Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00204
c ���
DEVELOPMENT r SERVICES ) 639 -4171 DATE ISSUED: 04/26/2000
PARCEL: 1S136CA-02900
SITE ADDRESS: 11155 SW 79TH AVE •
SUBDIVISION: FRIENDLY ACRES ZONING: R -4.5
BLOCK: LOT : 020 JURISDICTION: TIG
Project Description: Install a first branch circuit
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: 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:
BICKLE, ROBERT JAMES SR • GRF ELECTRIC
AND BETTE A 15460 SE PARADISE LN
11155 SW 79TH AVE MULINO, OR 97042
TIGARD, OR 97223
Phone: Phone: 503 - 829 -4146
Reg #: LIC 76751
SUP 1655S
ELE 3 -484C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT GEO 04/26/200C $37.50 0001722 Elect'I Final
5PCT GEO 04/26/200C $3.00 0001722 p R` G I N A L
Total *$40.50
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 t 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: • `-/- � 6' 06
LICENSE NO: /6 5
Call 639 -4175 by 7:OOpm for an inspection the next business day
•
06/20/1995 11:04 5038295747 GRF ELECTRIC PAGE 01
CITY OF TIGARD Electrical Permit Application .
Plan Check
13125 SW HALL BLVD. Recd By
TIGARD OR 97223 ,a Date Rac'd
Phone (503) 839 -4171, x304 0 Dace to P.E.
Inspection (503) 6391175 Print of Type `'V Date to DST
Fax (503) 598 - 1960 YP Permit K fce X000 -Od•7d c!
Incomplete or Illegible will not be accepted Called !
1. Job Address: 4. Complete Fee Schedule Below:
Madre of Development Number of Ins one rmlt allowed
. Name (or name of business) £f e. Service Included: Items Cost Sum
Address i I P 5 ' Ai 4a. Residential - per unit '
City /State/Zip , a 0 r-41 4,,N.A,1._ q - 7 2._"7- 1000 sq. ft. or leas $ 117,75 4
Each additional 500 eq. I. or
Commercial ❑ Residential poreon thereof $ 28.25 1
J Limned Energy $ 80.00
l , Each Manufd Home or Modular
2a. Contractor InS n o
tlon y: ���� ��` '�'�" 1f 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 G 0 &+ -G, 200 amps or less S 84.25
Address 15'#'t 5, 1 A r ad r'ce I7, . 201 amps to 400 amps S 85.50 2
.t State 'r n p 401 amps to 600 amps _ t 128.50 2
Chi j, State ,,21 �17f) 2_ 801 amps to 1000 amps $ 192.50 2
Ph
f e No. W Li g t 2.4 - '5 .7 Over 1000 amps or volts $ 383.75 2
Reconnect drily S 53.50 2
Elec. Cont. lice. No. 3" (t. g'1 C _ Exp.Date /0 f 0 4c, Temporary Services or Feeders �^
OR State CCD Reg. No. 7 (o 1 S Exp.Date q z7/ 44 installation. alteration. or retocauon
COT Business Tex or Metro No. Exp.Date q 7 1 0 0 200 amps or less : 53,50 2
201 amps lo 400 amps $ 80.25
Signature of Supr. Elec'n(� p 401 amps to 800 amps 5 107.00 - 2
Over 600 amps to 1000 volts, � --
• License No. ^ Exp pate J 1>-- Q see "b" above.
Phone No. Z4 '4J b. Branch t:IrEUlte
New. alteration or extension per panel
a) The fee for branch circuits
2b. For owner Installations: rdeN purchase of service or
feeder he.
Print Owners Name _ • Each branch dreuil _ S 5.35 2
Address b) The fee for branch dreulls
City State Zip without purchase of eerv/C°
or feeder he.
Phone No. First branch circuit i S 37.50 3 ( -
Each additional branch circuit $ 5.35 ^ ~_
The installation is being made on property I own which is not se. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation drde 5 42.75
Owners Signature • Each sign or outline righting $ 42,76 ~-
Signal circult(a) or a limited energy
3. Plan Review section (if required):* panel, alteration or extension $ 60.00
Minor Labels (10) S 107.00
Please check appropriate Item and enter fee in section BB. 4f. Each additional Inspection over ��
4 or more residential units in one structure the allowable In any of the above
Per Service and feeder 225 amps or more
Per hour S 50 00
System over 600 volts nominal • - .00
In Plant $ 59 $ 59.00
�_ _ Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 55, Fees:
Se Enter total of above fees $ 3?
r
' Submit 2 seta of plans with application where any of the above apply. ( ch
Surcharge (.05 X total fees) s "
Not required for temporary construction services. Subtotal $
NOTICE 60. Enter 25% of line tta for
Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal 5 - '_
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS
Krim Account �� y 3 $
AT ANY TIME AFTER WORK IS COMMENCED. balance Due b v
1:Aslslormti \ctectric,doc
•