Permit CITY � � J� �-
°
V DEVELOPMENT SERVICES ICAL PERMIT
13125 SKK Hall Blv� 7�a�,gR97��8�H��417l PERMIT #: EL[�97-0183
Tigard, � ' DPTE ISSUED: 03/31/97
PARCEL: 2811OPA-00300
7 ".7. TE T)pFSS..,:!4145 SW 10 :rH AVE
72UBDIVISI ON. ...: ZOK INS : R-12
OF.K..........: LOT... .....: JURISDICTION : TlR
Pr Descript ion: instl 1 signal circxit/bmited energy pane!
-_-_________ _____ _______________________________--'__
---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- -----MIGCELLANEOUS-----
1008 SF OR LESS. . . . : 0 0 - 200 amp. .. . .. . : G PUMp/IRRIGATION'.. . : 0
�RCH ADD'L 500SF...: 0 201 - 400 amp.......: W SIGN/OUT LINE LTG..: 0
LTMITED ENERGY. - 600 amp....,,.: N SIGNAL/PANFL.^,.,,,: 1
wP■7. SVC/FDR".: 0 601+amps-100N volts.: 0 MINOR LABEL (10)...: 0
----SERVICE/FEEDER---- ----BRANCH CIRCUITS----- ---ADD'L INSPECTIf
Jl - 20Q amp......: 0 IA/SERVICE OR FEEDER: 0 PER INSPECTION.... .1 0
E0 - 400 amp.. .. '. : W/O SRVC OR FDR. : @ PER HOUR...,..' . . , 0
401 - amp...,..: 0 EA ADD'L BRNCH CIRC: 0 IN PLANT..~........: 0
601 - 1000 amp...— : 0 -------- ----PLAN REVIEW SECTION--'-------''-----
�00�+ amp/volt.....: 0 >=4 RES UNITS........: ) 600 VOLT NOMINAL..:
Reconnect only. . . . . : 0 SVC/FDR >= 225 AMPS..: CLASS AREA/SPE7 OCC. :
3wner� ------------------ ------------ ------- FEES ----------------
TIGARD MEDICAL REHAB type amount by date 'ecp
PRMT $ 40.00 TAT 03/31/97 97-292424
5PCT 2.00 TAT 03/31/97 97-292424
7cntractn': --- ------------- ---� -
ROSE CITY ELECTRIC CO INC $ 42.00 TOTAL.
•0i 2 • !E CULL BLVD
REQUIRED INSPECTIONS -----
__
7 OPTLAND OR 97213 Ceiling Cover Underground Cove
Phan * #: 503-287-616 Well Cover Elect'l Service
Reg #..: 000835
7 pill it is issued subject to the roculatise cctatnod in the
- iyard Mxnicipal Cade, State of Ore. Specialty Codes and all other P ^t� t
applicable laws. Pll work will be done in accordance with
approved plans, This permit will expire if work is not started
within 1D0 days of issuance, or if work is suspended for ooro
thar 18g 0ays, Is.�ued By /•^
- ---------- -----------------QWNER INSTALLATION ONLY--- ----- -----------
The installation is being made on property I own which is not intended for
sale, lease, or rent,
OW^!ER' S SIGNATURE: __ DATE:
------------------------CO��TRACTOR INSTALLATION ONLY------- -- ----
SIGNATURE OF SUPR.. ELFC' N: ___ DATE: ___________�_________
LICENRF NOg •
Call for inspection - 639-4175
r Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. r fi cr
Tigard, OR 97223 Permit # G L- 7 "�� /o
/4 � „ Date Issued ..5// ?7
�� it Phone (503) 639 -4171
Y "'' FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: A 4. Complete Fee Schedule Below:
Name of Development , A. M A ! . A. ,..• Number of Inspections per permit allowed
Address ' 4 146 _ e ,C)10 Service included: Items Cost(ea) Sum
City /State /Zip I - 0N' J■.._ 0( "t' -2 4 - ') 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of • ess) Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial Residential n Limited Energy $25.00
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Electrical Contractor 11 r n •
Installation, alteration, or relocation $60.00 2
200 amps or less
Address_ . ■ w atin ma�11. 201 amps to 400 amps $80.00 2
Z I _S' 401 amps to 600 amps $120.00 2
City . _ - 601 =A P 601 amps to 1000 amps $180.00
Phone No. /� * I • A q iv 3 Over 1000 amps or volts $340.00 2
*- NO. Reconnect only $50.00 •
contractor's license NO. • I [ ') C- 4c. Temporary Services or Feeders
Contractor's Board Reg. o. /'t1 , . Installation, alteration, or relocation
Signature of Su r. Elec'n G� %� ■ 200 amps or less 2
License No. Q-:1S • one )4 7 (,p ILO 201 amps to 400 amps $50.00 2
401 amps to 600 amps $75.00
-
Over 600 amps to 1000 volts $100.00
. 2b. For owner installations: see „b„ above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
First additional na br $35.00
not intended for sale, lease or rent.
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy [7 �� 2
Please check appropriate item and enter fee in section 5B. . panel, alteration or extension I $40.00 69
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees: '/
5a. Enter total of above fees $ lie
NOTICE 5% Surcharge (.05 X total fees) $ 2
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. wordlcomdeNeiec- ❑ Trust Account #
$
prm app
Balance Due $ 7 2.