Permit C I TY OF. T A D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00741
Kr _�� I , DEVELOPMENT SERVICES DATE ISSUED: 12/13/1999
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1SI36DD -03700
SITE ADDRESS: 11725 SW 67TH AVE
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT : 008 JURISDICTION: TIG
Proiect Description: Installation, alteration, or relocation of a 200 AMP service /feeder.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVCI FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
LARSON, IRVING L /JENNIE E TRS OREGON ELECTRIC CONST /GROUP
BY JUDY L STROJNY 1010 SE 11TH AVE
555 CHESTERTOWN ST . PORTLAND, OR 97214
GAITHERSBURG, MD 20878
Phone: Phone: 234 -9900
Reg #: LIC 203
SUP 1302S
ELE 26 -95C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT GEO 12/13/199E $64.25 99- 320366 Elect'I Final
5PCT GEO 12/13/1999 $5.14 99- 320366 ORIGINA!
Total $69.39 L
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 - 0010 through OAR 952 - 001 - 0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE a - ISSUED BYA � _.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 6*'-t/ o DATE: la
LICENSE NO: 064-K5
Call 639 -4175 by 7:OOpm for an inspection the next business day
•
CITY OF TIGARD Plan
13125 SW HALL BLV EPECEIVE � '' Electrical Permit Application Recd By
-
TIoARDOR 97223 DEC 0 91999 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 63 IMUNITY DEVELUI�Muo Print Of Type ��� Pem,it # f ?cif
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: i Z-I ci 1 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) ca sh' s Rea 11 y Service included: Items Cost Sum
Address 1 1 7 2 5 SW 6 7 th 4a. Residential - per unit
City/State /Zip T i g a r d OR 9 7 2 2 3 1000 sq. ft. or less $ 117.75 4
Each additional 500 sq. ft. or
portion thereof $ 26.25 1
Commercial C Residential ❑ Limited Energy $ 60.00
Each Manut'd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders_ __ _ - - - --
information for COT data base). - ----` - - -- - - Installation, alteration, or relocation
Electrical Contractor Oregon Electric Group 200 amps or less j 1 $ 64.25 6 4.2 5 2
Address 1 01 0 SE 1 1 t- h A V P - 201 amps to 400 amps $ 85.50 2
City Portland State OR Zip 9721 4 401 amps to 600 amps _ $ 128.50 2
601 amps to 1000 amps $ 192.50 2
Phone No. i 2 3 4- 9 9 0 0 Over 1000 amps or volts $ 363.75 2
Job No. 81%3 % S 5C Reconnect only _ $ 53.50 2
Elec. Cont. Lice. No. b Exp.Date 4c. Temporary Services or Feeders
OR State CCB Reg. No. 2 0 3 Exp.Date Installation, alteration, or relocation
COT Business Tax or Metro o. Exp. a 200 amps or less _ $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n I 401 amps to 600 amps $ 107.00 2
.,e► Over 600 amps to 1000 volts,
see "b" above.
License No. 2 0 6 45 Exp.Date
Phone No. 2 3 4-9 9 0 0 4d. Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Address • b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
panel, alteration or extension $ 60.00
3. Plan Review section (if required): * Minor Labels (10) $ 107.00
Please check appropriate item and enter fee in section 5:. 4f. Each additional inspection over
4 or more residential units in one structure PCI the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as •
described in N.E.C. Chapter 5 5. Fees:
5a. Enter total of above fees $ 6 4.2 5
* Submit 2 sets of plans with application where any of the above apply. 8 %IeV0 Surcharge (.05 X total fees) $
Not required for temporary construction services. Subtotal $ 5 . 1 4
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ - 3
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