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Permit CITY OF T ELECTRICCALEPERMIO269 ^- m � M � I DEVELOPMENT SERVICES DATE ISSUED: 05/22 /98 97223 (503) 639-4171 PARCEL: 2S101DC -05300 SITE ADDRESS...: 13493 SW 75TH PL SUBDIVISION :PACIFIC RIDGE ZONING:R -3.5 BLOCK LOT .5 -6 JURISDICTION: TIG Project Descript : Worzniak hot tub - -- RESIDENTIAL UN I T---- -- -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: 0 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 DENNIS WORZNIAK type amount by date recpt 13493 SW 75TH PLACE PRMT $ 35.00 JSD 05/22/98 98- 30594E TIGARD OR 97223 5PCT $ 1'.75 JSD 05/22/98 98- 305942 Phone #: 620 -2225 Contractor: DENNIS WORZNIAK $ 36.75 TOTAL 13493 SW 75TH PL REQUIRED INSPECTIONS TIGARD OR 97223 Rough —in Elect'l Final Phone #: Elect'l Service Reg #..: This permit is issued subject to the regulations contain., nth• Tigard Nunici'-1 Code, State of Oregon Specialty Codes and all other applicable laws. All work will be done in accordance .th appro'ed plans. . permit will expire if work is not st -rted within 180 days of issuance, or if work is suspended !Iv' more than )80 day.. WENT %1 1 egon law requires you to follow the ules adopted by the Oregon Utility Notification Center. l rules are set fo th in OAR ' ' -0010 through OAR 952 ''{ ■ Yo. may obtain a copy of these rules or direct questions .o '11 „I bu ing / )2C yd �i� Permittee Signature: idiPle, _ I_sued 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 7:00 p.m. for an inspection needed the next business day ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ • CITY OF TIGARD Electrical Permit Application Plan Chec - 1 SW HALL BLVD. Rec'd By� fl TIGARD OR 97223 Date Rec'd U Date to P.E. Phone (503) 639 -4171, x304 Date to DST Inspection (503) 639 -4175 Print or Type Permit # ia.�all w �/�g Fax (503) 684 7297 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development 1� Number of Inspections per permit allowed - Name (or name of business) Pe ]u ,vi 5 Y �,J O A Z n i a-1 / ( Service included: Items Cost Sum Address / 3 V / S 'J 7 5 • f'/ e 4a. Residential - per unit v City/State/Zip T p Z Each additional 500 sq. ft. or 3 1000 sq. ft. or less $110.00 4 Ci ty p / f J Aka/ Q k 9 ' 7 L J portion thereof $25.00 1 Commer ial ❑ Resid ntiai Idl / C_[ Limited Energy $25.00 0.-ref ?c2 f" "X , 5 44 c �� ` e A �r,k Q � J /= Each Manuf'd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: (Attach copy of all current licenses) 4b. Services or Feeders Electrical Contractor Installation, alteration, or relocation 200 amps or less $60.00 2 Address 201 amps to 400 amps $80.00 2 City State Zip 401 amps to 600 amps $120.00 2 Phone No. 601 amps to 1000 amps $180.00 2 Job No. Over 1000 amps or volts $340.00 2 Elec. Cont. Lice. No. Exp.Date Reconnect only $50.00 2 OR State CCB Reg. No. Exp.Date 4c. Temporary Services or Feeders COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation 200 amps or less $50.00 2 Si nature of Su r. Elec'n 201 amps to 400 amps $75.00 2 g p 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License No Exp.Date see "b" above. Phone N( f / / eQ e /1-1 -7 1© 4d. Branch Circuits 0 � j� ^ / (� New, alteration or extension per panel r _ - 2b. or owner installations: a) The fee for branch circuits with ,, / purchase of service or Print Owner's 4 Nam PL' !u N (...5 I 1 '+/ d P 2 ' n i c� feeder fee. Address 13 St 9.7 Pi Each branch circuit $5.00 2 City r f 5 4e. Sta te G ti Zip `, 7 L without purchase of Z 3 b) The fee for branch circuits ty P Phone No. (Y U - Z 2 Z 3 service or feeder fee. ------3/ First branch circuit $35.00 2 The installation is being made on property I own which is not Each additional branch circuit $5.00 2 intended for sale, lease rent. 4e. Miscellaneous (Service or feeder not included) Owner's Signature `® Each pump or irrigation circle $40.00 2 Each sign or outline lighting $40.00 2 3. Plan Review section (if required): * Signal circuit(s) or a limited energy panel, alteration or extension $40.00 2 Minor Labels (10) $100.00 Please check appropriate item and enter fee in section 5B. 4 or more residential units in one structure 4f. Each additional inspection over Service and feeder 225 amps or more the allowable in any of the above System over 600 volts nominal Per inspection $35.00 Classified area or structure containing special occupancy Per hour $55.00 as described in N.E.C. Chapter 5 In Plant $55.00 / * Submit 2 sets of plans with application where any of the above apply. 5. Fees: ✓ J Not required for temporary construction services. 5a. Enter total of above fees $ 5% Surcharge (.05 X total fees) $ �� NOTICE Subtotal $ - `� �i !'" 5b. Enter 25% of line 5a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $ NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ❑ Trust Account # Total balance Due $ I: \DSTS \ELC96.APP Rev 9/96