Permit •
ELECTRICAL PERMIT
GITy OF TIGARD
.PERMIT #: ELC95•- -0594
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 11/30/95
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PARCEL: 281 1 1 AD -1 6400
SITE ADDRESS...: 09057 SW WESTLUND CT
SUBDIVISION MALLARD LAKES ZONING :R -4.5
BLOCK LOT • 30
Project Description: Install 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-- -
O - 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 - - - --
KATHY GARCIA type amount by date recpt
9057 SW WESTLUND PRMT $ 35.00 JSD 11/30/95 95-273409
5PCT $ 1.75 JSD 11/30/95 95- 273409
TIGARD OR
• Phone #: - -
Contractor: -- - - -- -• -- -•
D &' E ELECTRIC $ 36.75 TOTAL
PO BOX 459
• REQUIRED INSPECTIONS ---
TILLAMOOK OR 97141 Ceilino Cover Elect' 1 Service
Phone #: .Wail Cover Elect' 1 Final
Reg it..
This peroit 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 peroit will expire if work is not started C
within 180 days of issuance, or if work is suspended for oore
than 180 days. I sued y
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
•
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. C q �� _ D ,
Tigard, OR 97223 Permit #
A
Date Issued ) !- 3•-{ •
Phone (503) 639 -4171
FAX (503) 684 -7297 '
CITY OF TIGARD TDD No. (503) 684 -2772 ,
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development ` Number of Inspections per permit allowed
Q y
Address 1 1 � , u) (),./C 51 I ° 1 4 Service included. Items Cost(ea) Sum
City /State /Zip M., 04' Ci QOk 4a. Residential - per unit
1000 sq ft or less $110 00 4
Name (or name of business) l `1. X_ 6- AS1Li), Each additional 500 sq. ft or •
portion thereof $25.00
Commercial El Residential r1' Limited Energy $25.00 1
Each Maned Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders i •
Electrical Contractor b I� r tecicf `- In stalla 200 amps or less $60.00
Address. g3 c}$ Sr ( .L� CA n 201 amps to 400 amps $80.00 2
City co;A/1 State 4 01 amps to 600 amps $120.00 2
Zip 97m70 2
601 amps to 1000 amps $180.00
Phone No. 6 - l A ("h Over 1000 amps or volts $340.00 2
Job NO. Reconnect only $50 00 2 -
contractor's license NO. 3- (7 s 4c. Temporary Services or Feeders
Contractor's Board Reg. No. . • Installation, alteration, or relocation
Signature of Supr. Elec'n Cot_‘- 200 amps or less 2
License No. IG O S Phone No. 0 J-13. zo 201 amps to 400 amps $50.00 2
401 amps to 600 amps $75 00
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 without ,
The installation is being made on property I own which is purchase of service or feeder fee. 1 c bV 2
35
not intended for sale, lease or rent.
First branch circuit l $35.00
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: Ov
5a. Enter total of above fees $ -
NOTICE 5% Surcharge (.05 X total fees) $
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. wordlcomdevwec. ❑ Trust Account #
prm app $ ....
Balance Due '_77°/'n• - /�
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection:
Footing Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post /Beam Struct. Plbg. Top Out Elec. Rough -in FINAL:
Post /Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall / Gyp. Bd. - Elect.
Date Requested: k3- i ( 5 S- Time: AM K PM
Address: ( 76 ) ,..5 - 7 -
Builder: C0 /3 30 Permit #: F:L-
THE FOLLOWING CORRECTIONS ARE REQUIRED:
( -
Q 7/ v
Inspector: ' i , ,�� I : f■ Date:JZ �Q 1 -
PPROVED _DISAPPROVED _APPROVED SUBJECT TO ABOVE
_ For Reinsp. Q R Call y
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