Permit ,CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00169
DEVELOPMENT SERVICES DATE ISSUED: 4/12/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09805 SW PEMBROOK ST
04)/ PARCEL: 2S111 BD -01900
SUBDIVISION: CLOUD CAP ZONING: R -3.5
BLOCK: LOT G/ JURISDICTION: TIG
Project Description: Installation of three branch circuits.. Job No. J01150. ' Y
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: 2 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:
HORNBECK, WILLIAM H J + WEST SIDE ELECTRIC CO INC
WAHLER, KRISTIN E 1834 SE 8TH AVE
9805 SW PEMBROOK STREET PORTLAND, OR 97214
TIGARD, OR 97224 P; ' , P'RE®
Phone: Phone:
231 -1548
Reg #: LIC 13306
SUP 1556s
ELE 26 -135c
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT DEB 4/12/00 $48.20 0001351 Elect'I Final
5PCT DEB 4/12/00 $3.86 0001351
Total $52.06
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 copie these r : or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE // , /J 2 1, , , I1 / ISSUED :Y: " /� -- /
0 NER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
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CONTRACTOR I /''- STALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: ADO i" , � f - l ( DATE:
LICENSE NO: /556
Call 639 -4175 by 7:00pm for an inspection the next business day
APR -11 -00 05:44 PM WEST SIDE ELECTRIC 503 736 0677 P.01
oF. Electrical Permit Applicat Reed* ,,e-'a 131 HALL
131 5 SW HALL BLVD.. Date Recd q - /i O°
I TIG %RD OR 97223 Date to P.E.
i Phot a (503) 639 -4171, x304 Date to DST •"---
1 Inspo Ction (503) 639.4175 , Print of Type Permit • ate 'al4 /ivy
Fax ;503) 598 -1960 Incomplete or Illegible will not be accepted Celled
1. Job Address: i d t Complete Fee Schedule Below:
Niamrof Development - Number of Inspections per permit allowed
NamE (or name of business) ` /, « ac Service Included: Items Cost Sum
Addres 9,Q� .�/✓ , � / o v _ ^� [/ aa. Residential - per unit
City/gate/Zip r e ,. 4.�_ 4' / 2 2 / 1000 sq, IL of teas
P 9 ; Each additional 500 sq. ft. or $ 117.75 4
potion thereof 1 28.25 1
Comrierdal ❑ Residential Limited Energy • $ 60.00
Each Manufd Home or Modular
2a. , ontractor installation only: Dwelling Service or Feeder $ 72.75 2
• (Prior 0 permit Issuance, applicants must provide contractor license 4b. Services or Feeders
Infom4_ tion for COT data base), ; e--, . installation, alteration, or relocation
Book cal Contractor • / I e / C- 200 amps or less 5 64.25 2
Addres : ' ' Altir ld' 201 amps to 400 amps S 85.50 2
/ 4 tale Zip ! ?/ % 401 amps to 600 amps $ 128.50 2
City 17 P e01 amps to 1000 amps 5 192.50 • 2
Phon ! No. _ 3/-/ Over 1000 amps or vane $ 383.75 • 2
Job No. , 76 // SCE Reconnect only $ 53.50 2
Elec. Zont. Lice. No, 26 / if r� Exp.Date ac: Temporary Services or Feeders
OR S ate CCB Reg. No. / 3 Exp.Date Installation, alteration, or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or lass _ $ 63.50 2
201 amps to 400 amps 5 80.25 2
Signature of Supr. Elec'n 401 amps to 800 amps 5 107.00 2
Over 800 amps to 1000 volts,
see "b" above.
UcerL /56
e No. � Exp,Oate
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PhOn9 No. V- /, Ye? 4d. Branch Circuits New, alteration or extension per panalre ��
• a) The fee for branch circuits
2b. For owner Installations: with purchase of service or
feeder fee.
Print )wners Name Each branch circuit S 5.35 2
Addn ss b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee.
Phone N0, . First branch circuit / S 37:50 3
Each additional branch circuit Z , S 5.35 / (1 "a
•
The i istallation Is being made on property I own which is not se, Miscellaneous •
I inten led for sale, lease or rent. (Service or feeder not included)
Each pump or Irrigation circle $ 42.75
•
own. re Signature Each sign or outline lighting 42.75
Signal circuit(s) or a limited energy
3. Plan Review secti • n (if required):* penL alteration or ertlenslon $ 60.00
Q � Minor Labels (10) , $ 107.00
Pose check appropriate Item and enter fee In section 58. 4f. Each additional Inspection over
i : 4 or more residential unit's In one structure the allowable in any of the above
Service and feeder 225 t or more Per inspection $ 50.07
Per hour $ 50.00
i
System over 800 volts nominal in Plant $ 59.00
Classified area or structure containing special occupancy as •
r described In N.E.C. Chapter 5 5. Fees: I ► Z r,
6a. Enter total of above fees $ Y g
I ' Su irnit 2 sets of plans with application where any of the above apply. 5% Surcharge (.05 X total fees) S 3
No required for temporary construction services. Subtotal S
i 6b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) 5
PER; ITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED . 1 Sublotaat $
1 IS NCT COMMENCED WITHIN 18Q DAYS, OR IF CONSTRUCTION OR rr / /�. f /-: WORK IS SUSPENDED OR ABAf {DO NED FOR A PERIOD OF 180 DAYS Ttvat Account d '1)-' l AT A 1Y TIME AFTER WORK IS C. MMENCED, Total balance Due l t' v I., $ 517" i I J W
I
i . Apfr 511 •