Permit CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
' PERMIT #: ELC97 -0309
'!� - - --- 13125 SW Hall Blvd., Ti Tigard, OR 97223 503 639.4171 DATE ISSUED: 05/27/97
PARCEL: 2S1O4CA -05700
SITE ADDRESS...:13659 SW WESTRIDGE TERR
SUBDIVISION •HILLSHIRE ZONING:R -7 PD
BLOCK LOT °057 JURISDICTION: TIG
Project Description: INSTL 1 BRANCH CIRCUIT // JOB # ?
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION 0
EACH ADD'L 5O0SF...: 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
BRIAN O'DONALD type amount by date recpt
13659 SW WESTRIDGE TER PRMT $ 35.00 TAT 05/27/97 97- 294632
TIGARD OR 97223 5PCT $ 1.75 TAT 05/27/97 97- 294632
Phone #:
Contractor:
GRF ELECTRIC $ 36.75 TOTAL
15460 SE PARADISE LN
REQUIRED INSPECTIONS
MULINO OR 97042 Ceiling Cover Underground Cove
Phone #: 503 -829 -4146 Wall Cover Elect'l Service
Reg #..: 001015
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm e Si g n a e
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 more J
than 180 days. I ued 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
SIGNATURE OF SUP R. ELEC' N : ��I, DATE:
LICENSE NO: 3o 35
Call for inspection — 639 -4175
1
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST 0 3 a
Inspection (503) 639 -4175 Print or Type Permit # L # ''9
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development �J Number of Inspections per permit allowed
Name (or name of business) l/`I yi . 9 t D Vl (n) l� V Service included: Items Cost Sum
I
Address 1 3 LP S1 S � we S t r e. 4a. Residential - per unit
i r ,L OF . T r_. Each additional it ional 500 sq. ft. or or less $110.00 4
City /State /Zip Li 4 � '� Each addit
J portion thereof $25.00 1
Commercial ❑ Residentia Limited Energy $25.00
I 1 Z 3 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 6 12F E7t'r .41.-t� Installation, alteration, or relocation
< < ,p 200 amps or less $60.00 2
Address -
,�j0 5, Y� d (/1 201 amps to 400 amps $80.00 2
City M ( , t I i i d State 1` Zip 9-70 Z 401 amps to 600 amps $120.00 2
Phone No. b .-ci-- 4-%, 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 2Lo -1-1 C.- Exp.Date to/ 2q 15 7 Reconnect only $50.00 2
OR State CCB Reg. No. ) 0 I' 3 Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No.
r. Elec'n . Exp.Date " if ' Installation, alteration, or relocation
200 amps or less $50.00 2
Si of Su '�� 201 amps to 400 amps
$75.00 2
Signature p ,! ��J 401 amps to 600 amps $100.00 2
3 � Over 600 amps to 1000 volts,
�(��
License No. (/) Exp.Date see "b" above.
Phone No. ,.4- - 4-1
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. 3 C
First branch circuit i $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 z
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
panel, alteration or extension $40.00 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 Inspection over
Service and feeder 225 amps or more the allowable in any of the 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 s ets of plans with application where any of the above apply. 5. Fees: '3 �^ r, S
Not required for temporary construction services. 5a. Enter total of above fees $ 7
5% Surcharge (.05 X total fees) $ i
NOTICE Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY 3 (' - TIME AFTER WORK IS COMMENCED. El Trust Account #
Total balance Due $
I \DSTS \ELC96 APP Rev 9/96
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
• 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171 .
Date Requested: S- 1>1 \ 9,1 A.M. P.M._ MST:
Location: ' 7) 6 5 W L .[./X�.0 ) BUP:
Tenant: Suite: Bldg: MEC:q 7 Q f 3 L
Contractor: . r Phone: p-7-,3 q-06, I ( PLM:
Owner: Phone: ELC:
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct - Reconnect Vault
Bsmt Damp Drywall Storm . Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Hem, u p Low Volt
Approved - Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved roved Not Approved Not Approved
FINAL • FINAL IN FINAL FINAL •
•
1 1
a l ...-- 76
•
� n
. 1 cr/
�f '
O Call for re' tion O Reinspection fee of $ , V required befor next inspection O Unable to inspect
Inspector: Date: 3 01' 5 / ' 7 Page of