Permit ELECTRICAL PERMIT
PERMIT #: ELC�6-0065
1� OF � ' � �
— COMMUNXTY DEVELOPMENT DEPARTMENT PARCEL: 2S104DC
S � P m Pn 0 )7co3 .4 .uty L / :FR P n
SUBDIVISION....: MORNINGSTAR ZONING:R-4.5 PD
BLOCK..........: LOT.............:009
Project Description: New residence
_______________ __ ___________________ _________
---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- -----MISCELLANEOUS-----
1000 SF OR LESS....: 1 0 - 200 amp.......: 0 PUMP/IRRIGATION....: 0
EACH ADD`L 500SF...: 3 201 - 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/O SRVC OR FDR.: 0 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 ---
TOM ARVIDSON type amount by date recpt
15256 SW TEAL BLVD PRMT $ 185.00 JSD 02/01/96 96-275597
# B 5PCT $ 9.25 JSD 02/01/96 96-275597
BEAVERTON OR 97007
Phone #: 590-2955
Contractor: - ---- - --- ----------------- ----
L. GCHLOTTMANN ELECTRIC $ 194.25 TOTAL
5680 SE PUEBLO
------ REQUIRED INSPECTIONS
HILLSBORO OR 97123 Ceiling Cover Elect'l Service
Phone #: Wall Cover Elect'l Final
Reg #..:
This pero t is issued subjed to the regulatime contamd in tho .0
Tigard Municipal Code, State of Ore. Specialty Codes and all other Pefmittee Siggeture
applicable laws. All work will be done in accordance with
approved plans. This peroit will expire if work is not started
within 180 days of issuance, or if work is suspended for more L - �
6_ - _ - _ __-_---
than i80 day». 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: _
LICENSE NO: _ _____
Call for inspection - 639-4175
/ 9 Community Development ELECTRICAL PERMIT APPLICATION
t7,, ' A 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
4„,,,,4-1,,,s, � Permit # e 1.C�4— , (,S
• I �) Phone (503) 639 -4171 Date Issued GO
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by V
Inspection (503) 639 -4175 '
1. Job Address: 4. Complete Fee Schedule Below: .
Name of Development neyyij>i-�� (rtivr Number of Inspections per permit allowed
Address / 3 2 0 sce.) FGrtn Iri(3y._ C,b'Y," Service included: Items Cost(ea) Sum
City /State/Zip d + �-?'_ OZt 4a. Residential - per unit l��
(/ 1000 sq ft or less J "' $110 00
Name (or name of business)Cattc c L(.c. e 1` Each additional 500 sq ft or i
w r� portion thereof 3 $25 00 1
Commercial ❑ Residential all Limited Energy $2500
Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68 00
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor L.s G�/t c
a TrremmiAi 5C�,,, 200 amps or less $60 00 2
Address 6 ,S ; E. Paz-82e 201 amps to 400 amps ' $80 00 2
City 1. /LL s a RD State OR Zip 9'7/7-3 601 amps to 600 amps $180 00 2
�p °� �[(� ^� 601 amps to 1000 amps $180 00 2
Phone No. 6 -/ - / "7 7 / Over 1000 amps or volts $340 00 2
Contractor's License No. - g--/- 373 C Reconnect only $5000
Contractor's Board Reg. No. 9'3(e/ 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec', �,� _
.. . / s ; , _ 200 amps or less $50 00 2
License No. 6 5. ' '- Ph.! e No. 201 amps to 400 amps $75 00 2
401 amps to 600 amps $100 00
Over 600 amps to 1000 volts
2b. For owner installations: see •b• above
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
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
not intended for sale, lease or rent. First branch circuit $35 00 2
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 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40 00
4 or more residential units in one structure M inor 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:
NOTICE 5a. Enter total of above fees $ l
5% Surcharge (.05 X total fees) $
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. ❑ Trust Account #
$
Balance Due $ *
wad bon d.o\Nacprm app