12622 SW 115TH AVENUE ADDRESS:
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CITY OF TIGARD
ELECTRICAL PERh1il`
T DEVELOPMENT SERVICES PERMIT #: ELc96-+ 765
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171 DATE ISSUED: 1,12'105196,
PARCEL: 2SI03BD-00100
SITE AD PE t,,". . - : 12.6E-2 SW 115TH S T
SiJIID'.:V I'i'i ON. . , . : HUNTERS GLEN ZO1�I I NG:R-4. S PID
F.LOGi4.. . . . . . . . . . LOT. . . . . . . . . . . . .
'Pr-o.jeclt De�cr_ipt=ion : Installing-temporr-arv-y sect-vice-fora-constr +.rct ion-trailer_
RESTDF..FJTIAt_ +ii�IT-_- - ---TEMP SRVC/FEEDERS----- ------MISCIr_LLANEOUS--•--__
1O110 SF CR LESS. . . . 0 0 - EOk, amp. . . . . . . . 1 PUMP/I RR I GAT I ON. . . - : Q+
EACH faDC!' L_ 500aF'. . . : 0 201 - 400 amp. . . .
„ , : 0 SIGN/OUT LINE I_TG. . : 0
LIMITF_D ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 STGNAI_./PANEI.._. . . . . . . : 0
M1-1uF. 4M/ SVC/FDR. . : 0 601+-amps-11O01Z volts. : 0 MINOR LABEL ( 10) . . . ; 0
_-_.__..3F.-.RV I CE/FEEDER--------- ._.._--BRANCH CIRCUITS.-.------ .___._.ADD' L INSPECT IONS----
12.1 217+O amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPE::CTION. . . . . : 0
201 400 ar+p. . . . . . : 0 1st W/O SRVC OR FDR. : 0 PER HOUR. . . . . . . . . . . : 0
401 - 600 amp. . . . . . : 0 EA ADD' L RRNCH CIRC: 0 IN PLANT.. . . . . . . . . . . 0
(301 - 1000 amp. . . ,. . : 0 -- - _..______._._..____Eil_AN REVIEW SECTION
1000+ amp/ volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . e'+7+_^w__SVC/t=DR_1 =-;--25 AMPS. �c- -�� -_CL.ASS AREA/SPEC OC'C.
Owner: ---________ . FEES ___.
MATRIX DEVELOPME=NT type amot-int by date ecpt
7343
7160 SW HAZ.EL.FERN PRMT $ 50. 00 URA 12/O5/96 96-28.
SUII.E 100 CT `) r. 50 DRA 12/O5/96 96-287343 I
TIGARD OR 97223
Phone #: 6cO-60,.30
Contractor;
GARNER EI_.IECTRIC - ---- - $ 5 -'. 50 TOTAL
21785 SW TV HWY
#L •------- REQUIRED I NFF'
, ECT I ONS --- ..---- _
ALOHA OR 9'7006 --
h'hnne #: --
Ileq #. . 1. 1,6721 _ f
This permit is issued Subject to the regulations contained in the -•-----
T and Munir;pal Code, State of Ore. Specialty Codes and all other l i t t P e i' at+_rr-e
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 1N8 days of issuance, or if work is suspeneed for more _.._.`L _____..____-
than 180 days. ue'� DY
OWNER INSTALLATION -•_-----._--
c. The instellatirn-i is be inn made on rroperty I own which is not intencled for
c� sale, lease, (.,I, rent.
V) OWNER' S S I GNn URE: DATE:
----•--CONTRACTOR II•ISTAI__I_AT I ON
J
iSIGNATURE OF SUPR. ELEC' N: ��- -- — DATE: _
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—' LICENSE NO:
C:al l for, i nsper--tion -- 639-4175
I CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Focting Rain Drain Cov. _ervr' FINAL:
FounrJation Water Line Ceiling %7V Plumb.
Pas;/Beam Mech. Shear/Sheath Framing -Mech.
