Permit CITY OF TIGARD ELECTRICAL PERMIT
f , ; DEVELOPMENT SERVICES PERMIT ISSUED: ELC
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 s DATE
PARCEL: 2S1O4CD -10100
SITE ADDRESS...:1362O SW TRACY PL
SUBDIVISION •HILLSHIRE ESTATES NO. 2 ZONING:R -7 PD
BLOCK LOT •100 JURISDICTION: TIG
Project Description : Residential alteration.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 1
EACH ADD'L 5O0SF...: 0 201 — 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 (1O)...: 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/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
1000+ amp /volt • 0 > =4 RES UNITS • > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
MCKINNEY type amount by date recpt
13620 SW TRACY PL PRMT $ 40.00 DLH 05/29/98 98- 306122
TIGARD OR 97223 SPCT $ 2.00 DLH 05/29/98 98- 306122
Phone #:
Contractor:
CEDAR LANDSCAPE $ 42.00 TOTAL
14375 SW PATRICIA
REQUIRED INSPECTIONS
HILLSBORO OR 97123 Rough —in Elect'l Final
Phone #: 628 -3411 Elect'l Service
Reg #..: 000058
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001-0010 through OAR 952 -001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: /1/9 /L E,6 Issued By: 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 c� G
SIGNATURE OF SUPR. ELEC'N: /91- DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Electrical; iPgpnit Application Plan Check #
13125 SW HALL BLVD. Recd By b `A
�i 199 Date R 5/Z1/let
r " /
TIGARD OR 97223
Phone ( 503 ) 639-4171, x304 /I� Date to P.E.
�J Date to DST
Inspection (503) 639 -4175 C^ ,....1 Pdr. E PJTne Permit # ELC 9rP- 6�9/
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Hr / /54ire- E srq-1'eS Number of Inspections per permit allowed
Name (or name of business) Al c IlinlNey Res. De•+ce Service included: Items Cost Sum
Address / 2G g n 5 rr&c 7 pc 4a. Residential - per unit sq. ft. or less
City/State/Zip ]_r i4ec) (9v / / q 72 z 3 Each additional 500 sq. ft. or $110.00 4
portion thereof $25.00 1
Commercial ❑ Residential LE Li mited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(gnlach copy of all current licenses) 4b. Services or Feeders .
EleetficatContractor e eto4^ U9'ud - ..e .2'A✓c Installation, alteration, or relocation
Address /4" 37S Ski / r¢ A- ut 200 amps or tens $60.00 2
201 amps to 400 amps $80.00 2 -
City /!; / /sGoez State boZ. Zip q7 !Z 3 401 amps to 600 amps $120.00 2
Phone No. (.5na) 6 Z5 11 601 amps to 1000 amps - $180.00 2
Job No. Over 1000 amps or volts - $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. Exp.Date
OR State CCB Reg. No. £ 8'43 Exp.Date 6 O - 3€ ✓ 4c. Temporary Services or Feeders
COT Business Tax or Metro No. /Se/ Exp.Date 7- (76 Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n 201 amps to 400 am $75.00 2
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No.
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
City State Zip b) The fee for branch circuits
ty p without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
Owner's Signature E or irrigation circle I $40.00 y�� 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. 5. Fees: y0 0_
Not required for temporary construction services. 5a. Enter total of above fees $
ft
5% Surcharge (.05 X total fees) $ 2
NOTICE • Subtotal $ U 2
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 °'U
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ 1 42
Total balance Due
I:\DSTS \ELC96.APP Rev 9/96