Loading...
Permit • .� $ CITY O F T I G A R D ELECTRICAL PERMIT PERMIT #: ELC1999 -00197 DEVE PMEN� r S O ER 9 I CES 1 639 -4171 DATE ISSUED: 4/6/99 PARCEL: 1S133DA-06400 SITE ADDRESS: 11015 SW SUMMER LAKE DR SUBDIVISION: AMART SUMMERLAKE ZONING: R -7 BLOCK: LOT : 086 JURISDICTION: TIG Project Description: Installation of 1 branch circuit. 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: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREAISPEC OCC: Owner: Contractor: £,zs,tILt I FORCE, THOMAS H AND CAROLYN R 4 0 P 1 ' - AVE- PO BOX 1194 • — 8t01.✓tA -725/J 9700 TUALATIN, OR 97062 Phone: Phone: 4 ;4 _ </gl $ Reg #: 20 XS FEES Required Inspections Type By Date Amount Receipt Rough -in Elect'l Service PRMT DRA 4/6/99 $35.00 99- 314299 Elect'l Final 5PCT DRA 4/6/99 $1.75 99- 314299 Total $36.75 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. / • \ . Permit Signature: . �/ Issue By: l \ 0 L. a 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: ,. 0 . (4-f t tD DATE: LICENSE NO: 2-oa-B S Call! 639 -4175 by 7:00pm for an inspection the next business day . . 4 CITY OF TIGARD I Electrical Permit Application Plan Check 13125 SW HALL BLVD. (� Rec'd By - o TIGARD OR 97223 m I Date Recd V-0 9 Phone (503) 639 -4171, x304 4 Date to P.E. Print or Type Date to DST Inspection (503) 639 -4175 Permit # t6G X999 - DON 7 Fax (503) 684 -7297 V-zlncomplete 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) Tm /Y rot, ot, C G Service included: Items Cost Sum Address I 1 0 (S S W S K " " L-1 /c J)r 4a. Residential - per unit Ci /State/Zi T %5 4•-- 1000 sq. ft. or less $110.00 4 ty p Each additional 500 sq. ft. or portion thereof $25.00 1 Commercial ❑ Residenti L imited Energy $25.00 Each Manuf'd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: (Attach copy of all current licenses 4b. Services or Feeders I nstallation, alteration, or relocation Electrical Contractor E n v c l cc f�, "c 200 amps or less $60.00 2 Address i D Bo K /6 G / 201 amps to 400 amps $80.00 2 City 6 , -1,vr^ 6-^ State OA Zip q 7 D 7 S' 401 amps to 600 amps $120.00 2 Phone No. C 2 f Z f 3 601 amps to 1000 amps $180.00 2 Job No. Over 1000 amps or volts $340.00 2 �-� LC. only $50.00 2 9 2to Elec. Cont. Lice. No. 3 - c' S C Exp.Date i 1 OR State CCB Reg. No. 2 Exp.Datel f l 4c. Temporary Services or Feeders COT Business Tax or Metro No.00 Exp.Date 3 /2949 Installation, alteration, or relocation 200 amps or less $50.00 2 201 amps to 400 amps $75.00 Signature of Supr. Elec'n 401 amps to 600 amps $100.00 2 dl Over 600 amps to 1000 volts, License No. 2 2' S Exp.Date !© cof see "b" above. Phone No. 6 26 - Y V / 3 4d. Branch Circuits New, alteration or extension per panel 2b. For owner installations: a) The fee for branch circuits with purchase of service or Print Owner's Name feeder fee. Address Each branch circuit $5.00 2 - b) The fee for branch circuits City State Zip without purchase of Phone No. service or feeder fee. 3 S -47 First branch circuit I $35.00 2 The installation is being made on property I own which is not Each additional branch circuit $5.00 2 intended for sale, lease or rent. 4e. Miscellaneous (Service or feeder not included) Owner's Signature Each pump or irrigation circle $40.00 2 Each sign or outline lighting $40.00 2 3. Plan Review section (if required):* Signal circuit(s) or a limited energy panel, alteration or extension $40.00 2 Minor Labels (10) $100.00 Please check appropriate item and enter fee in section 5B. 4 or more residential units in one structure 4f. Each additional inspection over Service and feeder 225 amps or more the allowable in any of the above System over 600 volts nominal Per inspection $35.00 Classified area or structure containing special occupancy Per hour $55.00 as described in N.E.C. Chapter 5 In Plant $55.00 * Submit 2 sets of plans with application where any of the above apply. S. Fees: 3 S_cP Not required for temporary construction services. 5a. Enter total of above fees $ 5% Surcharge (.05 X total fees) $ f -- /S NOTICE Subtotal $ 5b. Enter 25% of line 5a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $ NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ❑ Trust Account # '3C.75 Total balance Due $ I: \DSTS \ELC96.APP Rev 9/96