Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00713
ma y4 DEVELOPMENT SERVICES DATE ISSUED: 12/01/1999
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103BC 01200
SITE ADDRESS: 12287 SW LANSDOWNE LN
SUBDIVISION: ZONING: R - 4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Reconnect only
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: 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: 2 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
MOSES, JAY H + MARY JO OWNER
19061 SW INDIAN SPRINGS RD
LAKE OSWEGO, OR 97035
Phone: Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT BON 12/01/1999 $107.00 99- 310082 Elect'l Final
5PCT BON 12/01/1999 $8.56 99- 310082 ORIGINAL
Total $115.56
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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: 017 A 0},\64
OWNER INSTALLATION ONLY
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The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: (tAVl P II0(.410 - 1A — I v yfitAkA DATE:
CONTRACTOR INSTALLATION ONLY
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SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check
1,312'5 SW HALL BLVD. Recd By
• TIGARD OR 97223 Date Recd ,/ (- - I C I
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # (=[C f' (' 49
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
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
Address (7-. 1 5i-6 Lc vv<, e)Ot Ovte- Lei✓4'v 4a. Residential - per unit
City /State /Zip 1. bC� ry r ( Z qi 1000 sq. ft. or less $ 117.75 4
J i Each additional 500 sq. ft. or
portion thereof $ 26.75 1
Commercial ❑ Residential ® 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). Installation, alteration, or relocation
Electrical Contractor 200 amps or less $ 64.25 2
Address 201 amps to 400 amps $ 85.50 2
City State Zip 401 amps to 600 amps $ 128.50 2
ry p 601 amps to 1000 amps $ 192.50 2
Phone No. Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 - ,J 2
Elec. Cont. Lice. No. Exp.Date 4c. Temporary Services or Feeders 1 pl'
OR State CCB Reg. No. Exp.Date Installation, alteration, or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n 401 amps to 600 amps $ 100.00 2
Over 600 amps to 1000 volts,
see "b" above.
License No. Exp.Date
Phone No. 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 1 .J4 (�oSe Each branch circuit $ 5.35 2
Address (4.0.6 .�,n.c \tetti I`∎w. S A�octi) b) The fee for branch circuits
`(� Zip (O3 S without purchase of service
City O Sat p or feeder fee.
Phone No. (0 Q4. 3 3 uJi G 3 4 - ct 9.G. First branch circuit $ 37.50
Each additional branch circuit $ 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
/e/Matin Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
3. Plan Review section (if required):*
panel, alteration or extension $ 60.00
Minor Labels bels (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
Per inspection $ 50.00
Service and feeder 225 amps or more
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 $ ! 10 7 bb
* Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ 47 . 570
Not required for temporary construction services. Subtotal $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
- PERMITS BECOME 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 $ 1( ,GtO
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