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CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC'37--0772
DEVELOPMENT SERVICES DATE ISSUED: 1. 1/21/97
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-41/1
PARCEL: 2S113AD-01800
SITE ADDRESS. . . : 16708 SW *72ND AVE #PRV1
SUBDIVISION. . . . : ROSEWOOD ACRE TRACTS ZONING: I--L-
SLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :0 1 1. JURISDICTION: TI(3
Project Descr-iption : Installation of one service or feeder at 200 amps or less.
---RESIDENTIAL UNI'*[----- ----TEMP SRVC/FEEDERS---- ------MISCELLANEOUS-- —
1000 SF OR LESS. . . . : 0 0 — 2-.'00 amp. . . . . . . : 0 PUMP/I RR I GAT I ON. . . . : 0
EACH ADD' L 500SF. . . : 0 201. — 400 Amp. . . . . . . : 0 bIGN/OUT LINE LTG. . : 0
LIMITED ENERGY. . . . . : 0 401 — 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
MANF. HM/ SVC/F*DR. . : 0 601+amps-1000 Volts. : 0 MINOR LABEL ( 10) . . . : 0
-
----SERVICE/FEEDER------ ----BRANCH CIRCUITS------ INSPECTIONS----
01 — 200 amp. . . . . . : I W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
x'01 — 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. ; 0 PER HOUR. . . . . . . . . . . . 0
401. — 600 amp. . . . . . : 0 EA ADD' L.. BFRNCH CIRC: 0 r,LANT. . . . . . . . . . . .. 0
F01 — le00 amp,. . . . . : 0 REVIEW SECTION---- - - ------- --
1000+
ECTION----
1000+ amp/vol.t. . . . . 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect Lnly. . . . . 0 SVC/FDR ) = 225 AMPS. . : CLASS AREA/SPEC OCC. :
Owner-: FEES
PACTRUST type amoi.tnt by date r-ecpt
16708 9W 72ND PRMT $ 60. 00 TJH 11/21/97 97-301. 1.31
TIGARD OR 97223 5PCT $ 3. 00 TJ11 11 /21/97 97-301131
Phone #:
Contractor: -----------------------------------------------------------------------
DACHOFNEr ELECTRIC INC $ 63. 00 TOTAL.
55 SE MAIN
REOUIRED INSPECTIONS
PORTLAND OR 97214 Ceiling Cover- Elect' l Service
Phone #: 233-2006 Wall Cover- Elect' l Final
Reg #. . : 000445
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Statp of Oregon Specialty Codes and all other
applicably laws. All work will be done in accordance with approved plans. This p2reit will expire if work is not started within 180
days of issuance, or if work is suspen-ed for sore :han 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center, Those rules are set forth in DAR W-NI-NIP through OAR 952-001-1987. You may obtain a copy
of these rules ur direct questions tij %W, by calling (503)246-1987,
a. -1 - -J
I et,m i t t P e S i gnat i-ir-e - /, 0, U
J!d1be( Isis,_tecl By : V-,4, 4,,il A
----OWNER INSTALLATION
The installation is being made on property I own which is not intended for-
sale, lease, or rent.
OWNER' S SIGNATURE : DATE:
Ln
INSTALLATION ONLY-------------------------------
SIGNATURE OF SUPR. ELECIN: DATE:
LICENSE NO:
4-++++++++-F-+.........f-++4-V++-t-+++4++++++--1.4-+++4•.......++4.....+++++++++++++++++++4...
Call 639-4175 by 7:00 p. m. for- an inspection needed the next bi-isiness day
+++4-+++++4-++++-4 4.............4......4.......11........... ......................J-++4.
rd
CITY OF TIGARD Electrical Permit Application Plan Check# r\+
13125 SW HALL BLVD, Reo'd By 1 c
Date Recd __)
TIGARD OR 97223
Date to P.E.
Phone (503)639-4171, x304 Date to DST_ 1112-110
Inspection (503) 639-4175 Print or Type Permit#
Fax (503) 684-7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below.
Name of Development_ Number of Inspections per permit allowed
Name (or name of business)_Pac`rust Service included: Items Cost Sum
Address 16708 Sl 72rd4a. Residential-per unit
1000 sq.11.or less $11000 __ q
City/State/Zip_ icim l CR Each additional 500 sq.It.or
Commercial® Residential❑ portion thereof $25.00
Limited Energy � $25.00
Each Manut'd Home or Modular
D _
2a. Contractor installation only: welling Service or Feeder $68.00
(Attach copy of all current licenses) 4b.Services or Feeders
Electrical Contractor E13id-of r lite 1Cr DL-. Installation,alteration,or relocation
200 amps or less 1 $60.00 `60_00_
Address 1;r; GR Nhin 201 amps to 400 amps $80.00
City Fctlalyd State CR Zip- 97214 401 amps to 600 amps $120.00 2
Phone No. (ci(1 ) 233-200 601 amps to 1000 amps $180.00 2
Job No. 6418Over 1000 amps or volts $340.00 _ 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 26451C _Exp.Datew,98 -_
OR State CCB Reg. No. 445a9 Exp.Date 3/r,198 _ 4c.Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date __ installation,alteration,or relocation
200 amps or less $50.00 _� 2
Signature of Si I r. Elect 201 amps to 400 amps $75.00 2
9 p -- 401 amps to 600 amps $100.00 2
Over 600 ampb to 1000 volts,
License Nc 2i308S E ate 10/1/98 see"b"above.
Phone 4 (503) 233-2006
- - - 4d.Branch Circuits
New,alteration or extension per panel
2b. For owner installations: a)The tee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each bram.h circuit $5.00
Cit State Zip b)The fee for branch circuits
Y P without purchase of
Phone No. service or feeder in.
First branch circuit $35.00 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. 4r,,Miscellaneous
iService or feeder not Included)
Owners Signature __. Each pump or irrigation circle $40.00Each sign or outline lighting $40.00
3. Plan Review section (if required) Signal circult(s)or o limited energy
panel,alteration or extension $40.00
Please check appropriate item and enter fee in section 5B. Minor Labels(10) $100.00
4 or more residential units in one ntructure 4L 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 $5500
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. 5. Fees: 60.00
Not required for temporary construction services. 5a.Enter total of above fees $
5%Surcharge(.05 X total fees) $ -J'�--
NOTICE Subtotal $ --- -
5b.Enter 25%of line Be for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review If require (Sec.3) $ ----
NOT COMMENCED WITHIN 160 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ - -
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 160 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. El Trust Account# ._
Total balance Due $
I'll°.1•'r,(,"AIr 1-1-.,X.,