Permit ELECTRICAL PERMIT
PERMIT #: ELC96-0603
CITY OF TIGARD DATE ISSUED: 09/19/96
COMMUNITY DEVELOPMENT DEPARTMENT
1u1usSw Hall Blvd. Tigard, Oregon u72o°m1oe 639-4171 PARCEL: 2S113AD-01700
SITE ADDRESS...: 16920 SW 72ND AVE
SUBDIVISION ^ ROSEWOOD ACRE TRACTS ZONING:C—G
BLOCK. .,...... . : LOT. . ..... ...... :30
Project Description: Installing first branch circuit and4 add'l circuits
_______________ _ _ _ _ __
---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..: 0
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.: 1 PER HOUR...........: 0
401 — 600 amp......: 0 EA ADD'L BRNCH CIRC: 4 IN PLANT...........: 0
601 — 1000 amp.....: 0 — —PLAN REVIEW SECTION--- ---
1000+ amp/volt.....: 0 >=4 RES UNITS........: ) 600 VOLT NOMINAL..:
Reconnect only.....: 0 SVC/FDR >= 225 AMPS..: CLASS AREA/SPEC OCC.:
Owner: ----- ----- --- FEES ----------------
BINGHAM INVESTMENTS type amount by date recpt
3939 NW ST HELENS RD PRMT $ 55.00 B 09/19/96 96-284184
5PCT $ 2.75 B 09/19/96 96-284184
PORTLAND OR 97210
Phone #: 224-2676
Contractor: ------- — — ---- — ---
VIKING ELECTRIC INC $ 57.75 TOTAL
4326 SE WOODSTOCK STE 518
------- REQUIRED INSPECTIONS -------
PORTLAND OR 97206 Ce' zng — over Underground Cove
Phone #: 775-3479 Wall Cover Elect' Servi e^
Reg #..: 056527
/
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Oro. Specialty Codes and all other Per 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 oure 62AV/Vv't __EW _
than l80 days. 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:
— CONT ACT`~ INS L N i
—
�
SIGNATURE OF SUPR. ELEC'N» 0 A _a�' DATE:
LICENSE NO:
Call for inspection — 639-4175
.--;- .
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # q tL-C ? (/
9 - O o
,, Date Issued • q----0-% _ l 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 / ► rr n rJ l Pfs//7 /- Number of Inspection per permit allowed
Address / 6 l dmo ( .1 , W 7 d Service indudet Items Cost(ea) Sum
City/State/Zip 17 r i ,ri _ s+tiC (.N' 4a. Residential - per unit
li // � 1000 R or less 3110.00 4
Name (or name of business) 40a/de ti S i »d /I
Each add4iorma1500 sq. It. or
Commercial ❑ Residential ❑ portion thereof 225.00
- Limbed Energy 32500 1
Eadn Maaf4 Nary or Modular
oWlling sago.
2a. Contractor installation only: Feeder 6156.00 2
_ / 4b. Services or Feeders
Electrical Contractor ■ r N /e : /A % e alteration, r l ar' O1 MOO 2
oss Address F' AM r . i r 201 a g
nps to 400 amps 200.00 2
City f " State ark .Tip 3 7 i ?- X01 amps to 600 al$1213.00 2
C4
601 amps to loon amps s/e0.00 2
Phone No. '7 ad - 3 474 Y Over 1000 amps arvolts 53400o 2
Job NO. ° ath 350.00 2
i-r
contractor's license NO. _
4c Temporary Services or Feeders
Contractor's Board Reg. " ,.. 6, , 5 ; !� A 0 I, ;m &Mention, or es,
Signature of Supr. Eie :'n, � ! ��ij y_,�(/�, {.rT� TA 201) amps w less 2
License No. 3 D 6 B 5 - v Ph. - No. 77' l7 S 3 5 201 amps m 400 amps t50.00
2
401 amps to 600 amps 375.00 2
Over 600 is to 1000 volts 3100.00
2b. For owner installations: as "tr.
4d. Branch circuits
Print Owner's Name Nem searamn or extension per pone
Address a) The tee tor branch ooas adds
City State Z1p pirchasa feeder fee. 2
Each brands drcyR 35.00
Phone No. b) The lee nor branch ca+r<s nrtmort 2
The installation is being made on property I own which is purchase of swim or feeder fee
not intended for sale. lease or rent. Prat branch crash • 33500 .3, 5.0 0 2
Each additional branch ciWS ss.00 )0.0U
•
Owner's Signature 4e. Miscellaneous
(Service or feeder not inc3uded) 2
3. Plan Review section (if required): Encm pump or irrigation tads 340.00 2
- Each sign car wine Wang SUM
Signal drodt(s) or a Muted mom 2
Please check appropriate item and enter fee in section 5B. panel, Bae:don or extension 340.00
4 or more residential units in one structure Minor Leases (10) 3100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4! Each additional Inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.EC. Chapter 5 Per inspection 335.00 -
Per hour $$.00
-
In
Submit 2 sets of plans with application where any of the above Plant 355.00 -
apply. Not required for temporary construction services. 5. Fees:
NOTICE 5a. Enter total of above fees s ,5--,°°
5% Surcharge (.05 X total fees) $ a . 7 S'
Subtotal $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5� Enter 25% of fine A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OR IF plan Review it required ( 3) S
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR
Subtotal
A PERIOD OF 18a DAYS AT ANY TIME AFTER WORK IS $
COMMENCED. oemd.....> ❑ Trust Account a
M „ e S
5
Balance Due
$ - x.75