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113-/0 SW ER:TE PLACE
CITY OF TIGARD
DEVELOPIAE'AT SERVICES ELECTRICAL PERMIT
13125 SW Nall Blvd., Pard,OR 97223 (503)679.4171 PERMIT #: ELC96--07 9:3
DATF•' ISSUED: 12/17/96
F•'ARCEL_: 2'5103DB094OO
SITE ADDRESS— c 11:370 SW ERSTE PL
SURD I V J S J ON. . . . :: GENESIS NO. 3 ZONING: R 4. 5
RLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :B I.
Project Descr-iption: add 1 branch cir•cr.iit
---RESIDE N f IAI...
UNIT------ ----TEMP SRVC/FEEDERS---_-- -----MISCELI_ANFOLJS--_...
1000 9F OR LESS. . . . : 0 0 – 200 amp. . . . . . . : 0 NI.JMP/I RR I GAT I ON. . . . : 0
(MACH ADD' L_ 500SF. . . : 0 201. – 400 amp. . . . . . . : 0 Si GN/OUT L..INE LTG. . : 0
I .I11ITED F_'NE:RCY. . . . . : 0 401 - 600 amp. . . . . . . . i0 SIGNAL_/F'ANEI_. . . . . . . .. Vi
MANF, HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . _ :. : 0
. - ---SERV I CF/FEEDER _. _ -.__BRANCH (_;I RCLI I TS__-___._ _-_._.ADii' 1.. I N SPECT J ON 5----
0 – 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
201 4O0 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 F'F_.R HOUR. . . . . . . . . . . : 0
40.1 (;OO ,amp. . . . . . : 0 EA ADD' L. PRNCH CIRC: 0 IN PLANT. . . . . . . . . . . 0
601 1000 amp. . . . . : 0 -_____...__...__---._ ----.-------PL_AN REVIEW
1000+ amp/volt. . . . . : 0 ) -4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR ) = 2:25 AMPS. . : CLASS AREA/SPEC OCC. :
Owner', __._._._..______.___.____________–______-----______–______.__.__. FFEg
TClirl AIIEYTA type amount by crate r,ecpt
11370 SW ERSTE PRMT $ 35. 00 TAT 12/17/96 96-287846
5PCT $ 1 . 75) TAT 12/ 17/96, 96-1 '87F46
TIGARD OR 97223
Ph ne #-
PHOEN T X ELECTRIC CO $ 36. 75 TOTAL_
77q SW TECH CENTER DR.
_---- -- REQUIRED INSPECTIONS
11GARD OR 97223 Ceiling Cover- Under-gro1_rnd Cove
Phone #: 503-684-,3'f=,00 Wall Cover Eler-t' l Service
Reg it : 26,47
Thio permit is issued subject to the regulations contained in the
Tigard Municipal Code, Stat? of Ore. Specialty Codes and all other Per'mitt Signatiar,e,..7
applicat:,- 'laws. Al' Mork will be done in accordance with I '
approved flrns. This permit will expire if work is not started r
wit►in IN olys of issuance, or if work is suspended for more _
than 180 days. I S s 1_r
I NST ALLA l ICN ONL_Y----•---- ._.
The installation is being made on property I own which is not intended for
1pasf ,, or• r-pnt .
OWNER' S SIGNATURE: DATE:
INSTALLATION
91 GNATURE OF SUPR. EL.EC' N: _ � _ DA T'E:
i_T CF"NSE NO:
Call for, inspection – 639-4175
Community Development ELECTRICAL, PERM'T APPLICATION
13125 SW Hall Blvd.
Tigard, OR 9/223 Permit # _. L
Date Issued
Phone (503) 639-4171
CITY OF TlGARD FAX (503) 684-7297
TDD No. ( 103) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Sch^dule Below:
Name of Development r Number of Insoections per permit allowed
Address.��JO ,:>L<J [�_�(� - Service included Items :ost(ea) SUM
City/State/Zip C10t. �-1 �� 4a. Residential -per unit
C 1000 sq. ft or lass $l to on
Name (or name of business es 2iS _ F.ach additional 500 sq It.or
portion thereof $25 00 _
Commercial ❑ Residential Limited Energy $2500
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services Or Feeders
Installation,afleration,or relocation
Electrical Contractor -i Dr 200 amps or leas $6000 2
Ad `-'-j LIL I r(' e r' 201 amps to 400 amps $80.00 2
City Stat -_ Zip 401 amps to 900 amps $120.00 _ 2
601 amps to 1000 amps $18000, 2
Phone fww Over 1000 amps or vans $34000 2
Job NO. x/14'1_ Recunnect only $5000 z
contractor's- license NO. ! �� _
No. 4c. Temporary Services or Feeders
Contractor's Board Reg. ��� _ Installation,alteration,or relocation
Signature of Supr. Elec'nffe 200 amps or less
License No. jG/Q� Onw-e NO S 201 amps to 400 amps $50 00
401 snips to 600 amps $75.00
Over 600 amps to 1000 vofls $100.00 ----
2b. For owner installations: see"b"above
40. 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.
Eacf branch circuit $5.00
Phone No. _ b)The tee for branch circuits without
The installation is being made on property I own which is Purchase of service orfow%rfee. 2
not intended for sale, lease or rent. First blanch circuit $3500
each adddlonel branch circuit $500
Owner's Signature 4e. Miscellaneous
(Service or feeder not included)
3. Plan Review section Of required): Each pump or Irrigation circle $4000
Each sign or outllne lighting $40 DO
Signal circufl(s)or a limited energy
Please check appropriate Item and enter fee in section bB. panel,alteration or extension $40 00
_ 4 or more residential units in one structure Minor Labels(to) $100 00
Service and feeder 225 amps or
—__ 4f. Each additional inspection over
System over 600 volts nominal
the all
Classified area or structure containing special occupancy ion
ectin any of t11e above
Per
as described in N E C Chapter 5 Per hour hour ion $35.00
$58.00 _
In Plant _ $55.00
Submit 2 sets of plans with application where any of the above
apply_ Not required for temporary construction services. F, Fees: _
5a. Enter total of above fees s -�• � ��
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) s _
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK 1S Subtotal $
COMMENCED F] Trust Account #
$ _
Mm•IM
Balance Due