Permit CITY OFTIGARD .
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~ � ,H�,, . ��� � �,���� ; i � DEVELOPMENT SERVICE ELECT �C L PERMIT
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PERMIT * . E L C 37--0166
DATE ISSUED: 03/31/97
PARCEL: S 134A:,- 026 Z!4
SITE ADD;RESS... , s :L 13 7:5 SW COTTONWOOD LN
'_: U la i V i 5I ON . CN!SL.L_WOOD t,!C. S , ZONING = R--•4, 5
BLOCt.. ....,a .... . LOT....... n .... , ° :i 61 JURISDICTION= TIC : '
Project Description: instl l branch circuit ' .
---RESIDENTIAL ON.IT_____ _- -- -ffTENP SRVC /FEEDERS- -- --
--MISCELLANEOUS-- 1 !00 SF CR LESS. . . _ : 0 0 -- 200 amp... , .... 0 PUMP/IRRIGATION....: 0
EACH Alai:?' L 500SF. , .: 0 201 -- 400 amp—.....: 0 SIGN/OUT LINE LTG-2 0
LIMITED ENERSY.. , .. , 0 401 -- 600 amp.. , .. .: 0 SIGNAL /PANE.L. , . „ .. , 0
31 Nt a HM/ VC /FDR..: 0 SOH-amps-1000 volts.. 0 MINOR LABEL (10i .. , o 0
----SERVICE/FEEDER---- ----BRANCH CIRCUITS -- -ADDS L INSPECTIONS_- -
0 - 200 amp<, . „ . . 0 W/ SERVICE OR FEEDER:, 0 PER INSPECTION, .. , . 0
201 -• 400 amp= .....: 0 1st W/0 'SRV'C OR FDR= ; 1 ' PER HOUR,. n z .. = u > w 0
401 - 61- p.'. a .. . 0 EA ADD' L B_ RNCH. t.: I RC: 0 IN ,'PL ANT . , , ... , 0 •
601 - 1000 amp . a , . • 0 ------ .------ __- .---- . - -PL.. IN REVIEW SECT I ON-- _- .- - - - - -- _.- -."_
1000+ amp /volt.... _ . 0 ? =4 RES UNITS. , 9 „ .... o ? 600 VOLT 'NL)N.INt=;!.....
Reconnect only.....: 0 SVC /FDR > _ 225 AMPS.. : CLASS AREA /SPEC 000.
MAR, BUESCH type amoe_int by d t e recpt
11375 SW COTTONWOOD LN PRMT $ 35. 00 TAA 03/31./97 97-292456
-L IGARD OR 97223 5PC,T ., 1.75 TAT 03/31/97 97- 292456
Phbne . *: . ,
Contractor: -------------------
PHOENI X ELECTRIC CO $ 36. 75 TOTAL
7379 SW TECH CENTER DR. . '
--- - - - - -- REQUIRED INSPECTIONS --- -----
TIGARD OR 97223 Ceilinri Cover Underground Cove
Phone : 503 -664 -3600 Wal:!. Cover Elect',I Service -
Reg 1`.. 000026 '
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This percit is issued subject to the regulations contained in the i _ // ' '
Tigard Municipal Code, State of Ore. Specialty Codes and all other Pe rm i t t e e Signature
applicable laws. All work will be done in accordance with •
•
approved plans. This per ^it will expire if work is not started /
within 1813 days of issuance, or if work is suspended for care ___ _. _ _ __ _ ______
than IN days. . I s s. -,ed By
----- ___- .-- - - - - -•-----: . ff._DNN1 R INSTALLATION ONLY--- -- -• - - - ------•-- -•___.___
ThP installation is being,niade on property I 'own -which is ndt intended for
sale, leases or rent.. , .
OWNERS SIGNATURE: ___ DATEa �__.. -__ _._ ._. _
__-_----------- .-- .-- .- .- __-- _-- .-- -- - - -- CONTRACTOR INSTALLATION ONLY _____________________
ST.GNATURE OF SUPR. EL EC' N o DATE o '
LICENSE NO
Call • cr inspection,- 639- -,4i.75
CITY 6F 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 Print or Type Date to DST
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # e1�'_9l ),WO
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Y "R� Number of Inspections per permit allowed
Name (or name of business) lLV' 11 Service included: Items Cost Sum
Address \ ‘- ' S �LA� C14\1_ t
I a u o 'r 4a. Residential - per unit
Ci /State /Zi l000 sq. ft. or less $110.00 4
ty p � O O q1a L Each additional 500 sq. ft. or
Commercial ❑ Residenti portion thereof $25.00 1
L imited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy • . I current licenses) _ 4b. Services or Feeders
Installation, alteration, or relocation
Electrical Contractor : r • A • .c.... , 11004 200 amps or less $60.00 2
Addr - `1M 201 amps to 400 amps $80.00 2
Ci s. • .. State • P Zip Ism 401 amps to 600 amps $120.00 2
Phone N• 550 - _ 601 amps to 1000 amps $180.00 2
Job No. II_ k I -. ... -_• •P.... ., , Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 34 Exp.Date t o l l 9
OR State CCB Reg. No. S-W e- Exp.Date t).p.3 7 4c. Temporary Services or Feeders
COT Business Tax or Metro No.� - SSG. Exp.Date lit 31 2 Installation, alteration, or relocation
1 200 amps or less $50.00 2
Signature of Supr. Elec'n 04 201 amps to 400 amp $75.00 2 -
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. /yD 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. �c 7�
First branch circuit N $35.00 S •o 2
The installation is being made on property I own which is not Each additional branch circuit $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
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 sets of plans with application where any of the above apply. S. Fees:
Not required for temporary construction services. 5a. Enter total of above fees $ en
5% Surcharge (.05 X total fees) $ t�
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
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ w / - .
Total balance Due
I. \DSTS \ELC96 APP Rev 9/96
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation E e
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: , /7fri1 A.M. P.M. Entry:
Address: r / :" 5' x _teL0 --cP ft
Tenant: Ste: MST:
BUP:
Con /Own: MEC:
PLM: a
ELC: MIO i-
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
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C �/ C 92 fec e
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Inspector`/ ` / (C-' - e ■ Lc .� / Date: y� X77
APPROVED _ DISAPPROVED /CALL FOR REINSP. CO
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