Pibg,L nd/FIS/Slab Plbg. Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: C1
Date: .1 '�� A.M. // P.H. Entry:
Address: ---
Tenant. Ste: _ MST:
BLIP:
Cor./Own:� '��12/ -J ' _ __ Ir1EC:
PLM:
EI-C:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
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InspActor: _' ' Date: r
APPROVED ,DISAPPROVED/CALL FOR FIEINSP. F CO
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'CITY OF TRiARD Electrical Permit Application) Plan Check li
13125 3W HALL L't_VD. Recd By
Date Recd _
TIGARD OR 97223
Date to P.E.-_
Phone (503)639-4171, x304 Date to DST__
Print or Type
Inspection (503) 639-4175 Incomplete or illegible will not be accepted Permit tt 6�q6
Fax (503)684-7297 Called
1. Job Address: l� 4. Complete Fee Schedule Below:
Name of Development 1 Ytl 11 Number of Inspections per rterm!t allowed
Name(or name of business) - /f� Service included: Items Cost Sum
Addres� rz62 �R 4a. Residential-per unit
1000 sq.it.or Icss $110.00 4
City/State/Zip_'-77f4*f 7A Each additional 500 sq.It.or
- 7 portion thereof $25.00 1
Commercial ❑ Residenti Limited Energy $25.00
Each Manu d Horre or Modular
Dwelling Service or Feeder $60.00 _ 2
2a. Contractor installation only:
(Attach copy of a!jcurrent licenses)-/' /1 4b.Services or Feeders
Electrical COntrartOr 11' Installation,alteration,or relocation
Address � 200 amps or less $60.00 - 2
201 amps to 400 amps $80.00 2
City _ State_Q) Zip !Z3 401 amps to 600 amps $120.00 2
P ty O. ! 2 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec.Cont. Lice. No. Exp.Date (jQ O -'
OR State CCB Reg. No.VY97 Exp.Date_ 1 4c.Temporary Services or Feeders
COT Business Tax or Metro No.�[ �_ExP.Ddte 0 7 2 Installation,alteration,or relocation
200 amps or less
201 amps to 400 amps $75.00 _ 2
Signature of Supr. Elec'n.-�-� 401 amps to 600 amps $100.00 2
l Over 600 amps to 1000 volts,
License Nc _7J Exp.Date LL�_J: ' see"b"above.
Phone No. 4e V OjI �- -_ --- 4d.Branch Circuits
New,alteration or extension per panel
2b. For owner installations: a)The fee for branch cirr.uits with
purchase of service or
Print Owner's Name_ v feeder fee.
AddressEach branch circuit _- $5.00 2
b)The Ice for branch circuits
City_ State_ Zip without pc.rchase of
service or feeder fee.
First uranch circuit _ $35.00 _ 2
The installation is being made on property I own which is not Fach additional branch circuit $5.00 2
intended for sale, lease or rent. 4e.Miscellaneous
(Service or feeder not included)
Owners Signature _ Each pump or irrigation circle _-_ $40.00 _ 2
Each-:Ign 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 Labc's(10) $100.00 -
Please check appropriate item and ente, tee in section 5B.
4 or more residential unils in one Etruc:ture 4f.Each eddiflonal Inspection over
CL Service and feeder 225 amps or mole the allowable In any of the above
Ln System over 600 volts nominal Per In3pection $35.00
> Classified area o.structure containing special occupancy Per hour $55.00
►- as described in N E.C.Chapte-5 In Plant $55.00
J
t *Submit 2 sets of plans with application where any of the above apply. Jr. Fees:
cD Not required for temporary construction service). 5a.Enter total of above fees $ iIT
w 5%Surcharge(.05 X total f,�es) $
-) NOTICE Subtotal $
5b.Enter 250%of line Sa for
PERMITS BECOME Vr)ID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required(Sec.3) $ --
NO) COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCT:(-)N OR WORK Subtotal $ ----
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFF-Pt WORK IS COMMENCED Trust Account ft - IS Total balance Due
I AeSTS\1,LC96 APP Fitt-0196