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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2000 -00485 - DEVELOPMENT SERVICES DATE ISSUED: 8/17/00 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103B6 -11100 SITE ADDRESS: 12115 SW 123RD CT SUBDIVISION: YE OLDE WINDMILL ZONING: R -4.5 BLOCK: LOT : 030 JURISDICTION: TIG Proiect Description: Installation of two branch circuits. Job No. R22 -16 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: 1 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: PITSINGER, ROGER D AND MARLEEN ABC ELECTRIC CORPORATION 12115 SW 123RD CT 135 NE 9TH TIGARD, OR 97223 PORTLAND, OR 97232 Phone: Phone: 233 -7551 Reg #: LIC 000002 SUP 1241S PLM * *SEE ** ELE 26 -2C FEES Required Inspections Type By Date Amount Receipt Elect'l Service PRMT DEB 8/17/00 $42.85 0004537 Elect'l Final 5PCT DEB 8/17/00 $3.43 0004537 Total $46.28 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. � f n PERMITTEE'S SIGNATURE, , �` � cY ISSUED B 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: -44 ,.41O DATE: LICENSE NO: / l '6 Call 639 -4175 by 7:00pm for an inspection the next business day • CITY OF TIGARD , M � Plan Ch�•4 # 13125 SW HALL BLVD. Electrical Permit Applicatio I t4 Rec'd B 1i i TIGARD OR 97223 f ED Date Rec'd P .. e REC Date to P.E. Phone (503) 639 -4171, x304 Date to DST Inspection (503) 639 -4175 Print of Type AUG 15 ZU © (1 Permit# Fce - SRS Fax (503) 598 - 1960 Incomplete or illegible will not be C accen V ELOPMENl Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections per permit allowed Name (or name of business) R p j (, rnfl r Service included: Items Cost Sum 4 ' Address 121 (X 0 1 A ( l t 4a. Residential - per unit 1000 sq. ft. or less $ 117.75 4 City/State /Zip Qr 0Q-- Each additional 500 sq. ft. or portion thereof $ 26.75 1 Commercial 11 esidential ❑ Limited 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 4b. Services or Feeders information for COT data base) In alteration, or relocation Electrical Contractor 2 a ll n rr�� irpk-\-jki 200 amps or less $ 64.25 2 Addre 1 J'3 t E 0 • 201 amps to 400 amps $ 85.50 2 City -(AI\ State Zip C j7 z 401 amps to 600 amps $ 128.50 2 601 amps to 1000 amps $ 192.50 2 Phone No. 23 3- 7 Over 1000 amps or volts $ 363.75 2 Job No. 7 2 2,- 1 Cpl Reconnect only $ 53.50 2 Elec. Cont. Lice. No. , - C Exp.Date IL, a 4c. Temporary Services or Feeders OR State CCB Reg. • ri�i _ . Exp.Dat -� / / �T • Installation, alteration, or relocation COT Business Tax o p.Da ■ 200 amps or less $ 53.50 2 201 amps to 400 amps $ 80.25 2 /A a 401 amps to 600 amps $ 100.00 2 X Signature of ,- • . < . /1111111111 .�. Over 600 amps to 1000 volts, see "b" above. License No. 12 1 ---/ ) - Exp. ap 12 07), 4d. Branch Circuits Phone No. . 3 7 j 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. / $ 37.50 37, � Phone No. First branch circuit Each additional branch circuit / $ 5.35 5, 7. 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 panel, alteration or extension $ 60.00 3. Plan Review section (if required): * Minor Labels (10) $ 100.00 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 $ 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 $ N * Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ Not required for temporary construction services. Subtotal $ 5b. Enter 25% of line 5a 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 FOR A PERIOD OF 180 DAYS ❑ Trust Account # AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 4 / i:\dsts\forms\electric.doc