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CITY OF TIGARD ELECTRICAL. F'ERMITc
DEVELOPMENT SERVICES DATE
#: -0398
DATEE ISSUEDD:: 0 0'93/03/97
13125 SW Nall Blvd., Tigard,OR 97223 (503)639-4171
PARCEL: 251O2CD-0712
SITE ADDRESS. . . : 11455 SW BULL MOUNTAIN RD
SIJRDIViSION. . . . :FREWINGS ORCHARu TRACTS ZONINC�:R-4. 5
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . .2E JURISDICTION: TIG
Pro.j ect Description: Reconnect services.
--RESIDE-NTIAL UIVIT---- - -TEMP SRVC/FEEDERS---- ------MISCELLANEOUS-----
1000 SF OR LESS. . . . : 0 0 200 amp• • • . • • • : 0 PUMP/IRRIGATION. . . . : 0
EACI I NDD' L 500SF. . . : 0 c_O1 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0
LIMITED ENE:RGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
MANF. HM/ SVC/F13R. . : 0 6O1•+-amps--1OOO volts. : 0 MINOR LABEL ( 10) . . . : 0
-----SERVICE/FEEDER------ BRANCH CIRCUITS----- -----ADD' L INSPECTIONS-•--
0 -.. 200 amp. . . . . . : 'L W/SERVICE OR FEEDER: 0
PER INSF'ECTTON. . . . . : 0
201 - 400 �AmP. . . . . . : 0 1st W/O SRVC OR FUR. : 0 PER HOUR. . . . . . . . . . . : 0
401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
601 - 1000 amp. . . . . : 0
------------------PLAN REVIEW SECTION----------------
tO@O+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : > 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 1 SVC/FDR )= 225 AMPS. . : CLASS AREA/SPEC_OCC. :
------------------------------ FEES -
APEX RPOPERTIES type amount by date recpt
11455 BULL. MOUNT IAN ROAD PRMT $ 50. 00 GEO 09/03/97 97--298897
TIGARD OR 97223 SPCT $ 2. 50 GEO 09/03/97 97-298897
Phone #:
Contractor: --------------------------_.._-_._._
ADAMS ELECTRIC CO INC $ 52. 50 TOTAL
2340 SE CLATSOP ------- REQUIRED INSPECTIrNS --
PORTLAND OR 97202 /�/`,G Elect' l Service _
Phone #: 234-9651 Elect 1 Final
Reg #. . : 000005
This permit is issued subject to the regulations contained in the Tigard Municipal lode, State of Oregon Specialty Codes and all other
applicable lams. All work will be done ;n 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 9Ki.,?-081-0010 through OAR 952 1-1987 You may obtain a cony
of these rules or direct questions to ODIC by calling (503)246-1987.
fly : rff -
F'ernittee Signat�_ire: �_ Iasued -
- OWNER INSTALLATION ONLY----------------------- - --
The
The installation is being made on property I own which is not intended for
sale, lease, or rent.
OWNER' S SIGNATURE: _ ____ DATE:
---CONTRACTOR INSTALLATION 0 ------------------------. _ - _
SIGNATURE OF SUPR. ELECT N t DATE- 4..L
L.I CENSE NO: 4 ,�Z�/
++++.+++.L++++++++++++++++++++++4+++++++++++++++++++++++++++++++++++++++++++-H++++
Call 639-4175 by 6tf)O p. m. for- an inspection needed the next business day
++++t++t+•Fh+.+++++i•+++++++++t++++++++4+14++tt+++t+++++++++++++t+++++++++++++++++
CITY OF TIGARD Electrical Permit Application Plan Check#
13,125 SW HALL BLVD. Recd By
rIGARD OR 97223 Date Recd
Phone (503)639-4171, x304 date to P.E.
