Permit OILY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 12/05/95
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 2S104BA -07700
SITE ADDRESS...: 13920 SW LIDEN DR
SUBDIVISION CASTLE HILL #2 ZONING:R -12 PD
BLOCK • LOT •112
Project Description: Residential 3,500 sq ft.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 1 0 — 200 amp 0 PUMP /IRRIGATION 0
EACH ADD'L 500SF. .: 5 201 — 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
BEAR ELECTRIC type amount by date recpt
PO BOX 389 PRMT $ 235.00 CJS 12/05/95 95- 273520
5PCT $ 11.75 CJS 12/05/95 95- 273520
DONALD OR 97020
Phone #: 503- 678 -1355
Contractor:
BEAR ELECTRIC $ 246.75 TOTAL
PO BOX 389
REQUIRED INSPECTIONS
DONALD OR 97020 Ceiling Cover Elect'1 Service
Phone #: Wall Cover Elect'1 Final
Reg #.. °
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signature
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. 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: O, a� DATE: j ?- S- Q-
LICENSE NO:
Call for inspection — 639-4175
'a Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # /_` c 06c' -
#4,4,....,,,i, 11 '' Phone (503) 639 -4171
:� �! Date Issued iA - ,c-9,c
CITY OF TIGARD FAX (503) 684 -7297 TDD No. (503) 684 -2772 Issued by CAa, /es .5ch$7,,1 t
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development 6,4t571£ //iLc- Number of Inspections per permit allowed
Address / ? 520 $L1 L /DEN OZ Service included: Items Cost(ea) Sum
City /State/Zip - I74,enS 0/1 , q7 z. 3 4a. Residential - per unit 4
1000 sq. ft. or less / $110.00 /LD , /o
Name (or name of business) P Each /80/1 f SErr HOli1 o additional 500 sq. ft. or
portion thereof S $25.00 `is .0 o 1
Commercial ❑ Residential Dr Limited Energy $25.00 - 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 BE,b11_ 6 L-EGY/LIL., IN G. 200 amps or less $60.00 2
9 9 201 amps to 400 amps $80.00 2
Address 1".o, L1t7X 7 401 amps to 600 amps $120.00 2
City Po n/.e*-0 State 9/1- Zip q7,02.,, 601 amps to 1000 amps $180.00 2 - Phone No. f 7b - /3 SC Over 1000 amps or volts $340.00 2
Contractor's License No. ; AP y io L Reconnect only $50.00 -
Contractor's Board Reg. No. ////%1/ 0 - : 4c. Temporary Services or Feeders
, Installation, alteration, or relocation 2
- Signature of Supr.
Elec ,�<<< 200 amps or less $50.00 2
License No. 7 Phone • . 679 _ /355 201 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
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
First branch circuit $35.00 2
not intended for sale, lease or rent. Each additional branch circuit $5.00
Owner's Signature 40. 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 mom 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 inspectio $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 $ 23S 0
5% Surcharge (.05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 2N • 7S
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) $ JC
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK_ IS Subtotal $
COMMENCED. ❑ Trust Account # x
Balance Due $ Lyt;. 7S
i, MortherndoNeise-prmeep