Permit i
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT *h: ELC96 -0074
COMMUNITY DEVELOPMENT DEPARTMENT LATE ISSUED: 02/05/96
,13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 2S 1 1 1 BD- -03100
SITE ADDRESS...: 09770 SW PEMBROOK ST
SUBDIVISION • CLOUD CAP EXp ZONING:R -3.5
BLOCK • LOT •13 RED
Project Description: Istall one service or feeder.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS-- - - --
1000 SF OR LESS • 0 0 - 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD' L 500SF...: 0 201 - 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 - 600 amp • 0 SIGNAL /PANEL • 0
i"1 NF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (107...: 0
- - - -- SERVICE /FEEDER - - - -- - - -- BRANCH CIRCUITS - - - -- --- -ADD'L INSPECTIONS-- -
0 - 200 amp • 1 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 - 400 amp • 0 1st W/0 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 --- - - - - --
1.000+ amp /volt • 0 > =4 RES UNITS • > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >_ 225 AMPS..: CLASS AREA /SPEC CCC.:
Owner: -. -. -- FEES
SUE HOPE type amount by date recpt
9770 SW PEMBROOK PRMT $ 60.00 CJS 02/05/96 96- 275646
SPCT $ 3.00 CJS 02/05/96 96- 275646
TIGARD OR 97223
Phone #:
Contractor: -- - - --
WESTSIDE ELECTRIC $ 63.00 TOTAL
7510 SW MACADAM AVE
-. REQUIRED INSPECTIONS -
PORTLAND OR 97219 Elect' 1 Service
Phone 4: Elect'1 Final -
Reg 4*.. .
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 lore issued f' �,, � - _
than 186 I
oays. ssued By
_.. - -- - -- -- -- - OWNER INSTALLATION ONLY - -- - --
The installation is being made on property I on which is not intended for
sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
------ - • - - - -- CONTRACTOR INSTALLATION ONLY -----
SIGNATURE OF SUPR. ELEC' N : �JJ04, DATE: 0- S 96 _
LICENSE NO:
Call for inspection - 639 -4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # Qfi - a 7s,<L /,
r. , 14h Permit # FL C 96 - 0 O -7z-/ . I
°` '` ' Phone (503) 639 -4171
1 '' FAX (503) 684 -7297 Date Issued a - s - 4 C
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by eh ar/e r s, , m ,%r7r
Inspection (503) 639 -4175
I 1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
q Address % 7 7 00 Veen ZI - DO, Service included: Items Cost(ea) Sum
City/State/Zip 77 C le 4a. Residential - per unit 4
��^^ / / 1000 sq. h. or less $110.00
-
Name (or name of business) JU€ /� ' // /7 • Each additional 500 sq. ft. or 1
portion thereof $25.00
-
Commercial ❑ Residential 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 , iiii / �L 200 amps or less $60.00 2
Address .' __Wll ' 201 amps to 400 amps $80.00 2 - 401 amps to 600 amps $120.00 2
State .
City ',z
� - • Zip sot amps to 1000 amps $180.00 2
Phone No. 7 -13 Over 1000 amps or volts $340.000 2 -
Contractor's License No. - " L Reconnect only $500.0000
- Contractor's Board Reg. No. AS I - 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n 200 amps or less $50.00 2 -
License No. /S1 - hone No. Z%J - - - T 7 glr 201 ampsto4000amp $100.00 2
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
ach branch circuit or feeder tee. $5.00 2
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 3c 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 Mi nor Labets (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 Sae Enter total of above fees $ -_r'
5% Surcharge (.05 X total fees) $ I
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 Subtot $
COMMENCED. Trust Account # $
Balance Due $ 3‘, ----
r�grm.gp
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL: /
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation OD
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: I I I I
qq qq . - 7 A.M. , P.M. Entry:
Address: i
// � .�
Tenant: ) Ste: MST:
LG/ 6_ /f _
Con /Own: (./XSL� BUP: MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
_ s e .,cT U IU(
NO () it-) vfr■ -e
Inspector: Date: i/� 79'
_APPROVED ISAPPROVED /CALL FOR REINSP. CF CO