Date to DST
Inspection (503) 639-41'75 Print or Type'
Incomplete or illegible will not be accepted Permit# j6ZO
Fax (503) 684-7297 _ Called
1. Job Address: i i 4. Complete Fee Schedule Below:
Name of Development_ n � /) 7-
Number of Inspections per permit allowed
Name(or name of business)_/ter � �1�'ll S P.�iFT_�-_• Service included: Item:, Cost Sum
Address/ -t)3� Razl .411 T�(/_ _ 4a. Residential-per unit
1000 sq.ft.or less $110,00
CityiState/Zip_ TiQ, n Each additional 500 sq It or
_
Commercial ❑ Residential` --- portion thereof $25,00 �
Limited Energy $25.00
Each Manuf'd Home or Modular
te -
.� Dwelling Service or Feeder $68.00a. Contractor installation only: -
(Attach copy of all current licenses) 4b.Services or Feeders
Electrical Contractor-_/3Pl� '
" installation,alteration,or relocation
Address "= 200 amps or less $60.00 2
201 amps to 400 amps $60.00 _
City State _Zip_ G�2� 401 amps to 600 amps $120.00 2
Photo No. 601 amps to 1000 amps $180.00 2
Job No. � - Over 10no amps or volts $340.00 2
-T __ Aeconnoct only $50.00 oda
Flee. Cont. Lice. No.- Exp.Date112 -� 2
OR State CCB Reg. No. xp.Dated/'7- 4c.temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date_ - Installation,alteratinn,or relocation
200 amps or less $50.00
Signature of Supr. Elec' -c� � 201 amps to 400 amps $75.00 _ 2 I
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No.---_;4,!T^ Exp.Date /r— 7.2_ see^b^above.
Phone No.-m.-a
- 4d.Branch Circuits
New,alteration or extension per panel
2b. ror owner installations: a)The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fae.
Address_ Each branch circuit $5.00 2
b)The fee for branch circuits
City _ Stat@ Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 _
The installation is being made on property I own whirh is not Each additional branch circuit _ $5.00 - 2
intended for sale, lease or rent. 49.Miscellaneous
(service or feeder not included)
Owner's SignatureEach pump or irrigation circle $40.00
Each sign or outline lighting $40.00
3. Plan Review section(if required):' Signal clrcuit(s)or a limited energy
panel,alteration or extension $40.00
Please check appropriate item and enter tee in section 51,3. Minor Labels(10) $100.00----
___4 or more residential units in one structure 4f.Enrh 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
ns described In N.E.C.Chapter 5 In Plant $55.00
'Submit 2 sets of piens with application whero any of thrr,above apply. Jam. Fees:
Not required for temporary construction,services. 5a.Enter total of above fees $ dd�
5%Surcharge(.05 X total fees) $
NOTLoE Subtotal $ 4-�1.SD
51).Enter 25%of line So for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review If reguir (Sec.3) $ --.
NOT COMMENCED WITHIN 18n DAYS,OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY ^
TIME AFTER WORK IS COMMENCED LJ Trust Account# tt S -
Total balance Due
I-\DSMELC96 Am nev 9/(10 -----'---.-
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-flour Inspection Line: 6394175 Business Phone: 6394171
Date Requested: _ A.M. P.M. MST:
Location:_ .6 BUP:_
Takao: Suite: Bldg: _ NEC:
eaaaaecor: _Phone: � ��,� PLM:
owner: _ —Phone: ;r����"f ��= -L--- ELC: 27
ELR:
SIT:
BUILDING BLDG(con's) PLUMBING MECHANICAI. ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover/Service Sewer/Storni
Footing Roof UndFl/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Line Rough-U UG Sprinkler
Foundation Insulation Sewer liood/Duct -iic�n reg; Vault
Bamt Damp Drywall Storm Furnace '1Ym g S-IT,ice MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire Spk1r/Alm Crawl/Found Di Heat Pump Low Voll
Approved Approved Approv.-d Approved
LApVpr/Sd,wlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL
Call for reinspection Rcinspec
on fee of'$._---- required before next inspection O Unable to inspect
Inspector: _ bete: Page of