Permit � CITY OF TIGARD ELECTRICAL PERMIT . .
( ,e�,ptl i . 0 A DEVELOPMENT SERVICES PERMIT #: ELC97 -051.8 .
�i i DATE ISSUED: 08/01./,97
:-'!� " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 15134DC -03000
SITE ADDRESS... :11130 SW TIGARD ST
SUBDIVISION.... :CI -JERRY HILL ACRE TRACTS ZONING:R-4.5
BLOC1'..vo......n. LOT ..... ... >.a.o :1 JURISDICTION: TIG
Project Description: Add two (2) branch circuits.
- - -- RESIDENTIAL UNIT - ---- _ -_ —TEMP SRVC /FEEDERS - - -- MISCELLANEOLJS----.---
1000 SF OR LESS....: 0 0 — 200 amp. ... e ..: '0 PUMP/IRRIGATION....: 0
EACH ADD' L 500SF. - a : 0 201 — 400 amp.......: 0 SIGN /OUT LINE LTGs .: 0
LIMITED ENERGY.....: 0 ' 401 — 600 amp =: 0 SIGNAL /PANEL.....-.: 0
MANF. HM/ SVC /FDR. e : 0 801 +amps -- 101.10 volts.: 0 MINOR (_ABEL (10) o . a : 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.: 1 PER HOUR- ..o.o..e.e: 0
401 — 6010 amp......: 0 EA ADD' L BRNCH CIRC: 1 IN PI_.ANT...........: 0
601 — 1000 amp : 0 --PLAN REVIEW SECTION -°-
1000+ amp /volt. fl n ..: 0 ) =4 RES UNITS........: > 600 VOLT NOMINAL..:
Reconnect only . 0 SVC /FDR >_ 225 AMPS..: CLASS AREA/SPEC OCC.:
Ova.e r : - - - -- - -- --------- -• - - -- - - - -- - - - -- --- - - - - -- - - - - - -- -- - - - - -_ - _ FEES _ — _ _
TIGARD—TUALATIN SCHOOL DIST type amount by date recpt
13137 SW PACIFIC HWY PRNT $ 40.00 GEO 08/01./97 97- 297851
TIGARD OR 97223 SPCT $ 2.00 GEO 08/01/97 97- 297851
Phone #:
Contractor: _ -. _.__ - -_ —_— _- _________
l= RAHLER ELECTRIC CO $ 42.00 TOTAL
11860 SW GREENHURG RD .
-------- REQUIRED INSPECTIONS ---
TIGARD OR 97223 Rough —in Elect'l Service
Phone #: 639 -4627 ' Underground Cove Elect' 1 Final
Reg #..: 000374
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- 10 through OAR 952 -001 -1987. You may obtain a copy
of these rules or direct questions to OUvC by calling (503)246 -1987.
P e r m i t t e e Signature: Issued P y :_
-- -- •-- -- --- -• - - -- 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': Vii" DATE: 0' v -/- 'T a I
LICENSE NO: I /CI-
+-F +- 1_ + + + + + + + ++ + + + + + + + + + +-I + ++ + + ++ +.4. ++ -1--i- 1- + + + + ++ + + ++ + + +++-1- + ++ + +-1 -+ -1 + + + +++ + + + + +-i--1-+++
Call 639 -4175 by 6 :00 p.m. for an inspection needed the next business day
+ + ++ + ++ + + + + + + ++ + + +-i ++++++++++ + + + ++ + + ++ + + + + + ++ + +-1-•i-++ + + + ++ F• + + + + +i--I + +++++ +-17•-1- +++ + ++
ID ,.
is
CJTY TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
Date Rec'd
TIGARD OR 97223 Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit #f L C 9 - 7 - 0 Jl ir
Fax (503) 684 -7297 Incomplete 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) E.S.D. O F F I C E Service included: Items Cost Sum
Address 11130 S.W. TIGARD 4a. Residential - per unit
1000 sq. ft or less $110.00 4
City /State /Zip TIGARD , O R E OG N 97223 Each additional 500 sq. ft. or
Commercial ® Residential 1=1 Limited thereof $25.00 1
Limited 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
Electrical Contractor F RAH LE R ELECTRIC COMPANY Installation, alteration, or relocation
200 amps or less $60.00 2
Address 11860 SW GRFFNRIIR( ROAD 201 amps to 400 amps $80.00 2
City TIGARD State OR Zip 97223 401 amps to 600 amps $120.00 2
Phone No. 639 -4627 601 amps to 1000 amps $180.00 2
Job No. 57356 Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 34 -13C Exp.Date 10/1/97
OR State CCB Reg. No. 37410 Exp.Date 7/2/98 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 19 7 Exp.Date 12 / 1 / 9 7 Installation, alteration, or relocation
�f 200 amps or less $50.00 2
Signature of Supr. Elec'n /'-e✓ 401 amps to 600 amps $ 2
1816S 10/1/98
Over " b 1000 volts,
" above.
License No. Exp.Date
Phone No. 639 - 4627
4d. Branch Circuits
�PPUCATION New, alteration or extension per panel
2b. For owner inst. l!;::i '�,�° t'° t a) T he fee for branch circuits with
purchase of service or
Print Owner's Name copy 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.
First branch circuit 1 $35.00 :1ri no 2
The installation is being made on property I own which is not Each additional branch circuit 1 $5.00 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. 5. Fees: 40.00
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ 2.00
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 # $ 42.00
Total balance Due
I \DSTS \ELC96 APP Rev 9/96
A