Date Recd 9v2k 4
TIGARD OR 97223
Date to P.E .---
Phone (503) 639 -4171, x304
Date to DST � ��
Inspection (503) 639 -4175 Print of Type Permit # e�2dE_71rr____42
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
/ ' Name of Development 660 5 Le" WAL-Mirrep,e Number of Inspections per permit allowed
Name (or name of business) CA yrr Deleete Service included: Items Cost Sum 4
\ \ Address 660 S c.c.s t-t'RLK Lir TL 4a. Residential - per unit
\ City /State /Zip i7Gf1QD 0Q- - -2- 1000 sq. ft. or less $ 117 75 4
Each additional 500 sq. ft. or
portion thereof $ 2615 1
Commercial ❑ Residential ® Limited Energy $ 60 00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation
Electrical Contractor 200 amps or less $ 64.25 2
Address 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128 50 2
City State Zip 601 amps to 1000 amps $ 192 50 2
Phone No. Over 1000 amps or volts $ 363 75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. Exp.Date 4c. Temporary Services or Feeders
OR State CCB Reg. No. Exp.Date Installation, alteration, or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
see "b" above.
,License No. Exp.Date
Phone No. 4d. Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name CA-) 0_`• be (E3 Each branch circuit $ 5.35 2
Address t'o�. ? 5 UJ/VL41 7-L5j2/C. b) The fee for branch circuits
City "76Aini) State O2 Zip `7 7 2 Z- 3 without purchase of service
p or feeder fee. - 7 U
Phone No. Zvi 9 61)3-7 First branch circuit / $ 37.50 3 / ' S
Each additional branch circuit / $ 5.35 lj ■ 3 `)
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
panel, alteration or extension $ 60 00
3. Plan Review section (if required): * Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.0 Chapter 5 5. Fees:
5a. nter total of above fees 4 g $ c' % "
* Submit 2 sets of plans with application where any of the above apply. /746 /o Surcharge (.05 X total fees)
d 22 D C) $
Not required for temporary construction services. / Subtotal ' $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # y
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due ` J $
i. \dsts \forms \electric doc 9 --5(g O /N°