Permit ELECTRICAL PERMIT
CIN O F T I CARD PERMIT 02/0889
_.�
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
•
PARCEL : 2511 2AA -00100
SITE ADDRESS...: 14100 SW 72ND AVE
SUBDIVISION ZONING: .
BLOCK LOT ............. .
Project Description: ELECTRICAL PERMIT FOR ONE SIGNAL CIRCUIT /OUTLINE.
- -- RESIDENTIAL UNIT - - -- ---TEMP SRVC /FEEDERS - - -- ----- MISCELLANEOUS - - - --
1000 SF OR LESS • 0 0 - 200 amp • 0 PUMP /IRRIGATION.... : 0
EACH ADD'L 500SF...: 0 201 - 400 amp • 0 SIGN /OUT LINE LTG..: 1
LIMITED ENERGY • 0 401 - 600 amp.......: 0 SIGNAL /PANEL.......: 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- -- ----BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 - 200 amp • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 - 400 amp......: 0 1st W/O SRVC OR FDR.: 0 PER HOUR...........: 0
401 - 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT . - 0
601 - 1000 amp.....: 0 - -- PLAN REVIEW SECTION -- - - --
1000+ amp /volt • 0 > =4 RES UNITS • > 600 VOLT NOMINAL..:
Reconnect o n l y • 0 SVC /FDR > = 25 AMPS.. : CLASS AREA /SPEC OCC. :
Owner: -. - - - -- - - - - - -- FEES -• - - --
WILLIAMS CONTROL type amount by date recpt
14100 SW 72ND PRMT $ 40.00 JMH 02/08/96 96- 275761
5PCT $ 2.00 JMH 02/08/96 96- 275761
PORTLAND OR 97221
Phone #:
Contractor: ---- ---- - - - - -•
CHRISTENSON ELECTRIC INC $ 42.00 TOTAL
10250 SW GREENBURG ROAD
-- REQUIRED INSPECTIONS - - - - - --
TIGARD OR 97223 Ceiling Cover Elect'1 Service
Phone #: Wall Cover Elect' 1 Final
Reg it.. :
This permit is issued subject to the regulations contained in the t' ' " Ldl"
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm i t t ee Signature
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 _ l ' / or or _
than 180 days. "sued By
----- ----- OWNER I NSTALLAT I Gib ONLY - - -- - - - --
The installation is being made on property 1 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 for inspection - 639 -4175
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Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. �iI fm d
Tigard, OR 97223 Permit # Cw 1 Ob 1
A l Date Issued �k °1 ° 10
�.� I Phone (503) 639 -4171
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development WILLIAMS CONTROL Number of Inspections per permit allowed
Address 14100 SW 72ND Service included: Items Cost(ea) Sum
City /State /Zip PORTLAND OR 97221 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) WILLIAMS CONTROL Each additional 500 sq. ft. or
portion thereof $25.00
Commercial a Residential ❑ Limited Energy $25.00 1
Each Manurd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Electrical Contractor CHRISTENSON ELECTRIC, INC Installation, ta amps alteration, n, or relocation $60.00 2
Address 111 SW COLUMBIA, SUITE 480 201 amps to 400 amps $80.00 2
City PORTLAND State OR Zip 97201 -5886 401 amps to 600 amps $180.00 2
ry 6 amps to 1000 amps
Phone No. 241 -4812 Over 1000 amps or volts $340.00 2
Job NO. 509 -6932 Reconnect only $50.00 2
contractor's license NO. 26 -34C 4c. Temporary Services or Feeders
Contractor's Boar. . " • • ■ , 1 1 Installation, alteration, or relocation 2
Signature of Supr. i�� .�Zr�it�� `.,, 200 amps or less 2
License No. 873 Phone N - 201 am to 400 amps $30.00 2
4 01 amps to 600 amps $75.00
Over 600 amps to 1000 volts $100.00
. 2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
City State Zip
purchase of service or feeder fee. 2
Each branch circuit $5.00
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $35.00
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension 1 $ 40 , 00 40 .
4 or more residential units in one structure Minor Labels (10) $100.00
-
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
-
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ 4Q
NOTICE 5% Surcharge (.05 X total fees) LL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 42.
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. wordcomde.ekr. ❑ Trust Account #
mm.0oo Balance Due
$ 42.