12173 SW 125TH AVENUE P
ADDRESS:
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ELECTRICAL PERMIT
On' OF T
PERMITISSUED:C09 X 3/96
COMMUNI--✓ IIFVFLOPMENT DEPARTMENT
13125 SW';all Ulwd.Tigard,O.-egan 07223.8199 (503)634-4171 �'ARCF L: -f;i 1171;; D•-I I`' Q1171
SITE_ I il:)rREfJ'1,. . . . 1 1.1;, .�W I.._ i (iVL_
SURD I J I'3I ON. . . . : BRGOKWAY l ON I N(?:R-4. 5
FLOCK. . . . . . . . . . . LOO.. . . . . . . . . . ,.
Fir^ojec:t Description: Installing one branch cit-chit.
-•---RES I riENT I AL UNIT---- ---TEMP' SR VC/FE:EDE RS---- ------M I SCELLANEOU13------
1000 SF= OR I_e_35. . . . : 0 0 - 1700 amp. . . . . . . : 0 PUMP/IRRIGA'rION. . . . : 0
EACH ADD' L 5005)F. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT Lll,.E LTG. . : 0
I._Ilyll TED ENERGY. . . . . n 401 --- 600 tamp. . . . . . . : 0 (•SIGNAL/PANE-_L. . . . . . . : 1/1
MONF. HM/ SVC/F"DR. . : 0 601•+amps--I00CA volts. : 0 MINOR LABEL ( JO) . . . : 0
. --_SERVICE/FEEDER--•--- ._------BRANCH l::If7CUI1S_.___.....___. _.-...--_.ADD' L INSPECTIONS_
Q1 200 amp. . . . . . : 0 W/SERVICE: OR FEEDER: 0 PER INSPECTION. . . . . .. 0
201 4.00 amp. . . . . . : vI 1st: W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 171
401 - 600 amp. . . . . . : 0 EA ADD' L RRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : V
(:O01. - 1000 amp. . . . . : VI _._..____.__.____...___-•-RL_AIJ REVIL"WSECT I
1O00+ amp/volt. . . . . : 0 )=4 RES UNITS. . . . , . . . ) 6O0 VOLT NOMINAL. . :
Reconnect only. . „ . . : 0 SVC/FDR > = 4'25 OMF'S. . : CLASS (AREA/SPDEC OCC. ".
Owner: ____.___._____..._.._._.________----._._._.___.__._-.____.__..----______-- F-'[--.ES
KATHY HARDIN type alno -Int by date recpt
12173 SW 125TH AVE PRMT $ 35. 00 D*A 09/03/56 96263b.16
5PCl $ 1.. 75 D*A 09/03/96, 9612:183516
TIGARD OR 97223
Phone #-
JPCI ELEC"rRICAL SERVICES Ih•G $ ?:,6. 7''1 TOTAL
4040 BE T" ,E=RNAT I ONAL WAY
- - REQUIRED I NSP,ECT I ONS - - --
MILWAUKIG OR 9721*2; Wa' i '-aver r::1ectI 1 E i n a I
Phone #: 5`3-654-332b -:Pct' 1 Service
Rey #. . : 93774
This permit is issued subject to the regulations contained in theIJ I✓G,D _ _
Tigard municipal Code, St,:'e f Ore, Specialty Codes and all other Permittef? Signator^e _-�'-
aprli:abie laws. All work wi;1 be done in accordance wrto
ai.pro+ed plans. This permit will expire if work is n;,t started
within 180 days o+ issuance, or if work is suspended for tore __
_. ._ .._.._.._._.. _..............-
su
than 180 days. Iaed y
---DWIVE F?
INSTALLATION ONLY
The in5tzllation is beim u.nie on property I own which is not intended for,
gale, lease, or, rent.
OWNERI S SIGNATURE: DATES
INSTALLATION
3IGNATURE OF SUF'R. L LEC' N: D
ATE:
C I 1.._I CL'.NSE. NO: .. _ ..__...._....._.__...._.._..._.
C.7
W
Call for- inspection - 639-4175
CITY OF TIGARD 31J�LDING INSPECTION NOTICE
Inspection Line: 639-4115 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Nater Line Ceiling Plumb.
Post/Beam Mech. Shear/Sheath Framing -Mach.
Plbg.Und/Flr/Slab Plbg Top Out Insulation -Elect,
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk
Other: __ _-Q&xf..) -
Date: 0 A.M. .*P.M. Entry:
Address: --
Tenant: — Ste: MST: _
�rBUP:
-7
Con/ iwr �1.L1�_ I— / Y a I MEC: _
/ _ 1 PLM:
t' 7 GUV ION ��� ELC:��Z.
