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Permit CITY OF T ELECTRICAL PERMIT PERMIT #: ELC2000 -00374 W 16* DEVELOPMENT SERVICES DATE ISSUED: 07/05/2000 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 1 S136DB -02600 SITE ADDRESS: 11201 SW 72ND AVE SUBDIVISION: ZONING: C -G BLOCK: LOT : JURISDICTION: TIG Proiect Description: INSTALLATION OF (3) BRANCH CIRCUITS 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/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 2 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: STEWART, PHYLLIS T AND J + J ELECTRIC INC STEWART TRUST PO BOX 813 621 SW ENGLEWOOD DR ALBANY, OR 97321 LAKE OSWEGO, OR 97034 Phone: Phone: 541 - 928 -7695 Reg #: SUP 3252S LIC 00000322 ELE 22 -3C FEES Required Inspections Type By Date Amount Receipt Elect'l Final PRMT DST 07/05/200C $48.20 0003447 5PCT DST 07/05/200C $3.85 0003447 ORIGINAL Total $52.05 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 of these rules or direct questions to OUNC at (503) 246 -1987. PERMITTEE'S SIGNATURE ISSUED BY: 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: DATE: LICENSE NO: Call 639 -4175 by 7:OOpm for an inspection the next business day 01/19/00 WED 17:37 FAX 503 598 1960 CITY OF TIGARD -e'S l.Y XJ002 .. -CITI OF TIGARD ED Plan Check # Electrical Permit Appl l Recd By 1 A 1 13125 SW HALL BLVD. 3 z .6 TIGARD OR 97223 2 apc7 "o ff JUN 2 9 2000 Date Redd Data tO P.E. Phone (503) 639.4171, x304 i- l.� Date to DST Inspection (603) 639 -4175 Print of TyptomautiilY pEIEWIP IENI. Perm* # . LE. 2000 - 003 Fax (503) 598 -1960 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) //70- )er✓A(../) 3 Service included: Items Cost Sum y Address /a o/ / S4J 741do Ave, 4a. Residential - per unit City /State/Zip 714:1 02 97.2 3 Each additional it or less $ 117.75 4 i Each additional 600 sq. ft. or Commercial El Residential ❑ pardon thereof $ 26.75 1 portion Energy $ 80.00 Each Manufd 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 .T t -.T Cc rZt O. 200 amps or less $ 84.25 2 Address R. nn 1, • /q0)( Pi /3 201 amps l0 400 amps $ 85.50 2 401 amps to 800 amps $ 126.50 2 City A/.Qa�ri State ©� Zip X173° -" 601 amps to 1000 amps $ 192.50 2 • Phone No. 1 9.2.8 - /76q- Over 1000 amps or volts $ 383.75 2 Job No. ,-000-36.3 Reconnect only $ 53.50 2 Elec. Cont. Lice. No. .L.Z jC Exp.Date /0'U /- eo .4c. Temporary Services or Feeders OR State CCB Reg. No. 32-2 Exp.Date 0'/;77 -01 Installation, alteration, or relocation COT Business Tax or Metro No. Date 200 amps or less $ 53.50 2 201 amps to 400 amps $ 80.25 2 Si nature of Su r. EIeC'n /1 c�,� 401 amps to 800 amps $ 107.00 2 9 p -!' Over 600 amps to 1000 volts, see "b" above. License No. 3.2S2S Exp.Dat O -D /- 0..2 4d. Branch Circuits Phone No. .t'/ /= 4 .18. 7445 New, alteration orextension 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 dreult $ 5.35 2 Address b) The fee for branch drerlta without purchase of service City State Zip Phone No. First h circuit t $ 37.50 . g7.S�0 Each additional branch ctrcult .2, , $ 6.35 • n. 7U Miscellaneous The installation is being made on property I own which is not 4e. - Intended for sale, lease or rent. (Service or feeder not Included) Each pump or irrigation drde $ 42.75 Owners Signature Each sign or outline lighting $ 42.75 Signal dreutt(s) or a limited energy 3. Plan Review section of required):* * panel, alteration or extension $ 60.00 i 1 Q �+/ Minor Labels (10) $ 16798 Please check appropriate item and enter fee In section 3B. 4f. Each additional Ina pection over /404, 4 or more residential units in one structure the allowable in any of the above Service and feeder 225 amps or more Per hour tlon $ 50.00 Per hour $ 50.00 System over 800 volts nominal In Plant $ 59.00 Classified area or structure containing spedal occupancy as described in N.E.C. Chapter 6 5. Fees: Eider total of above fees $ 48.,2 * Submit 2 sets of plans vrlth applicatiorrwhere any of the above apply. $v5 & Surcharge (O&X total fees) $ 32 .b Not required for temporary construction services. Subtotal ' ar $ 6b. Enter 25% of line 6a 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 FORA PERIOD OF 180 DAYS ❑ Trust Account # AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ S p ' is \dstslforms \efectric.doc JAN -19 -2000 17:42 503 598 1960 P.002