Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00369
, q?It; DEVELOPMENT SERVICES DATE ISSUED: 07/03/2000
�'' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171.
PARCEL: 2S1 12 B D -04400
SITE ADDRESS: 14859 SW 79TH AVE
SUBDIVISION: RAZE MEADOWS ZONING: R - 4.5
BLOCK: LOT : 026 JURISDICTION: TIG
Proiect Description: Installation of (1) branch circuit w/o feeder
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/ SVCI 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:
BUNNELL, GREGORY A + CAMI L BECK ELECTRIC INC
14859 SW 79TH AVE 9318 SE CHURCH ST
TIGARD, OR 97224 CLACKAMAS, OR 97015
Phone: Phone: 656 -7396 EXPIRED
Reg #: SUP 1326S
LIC 00002629
ELE 3 -5C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Final
PRMT DST 07/03/200C $37.50 0003431
5PCT DST 07/03/200C $3.00 0003431
Total $40.50 ORLGINAL
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 ISSUED BY: 6._
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 NOc
Call 639 -4175 by 7:OOpm for an inspection the next business day
• CITY OF TIGARD Electrical Permit Application Plan Check B `# .
13125 SW HALL BLVD.
TIGARD OR 97223 ./ v RECEr � Date Recd (9-74 -
Phone 503 639 -4171, x304
Date to P.E.
( 2 g 2000 Date to DST
Inspection (503) 639 -4175 Print of Type , Permit# eLCZ6 - 00361
Fax (503) 598 -1960 Incomplete or illegible will not be IOPt "E� Called ilk 1 { 0 /
col
1. Job Address: • 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum • 4,
Ad / 7 R.59 00 '7 922 4 4a. Residential - per unit
City /State/Zip / /i y c1,■ 0 ✓e.- C I 7 a•t9-`71. 1000 sq. it or less $ 117.75 4
Each additional 500 sq. ft. or
portion thereof $ 26.75 1
Commercial ❑ Residential K Umited Energy •$ 60.00
-
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 db. Services or Feeders
information for COT data base). // Installation, alteration, or relocation
Electrical Contractor . .fec_/ cecd,- r U 200 amps or less $ 64,25 2
Address ' 7 3l P j Clu a rc, 201 amps to 400 amps $ 85.50 2
C-I&cKa ✓4 -r 4 S State 0 Q- ZI '70I S
401 amps to 1000 amps $ 128.50 2
City P c l 601 amps to 1000 amps $ 192.50 2
Phone No. (p S (o - "i9 Over 1000 amps or volts $ 363.75 2
Job No. Q)f/ •3 Reconnect only $ 53.50 2
Elec. Cont. Lice. No. 3 - 5 - c- Exp.Date /0 - f-0 O 4c. Temporary Services or Feeders
OR State CCB Reg. No. a (p ' 9 Exp.Date / / -/ -00 Installation, alteration, or relocation
COT Business Tax or Metro No. S 5 5 EXD.D -te /a - oa 200 amps or less $ 53.50 2
,• / ' / 201 amps to 400 amps $ 80.25 2 •
Signature of Sur. Elec'n/ `.i • _ 401 amps to 600 amps 5 107.00 2
g p - Over 600 amps to 1000 volts,
License No. 3 2 -- '-S .." Exp.Date / O-/ - O / see mob' above. - ..
Phone No. Co•S (a- 7 3 `ice 4d. Branch Circuits -
New, alteration or extension 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 circuit $ '5.35 • 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee. 3 1 5°
/
Phone No. First branch circuit / $ 37.50
Each additional branch circuit 5 5.35 .
The installation is being made on property I own which is not 4e, Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
. Signal circuit(s) or a limited energy
3. Plan Review section (if required):* Minor Labels (10) or extension $ 107.00
Please check appropriate item and enter fee in section 5B. 4f. Each additional Inspection over
4 or more residential units in one structure the allowable in any,of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant 5 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
5a Enter total of above fees $ 3 '7 - 5
* Submit 2 sets of plans with application where any of the above apply. kA, Surcharge (.des( total fees) s •
Not required for temporary construction services. Subtotal $ O.fO
5b. Enter 25% of line Sa 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 . $ , % • . 5
i :ldsts\formslelectric.doc • .
EXPIRED