THE FOLIONS LOWING CORREC R�E UIRED: ELK
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Inspector. — Date
APPROVED —DISAPPROVED/CALL FOR REINSR CF CO
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 Mach. Shear/Sheath Framing -Merh.
Plbg.Und/Fir/Slab Plbg.Top Out Insulation <k!l .
Post/Beam Struct. Mach. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: A C q-
Date: -L J — A.M. _P.M. Entry:
Address: . �-1 -7_3
Tenant: Ste: MST: _
r�-q::�,- BLIP:
Con/Own:��C E _ MEC:
PLM:
ELC:�_C1_
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: _
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Inspector. /; -- Date:
_APPROVED _ ISAPPROVED/CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceding -Plumb.
PosVBeam Mech. Shear/Sheath Framing -Mech.
Plbg.Und/Flr/Slab Plbg.Top Out Insulation -Ele
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. ;;ewer Gas Line Appr/Sdwlk
Other:
Date: 7 A.M. _P.M.—_ Entry:
Address: _L4 1:7 T 1 __—
Tenant: Ste:__— MST: _
BUP; �.
Con/Own:_ 7 —' � MEC; —
PLM:
ELC:
THE FOLLOWINC-. CORRECTIONS ARE REQUIRED: ELR:
rqr 4e
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Inspector: den VIP Date
—_APPROVED ISAPPROVFD/CALL FOR REINSP. CF CO
,op I't I I fill
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fit
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AMIA-IN 1 14-1111) 36. 75
Community development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. h
Permii r F'c
Phone (503) 639-4171 Date Issued
CITY OF TIGAftD FAX (503) 684-7297 Issued by
TDD No. (503) 684-2772
Inspection (503) 639-4175 _
1. Job Address: �4. Complete Fee Schedule Below:
Name of Development /1�_/ Number of Inspections per permit allowed
iV
Address_ ), 1 7 I �� T r Service inclu&d Items Cost(ea) Sum
City/State/Zip�, ay" 4a. Reusidenlial-per unit
I `f 1000 aq It or less $11 DO
Name (or name of business) j /A �N moi' H A��n/ Each add4ron,al 500 aq It or I
portion thr real $2500
CommercialEl Residential w Limited Energy ____ V500 _
Eno,Mnmird Home or Modular 2
Dwelling Service or Feeder - $8600
2a. Contractor installation only: 4b.Services or Feeders
Installation,alteration,or relocation 2
Electrical Contractorsi�- St,- C& 200 amps or less $eo 00 2
Address if,PO -56 GO P- 201 arrrps to 400 amps $80 00 2
Z
CiryJrl f 1-UD A" i E State—ZK-- I,-- i �07 401 amps to 600 amps $12000 Zip _ 601 amps to 1000 amps $160 00
Phone No. S - 3 3 a S over 1000 amps or volts $34000
Contractor's License No. ? � - Recortned only $5000
Contractor's Board Reg. No. Coq, -7'7(-/ 4c.Temporary Services or Feeders
Installation,alteration,or relocation 2
Signature of Supr. Elec'n 200 amps or(ass $5000
LIC@nS@ N0. l @ N0, 5 U - ,�S 201 amps to 400 ampa $75 on
401 amps to 600 amps $10000 -y
Over 600 amps to 1000 volts
2b. For owner installations: see•b•above
4d.Branch Circuits
Print Owner's Name _ Now,0eralron or extension per panel
Address a)The lee for branch areu4s wffh
purchase or aeroke or Arealer Are.
city_ St.1e 71p_ Each branch arcud $5 ro _
Phono N0. b)'rhe Ise for Manch aranls without
The installation is being made on property I own which is purchase of"tyke or M.arrr Are.
not Intended for sale, lease or rent. First branch arced �� $ 5 00 3t-s--UNG,
Each additional branch arcud $500
Owner's Signature _ 4a. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation arae -- $40 00 _
Each sign or outline lighting $40 00
Signal circuit(s)or a landed energy
Please check appropriate item and enlw lee in section 58. panel,alteration or extension $40 0.> _
_ 4 or more residential units in one structure Moor Labels(10) Von n0
Service and feeder 225 amps or more
System over 600 volts nominal 4f =ach additional inspection over
Classified area or structure containing special occupancy
the allowable in any of the above
~ as des.;ribed in N E.C. Chapter 5
Per npedion _
1- Per,your �_ t55 00
n In Pleat $5600
>. Submit 2 sets of plans with applicrlion where any of the above `—
t"' apply. Not required for temporary construction services.
.� 5.. Fees: _
-.4 So. Enter total of above fees s 3'S;• o
n NOTICE r 5%Surcharge(05 X total fees) $ -'�� • t
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
Fnter 25%o1 line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Llb. plan Review it required(Sac 3) $ _
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
:OMMENCED. ❑ Trust Account fill $
Balance Due s .3(y .'7
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