Permit CITY OF TIGARD ELECTRICAL PERMIT
„ PERMIT #k: ELC96-- 0623
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 10/03/96
13125 SW Hell Blvd. Tigard, Oregon 9722308199 (503) 639 -4171
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PARCEL: c51101DB- t�+[12
00
SITE ADDRESS...: 15268 SW ROYALTY PKWY #kA •
SUBDIVISION - WILLOWBROOK FARM /ARBOR HEIGHTS ZONING:R -25
BLOCK........... LOT ............. :8 -
Project Description: Installing temporary service 200 amps or less
•-- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - - - -----MISCELLANEOUS-----.
1000 SF OR LESS....: 0 0 - 200 amp - 1 PUMP/IRRIGATION,...: e0
EACH ADD' L 302ISF...: 0 201 - 400 amp - O 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)'.'..: 6,
----SERVICE/FEEDER---- - - -- BRANCH CIRCUITS --- ADD'L I'NSPECT.IONS-----
, 0 - 200 amp.... : 0 W /SERVICE OR FEEDER: 0 PER INSPECTION ' 0
201 - 400 amp. . . . e . ;. 0 1st W/O SRVC OR FDR. : 0'. PER f SOUR....... . . . ., : O•
401 600 amp......: 0 , 'EA ADD' L BRNCH CIRC: 0" IN SLANT...........: 0
601' - 1.000 amp.. o . .: -0 ---- -• - -•- - -PLAN REVIEW SECTION-
1000+ 'amp / v:o l t .....: '0 >' -4 RES UNITS........: > 600 VOLT NOMINAL..:-
Reconnect on Z y.....: 0 SVC /FDR ›..= 225 AMPS..: CLASS AREA /SPEC OCC. :
Owner: - - - _ - - -- _ -- - - - - -- FEES -- -
NORTH VALLY ELECTRIC type amount by .date recpt
PO BOX 222 -PRMT $ 50.00 B 10/03/96 96- 234714 V
• SPCT 2.50 B 10/03/96 96- 284714
WOODBURN OR 97071
Phone #k: 503 -982 -5916
Contractor: --
' NORTH VALLEY ELECTRIC.INC $ 52.50 TOTAL
PO BOX 222
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REQU I RED INS PECT I ONS -- -° - - - --
WOODBURN OR 97071 Ceiling Cover Underground Cove
Phone #: 503- 982 -5916 Wall Cover Elect'l Service
Reg #..: 88302
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This peroit is issued subject to the regulations contained in the i J
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm i t t e e Signature
applicable laws. All work will be done in accordance with
approved plans. This peroit will expire if work is not started i •
Within 180 days of issuance, or if work is suspended for Bare' _ (�� i/ _ �--- —_ __
than 180 days. • Issued By
- -- °- - CIWNER 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
J - --
SIGNATURE OF SUPR. ELEC' N :. OWI. )� �� DATE: — -
P
LICENSE NO -
Call for inspection - 639 -4175
Community Development ELECTRICAL PERMIT APPLICATION
e A 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit# Ciz1 -01nZ
_,,' '��I�j Phone (503) 639 -4171 Date Issued lD- . 6' c ilc
FAX (503) 684 -7297 jp/'
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by rj w
Inspection (503) 639 -4175
1. Job Address: 15Lf0 s «% � � � ( P� w 4. Complete Fee Schedule Below:
Name of Development
IN bor i , c� 4} L'. p .)-= s Number of Inspections per permit allowed
Nor ' fHiw, -ct o r-nf - (9)c-.5,11 1 . /V1ctefre 5
Address anbt Prn toc / 6/14 . 1 r 1 e' C„ Service included: Items Cost(ea) Sum
City/State/Zip -i Can rr11 C' t I \ 4a. Residential - per unit 4
Q t 1000 sq ft or less $110 00
Name (or name of business) Each additional 500 s q ft or i
portion thereof $25 00
Commercial pl Residential ❑ Limited Energy $2500
Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68 00
2a. Contractor installation only:
4b. Services or Feeders
Val I Installation, alteration, or relocation 2
Electrical Contractor �ptz�� v0. ��� e� 2 t e ( 200 amps or less ciao 00 2
Address Y .0 . OX (y y / 201 amps to 400 amps $80 00 2
401 amps to 600 amps $120 00 2
Zip / C
City �Stx, p p-}—J1-0111..e_ State Ui2 Zi O
D (� I , h 601 amps to 1000 amps $180 00 2
Phone No. I - IS Q - 7 SAP •- S3 00 Over 1000 amps or volts $340 00 2
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Contractor's License No. el U - ;30 - c Reconnect only $so 00
Contractor's Board Reg. No. 823 Off. 4c. Temporary Services or Feeders
Irstallation, alteration, or relocation 2
60 2
Signature of Supr. Elec'n . � / % � `�� 20 amps or less 1 $5 2
License No._.9000- S ; No -, .. 46-4,-,S300 201 amps to 400 amps $7500
401 amps to 600 amps $100 00
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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 lee for branch circuits with
City State Zip purchase of service or feeder fee. 2
Each branch circuit $5 00
Phone No. b) The lee for branch circuits withou
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
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 irngation arde $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
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4 or more residential units in one structure Minor Labels (10) $100 00
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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 ins $35 o0
Per hour $55 00
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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 tees $ O
5% Surcharge (.05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ S )SO
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 Subtotal $ 5 .50
COMMENCED. ❑ Trust Account # $
Balance Due $ s a s_
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