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Permit i CITY OF TIGARD ELECTRICAL PERMIT IN DEVELOPMENT SERVICES PERMIT #: ELC97 -0701 ^ �i�� j� DATE ISSUED: 10/21 /97 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 25111BA -03800 SITE ADDRESS...: 14140 SW 98TH CT SUBDIVISION •MCDONALD ACRES ZONING:R --4.5 BLOCK • LOT .............:013 JURISDICTION: TIG Project Description: Install a first branch circuit to an existing single family dwellin -- --- 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/0 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 - -- JOHN MICHELITCH type amount by date recpt 14140 SW 98TH PRMT $ 35.00 GEO 10/21/97 97- 300265 TIGARD OR 97223 5PCT $ 1.75 GEO 10/21/97 97- 300265 Phone #: 684 -3356 Contractor: ------ ALLTEC SECURITY $ 36.75 TOTAL PO BOX 55310 - --- REQUIRED INSPECTIONS - - - - -- PORTLAND OR 97238 -5310 Elect'l Service Phone #: 331 -2620 Elect'l Final Reg #..: 001188 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-1-Y through OAR 952- 001 -1987. You may obtain a copy of these rules or direct questions to O(AVC by callin (503)246 -1987. / / Permittee Signature: Issued B � ge - -- - -- -- -• -- 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 : f ' DATE: 1,q//97 LICENSE NO: 3 043 — —S ___. __..___ ++++++++++++++++++++++++++++++- I+++++++++++++++++ + ++ + + + ++ ++ + + + + ++ + + + ++ + + + + + + + + ++ Call 639- -4175 by 7:00 p.m. for an inspection needed the next business day + + + + + + ++- ++++• 1-++++++++++++++++++++++++++++++++++ + + + ++ +++ + + + ++ + + + + ++ + + ++ + + + + + + ++ 10/2111997 09:12 5038295747 GRF ELECTRIC PAGE 01 w CITY OF TIGARD Electrical Permit Application Plan Check # 13125 SW HALL BL D. Recd By TIGARD OR 97223 Data Reed Date to P.E. Phone (503) 639-4171, 04 Print or Type Date to DST Inspection (503) 639-4 s Incomplete or Illegible will not be accepted Permit ## q� -moo/ Fax (503) 684 -7297 Caned 1. Job Address: 4. Complete Fee Schedule Below: Name of Developmen Number of Inspections per permit allowed Name (or name of busin • s) J_Qh I2 1 C,, 1 e. 1 i fU Service included: (tame Coet Sum Address I a9 / 4a. Residential - per unit • 1000 sq. ft. orless 5110.00 4 City /State/Zip I /. o w_ . . Each additional 500 sq. ft. or Commercial ❑ Residential L portion thereof $25,00 1 Limited Energy $25.00 - Each Manul'd Home or Modular Dwelling Service or Feeder 568.00 2 2a. Contractor ins 'tenon only: (Attach copy of all rrant licenasra 4b. Services or Feeders Electrical Contractor 6.-_ e-P)1 C-/ Installation, alteration, or relocation 200 amps or lees $80.00 Addre�4 /5 Cr C' {��l y741 t1 < 201 amps to 400 amps $80.00 2 City y 4+ i 4 tate Ip 401 amps to 600 amps $120.00 2 Phone No. -. 4- 601 amps to 1000 amps $180.00 2 2 Job No. Over 1000 amps or volts $340,00 - 2 Reconnect only 550.00 2 Elec. Cont. Lice, No. "� C�Exp,Oate OR State CCB Reg. No. / Q 1 c, t-t-' Exp.Date ac. Temporary Services or Feeders COT Business Tax or M ro No. Exp.Date i alteration, or relocation 4 200 amps or less $50.00 2 201 amps to 400 amps $75.00 Signature of Supr. Elec' 401 amps to 600 amps $100.00 _ 2 - Over 600 amps to 1000 volts, License No. 3 61) S Exp.Date ee "b" above, Phone No r _ 4d. Branch Circuits �'( New, alteration or extension per panel 2b. For owner in allation : a) The fee for branch circuits with purchase of service or Print Owner's Name feeder fee, Address Each branch circui $5.00 2 b) The lee for branch circuits City State Zip without purchase of Phone No service or feeder ter. II First branch