10135 SW KATHERINE STREET 0
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ir1TT #: EC9C:--0vr1SCITY
f"1=R
DATE ISSUED: 0111011r,
COMMUNITY DEVELOPMENT DEPARTMENT
13126 8W Hall 91vd.Tigard,Oregon 97223n6190 (603)630.4171 PARCEL: I._135CC__03000
)ITE FaDDRESS. . . 10135 SW KATHE:R T NE S?'
UDDIVISION. . . . : GREENBURG HEIGHTS .1DDITIGhr ZONING: R-•4. 5 OLOCI1� -%. . . . . . . . . . . LOT. . . . . . . . . . . . . : 1.
'''rrr,ject Descriotion: Install three branch Circuits.
--REE�IDENTIAL UNT7*--._..- SRVC/FEEwLtRS- --- ---•--MISCELLANEOUS-•_-
1000 SF OR LESS. . . . : 0 0 - 200 ,amp. . . . . , . r 17J PUMP/IRRIGATION. . . . ; 0
TACH ADD' L 500SF. . . : 0 201 - 420 amp. . . . . . . : 0 S I ON/OUT L.I NE L TG. . 0
LIMITED ENEPOY. . . . . . 0 401 600 4amp. . . . . . . . 0 31GNAL/PANE L. . . . . . . :r t)
MANF. EaM/ SVC/FDR. . : 0 6014 amts- 1000 volts. : 0 MI PJOR LASEL (10) . , . s 0
_.....-SE RVT(:C/F('EDER _ _.._.._BRANCH CIRCUITS..__.__....-. .ADD' l_ INSPECTIONS—-
0 .'00 amp. . . . . . .. 0 W/SE'RVICE OR FEEDER: 0 PPR TNSDECTIIIN. . . . . : 0
201 - 400 amp. . . . . . : 0 1st W/0 SRVC OR FDR. : 1 PER HOUR. . . . . „ . . , . . t�
401 600 M m p. . .. . . . : 0 EA ADD' L BRNCH CIRC: 2 IN PLANT. . . . . . . . . . . s 0
(�01 - 1000 amp. . . . . : 11) _PLAN REVIEW GEC TI01V__
10024 e-t,np/volt. . . . . .. 0 ) w4 RES UNITB. . . . . . . . r ) 600 VOLT NOMINAL. . :
Reconnect oniv. . , . . : 0 SVC/FDF ) = 2.2,5 AMpS. , s CLASS .1RCAI'5PE�C 0(--C.
Owner: FEES
ELLCTRTCAL. CONTRACTORS tvpeamr, .rntr ^ by riat p ~--T_pc.p}..._ . ..
150 NE VICTORY PRMT $ 45. 00 CJS 01/10/96 96-274766
SUTTE- n SaC.T $ 2. 25 CJS3 01/10/96 96 -2,74 7
GRESHAM OR 97030
Phone #: 503__666--93510
Contract or z
P'31)E' 6 47. 25 ro,rAc..
REDU I RE'D I NGPE:CT I ONS,
Ier.:'t' 1 Sprvrrrp
Req E'1'ar'e : Elect' I Final
This permit is issued subject to the regulations contained in the
Tigard Municipal Code. State of pre. Specialty Codes and all other e_rmittee Sicinature ��
applice le law;. All work will be done in accordance with
aporoved plans. This cereit will expirr it .cork is not started
within IPA days of issuance. or if work is suspended for soregTr s' ���"14
than 180 days. 11-1
I551.tecl By
INSTALLATION OM._r---. .
The installation is being m.:,Ac1e on property I own which i � .,ot intended for-
lease. or rpnt,.
, WNER1 S SIGNATURE~: rs1TF:
I NSTALLAT I OI\i ONLY- --- --
SIGNATURE'
NLY_ -----._ ._ICdNATUE2E OF SLJi"'K. E'LEr'1N: / je .!/r.. .__ ,._. ._.. .. ..-_ DATE :
L I CE.NSF 1\10:
Call i or^ in=•rection 639--4175
i
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # '96- ,1?
Permit # 0zC96-on,, -
Phone (503) 639-4171 Date Issued
OF TIGARD FAX (503) 684-7297 Issued b' -S,
CITY
TDD No. (503) 684-2.772 - C� �`�
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below: —�
Name, of Development__— � _ Number of Inspections per permit allow-d
Address1O 1 3 5 S W . K a t h e r i n E-- Srt,vice included Items Cost(ea) Sum
City/State/Zip_Li-g-i;Lr d 4a. Residential. per unit "
1000 eq h or lees $11000 _
Nameor name of business Fath nddiliorud 500 sq it or
( )s portion thereof $21,00 '
i
Commercial❑ Residential® Each
Energy $2500
k
Each Manul'd Home 0i Modular 2
Dwell ,b Service or Frieder -_ $6C 00
2a. Contractor installation only: 4b.Services or Feeders
UgitFa�r011 c a 1 Contractors & Des i y n rslellahon,allnration or relocat on
F lectrlcal Ff 200 nmpc.or lose $60 00
Address- u E +F . V i t o r4_S11-i t P_ A 201 amps to 400 amps $8000 2
-fir - c 401 amps 10 600 amps $12000
City-1'ir P r,ha In State n r p, Zip q 7 1-10 601 amps to 1n00 amps $18000 2
Phone No ()66-9358 over 1000 amps or voha _— $14000
Contractor's License No..._2_6 Reconnect only $5000
.4 6 6 C__
Contractor's Board Reg, No. 4 7 7 12 _
4c. Temporary Services or Feeders
( /,
Installation200amps
of less or relucahon 2
Signature of Supr. Elec'n _ (a -_ 200 amps or lass $`+0 00
11
License No. 7 p p � Phone NO �.-9 3 J 8 201 amps to 400 am on $11,00
-1.t11LL..�. .... 401 amps to 600 amps $10000
Over 600 amps 10 1000 volts
2b. For owner installations: see•b•above
4d. Branch Circuits
Print Owner's Narne _ New efleration or 9x1ension per panel
Address n)The Ise for oranch circuits with
City state-- Zi- -- purchase or wrvba or bottler Me.
Zip_____ Each branch circuit $b n0
Phone No. - _ h)The fes for branch circuits without
The installation is being made on property I own which is purchase of Pervice or Mees M..
not Intended for sale, lease or rent.
First Eaach addAdds h slabs$ _ $ 5 00
,ornl brands circa,' $
$5 00 �V U -
Owner's Signature 4e. Miscellaneous
(Service or feeder not included)
3. Plan Review section (it required): Each pump or irrigation circle $4000
cath sign or outline lighting $4000
,ognal cirruil(s)or a limited anorgy
Please check appropriate item and ente•lee in section 5B. panel aReratiun or arienston $4000
4 or more residential'hilts in one structure Minor I Ahnls jIC) ^-_ $10000
Ser✓ic(,and feeder 225 amps or more
System over 610 volts nominal 41. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as describod in N E C Chapter 5 Par haps Dori -_- $3500
Per hour E55
5 00 _
In Pinot - $5500
Submit 2 sets of plans with application w►:dre any r)I the above ^� _
apply. Not required for temporary constructs-n services. 5. trees:
NOTICE 5s. Enter total of above fops $ 4-5 -00
5%Surcharge(05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT ;OMMENCED WITHIN i8n DAYS,OR IF 5b. Enter 25°/of linin A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Revieo if roquired(Se, 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTERWORK IS Subtotal $
COMMENCED 1-1 Trust Account N
Balance Due $ 47 . 25
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