circuit I $35.00 2 The installation is being ade on property I own which is not Each additional branch circuit $5.00 2 intended for sale, lease rent. a. Miscellaneous 4 (Service or feeder not included) Owner's Signature Each pump or irrigation circle $40.00 2 Each sign or outline lighting 540.00 2 3. Plan Revie lion (If required) :' Signal clrcuit(s) or a limited energy panel, alteration or extension $40.00 2 Minor Labels (10) $100,00 Please check approp to item and enter fee In section 5B. 4 or more re units In one structure 41. Each additional Inspection over Service and 'feeder 5 amps or more the allowable in any of the above System over 600 nominal Per inspection $35.00 Classified area ors cture containing special occupancy Per hour $55.00 as described In N.E . Chapter 5 In Plant $55.00 Submit 2 sets 01 plans Ith application where any of the above apply. 5. Fees: 3 5_ _ Not required for tempo ry construction services. 5a. Enter total of above tees $ 5 Surcharge (.05 X total fees) $ 1 ).S 1 NOTICE Subrosei S Sb. Enter 25% of line S. for PERMITS BECOME VOID I ORK OR CONSTRUCTION AUTHORIZED IS Plea Review K re oulred {Sec.3) $ NOT COMMENCED WITH! 80 DAYS, OR IF CONSTRUCTION OR WORK Subto ! S IS SUSPENDED OR ABAN NED FOR A PERIOD OF 180 DAYS AT ANY TIME LIFTER W01911 IS GO ENOED. rust Aaccu M - 3 + p.( `2 7-7 Tot5e1 bal8nce D ue f l y CITY OF TIGARD Electrical Permit Application Plan Check# 13125 SW HALL BLVD. Recd By TIGARD OR 97223 1 Date Recd Phone (503) 639 -4171, x304 I. e to P.E. ( ) Date to DST Inspection (503) 639 -4175 Print or Type Permit # tL C `17 b °7n 1 Fax (503) 684 -7297 Incomplete or illegible will not j - = ed Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections per permit allowed Name (or name of business) i (a k Y) �l C h t, i ±L Service included: Items Cost Sum I Address 1 L 1 ' - I - 1 �W 6 C� 4a. Residential - per unit ''' 1000 sq. ft. or less $110.00 4 City /State /Zip ! i A Each additional 500 sq. ft. or Commercial El L� Residential portion thereof $25.00 1 Limited Energy $25.00 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 , 2 - L .4,""C.._., Installation, alteration, or relocation 200 amps or less $60.00 2 Address 1511 -te 0 a t-'nf rP., 4 . 201 amps to 400 amps $80.00 2 City / 1 1 j e State ®P�_ Zip Gin 0% 401 amps to 600 amps $120.00 2 Phone No. ( - -'�j -i 4- ( t.2 601 amps to 1000 amps $180.00 2 Job No. Over 1000 amps or volts $340.00 2 Reconnect only $50.00 2 Elec. Cont. Lice. No. - (P' SC'C.--Exp.Date OR State CCB Reg. No. i O I -('�� Exp 4 c. Temporary Services or Feeders COT Business Tax or Metro No Exp.Date I alteration, or relocation Q 200 amps or less $50.00 2 Signature of Supr. Elec'n 201 amps to 400 amps $75.00 2 401 amps to 600 amps $100.00 2 3 I 3 _ Over 600 amps to 1000 volts, License No. 11 (/ Exp.Date see "b" above. Phone No. $ - * 4d. Branch Circuits New, alteration or extension per panel 2b. For owner installations: a) The fee for branch circuits with purchase of service or Print Owner's Name feeder fee. Address Each branch circ $5.00 2 b) The fee for branch circuits City State Zip without purchase of Phone No. service or feeder fee. 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 or 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: Not required for temporary construction services. 5a. Enter total of above fees $ �� 5% Surcharge (.05 X total fees) $ I NOTICE • Subtotal $ 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 Subtot 1 $ 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