11736 SW 125TH COURT �.. I I , ��� .����1 I ,_ I'I'I I �,����i�,�,
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT ELECTRICAL PERMIT
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839.4171 PL RIYI I T #: ESL C9 C-0108G
DATE ISSUED: 02/12/96
PARCEL: 1S133DT)-06600
ITE ADDRESS. . . : 1. 17 G SW 3.25TH CT
.IBD I V I S I ON. . . . : VILLAGE AT SUMMER LAKE PARK 3 ZONING: R-4. S
L1C1�,. . . . . . . . . . . L01.. . . . . . . . . . . . . : 105
"o.je:ct Descript :Lan .
- --RESIDENTIAL UhlI1' - _ ---TEIYII=' SR')C/FEEDER 7.-_-.-_ -
1L1010 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . . 0 PUMP/IRRIGATION. . . . : 0
.ICH ADD' L 3001SF. . . : 0 20.11 - 400 amp.. . . . . . . : 0 SIGN/OUT LINE LT'G. . : 0
IMITED ENERGY. . . . . : 0 41711 - 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
al"SIF. I-ill/ GVC/FDR. . : 0 601 +.amps--100101 Volts. . 0 MINOR LABEL ( 101) . . . : 0
--SERVICE/FE EDEN -- - ___.._ pRANCII
CIRCUITS--------, ._--ADD' L INSPECTIONS--
21210
NSPECTIONS--
21210 amp. . . . . . . 01 W/SE_RVICE GR FEEDER: 0 PER INSPECTION. . . . . : 01
?11 - 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0
1 60101 ukmp. . . . . . : 0 CA FDD' L BRNCH CIF21_, : 121 IN PLANT. . . . . . . . . . . 1 0
Z11 1012101 &nip. . : 0 ______.-•-------_.._F'LNN REVIEW5ECT1ON_.--.--.-- --..---_.___.._-_
'1001+. atmp/voIt. . . . . : 0 ) =4 RFS UNITS. . . . . . . . : ) 600 VOLT NOMINAL. .
aconnect only. . . . . : 0 SVC/FDR ) = 225 AMPS). . : CLASP, AREA/SPEC OCC. :
Qwner: __....__._. ..._ .. __..... _..._-- -.... ..._____._._.__ FEE'S _.._----_........._...-._._...__.__..
�_O*6) QUID1NG type amount by date rem-pt
1 7:1(; 5W 1125TH PRMT $ 35. 00 CJS 02/12/-)6 `3C,-275831.
5PCT $ 1. 75 CJS 02/12/96 96--E7583i;
CARL CJR �3 1,_c::,
cone #:
.L CITY ELECTRIC :.,G. 75 TOTAL
117 NE HWY 99
J i T E 1 16 -_-- REDU I RED I NSPECT I ONS - -
iNLU1JVL-R WA '3ElE L :; E:lec�t " 1 Sor•vic:e
Lorre 0 : E1ec:t' l Final
.s permit is issued suiject to the regulations contained in the
�:ard Munic:pai Code, State of Ore. Specialty Codes and all other C'er mittee aignatl.lre
,Aicalale lawn. All work will be lore in accordance with
,,roved plans. This permit will expire if work is not started
.hin IW days of issuance, or if work is suspended fo. sore
;n ;60 days. Iss._ted By
0WNER 1NSTA_LAT101\1 ONLY
1e installation is beinq made on property I own which is not intended fur-
.,le, lease, or rent .
;NL R' S G l UNA1-URE. : I.1E- I L -
_. .. -CONTRACTOR INSTALL_AT ION ONLY-..-- - --
Lji`1ii (URE_ OF 5UPP., F:.:L.f-I C! NIC'Cl DA I ! I?- l a- 4S-
0.:111 fo- inspection -- 62"31- 4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Fiali Blvd.
Tigard, OR 97223 Planck/Rec. # �E.
Permit # EIC 96 Un 5'6
Phone (503) 639-4171
Date Issued i -�- y�
FAX (503) 684-7297 Issued by
CITY OF TIGAIRD TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Nance of Development_ Number of Inspections per permit allowed —
Address (\'4-3\0 �)�i 1 \�.�j LT Service included Items r;o.t(ea) Sum
City/State/Zip C�, V 9, TA aa-3 4a. Residential- per unit 4
1000 bq It or less $11000
Each ad
Name (or name of business) C=`^'1�' �\ \Ii�AYIG portion thereof
f sq It or
ol t>25 00 1
Commercial ❑ Residentiarg Landed Energy $2500 2
Foch Manut'd Home or Modular
dwelling Service or Feeder W 00
2a. Contractor Installation only: 4b.Services or Feeders
Irrlallation,allerahon.or reloc°tion 2
Electrical Contractor lk�\ C_►VLA tide-L,#*n c. 200 amps or last. $6000 2
Address N r- C{C 1l Lip 201 amps to 400 amps $8000 2
401 amps to 000 arnpu $12000 2
City LL,_v State �V Zlp 1 ` .. 601 amps to 1000 amps $18000 _ 2
Phone N0. a3 3 - L 5gl a Over 1000 amps or volts $34000 2
Contractor's License No '4 - "1 C- Reconnect only $5000
Contractor's Board R, f►vV� 4c.Temporary Services or Feeders
•�1,n/4 Installation,alteration,or relocation
Signature of Supr. Elec'n _ 200 amps or lose $5000 _
License No. Phone No. a ?3 -US�t d 201 amps to 400 wnpb _ $7500
2 401 amps to 600 amps $10000
Over 600 amps 10 1000 volts
2b. For owner installations: see•b•above
4d Branch Circuits
Print Owner's Name _._ New alteration or extension par penal
Address _ a)The tee for branch circuits with
Cj
ty StatP Zip —� purchase of emvkfe
e or feeder e. --��
Each branch circuit $5(10
Phone N0. b)The lee for yanch cacultc without
The installation is being made on property I own which is purchawof service or Meador hie '
Fret
not intended for sale, lease or rent. additional
circuit ( $ 00
Each additional branch crrctin $5$5 110
Owner's Signature__ __ 4e. Miscellaneous
(Service or leader not included)
3. Plan Review section (if required): t itch pump or irrigation circle $1000 _
fSach sign or outline Ightmg _ $4000
Signal carru t(s)or a Irm.',.0 energy
Please chock appropriate item and enter fee in secaion 5B. panel,alteration or extension $4000
_ 4 or more resldenfial units in one situcture Minor Labels(10) $100 00
Service and feeder 225 amps or more
System over 600 volts nominal 4f, Each additional inspection over
Classified arca or structure containing special iccupancy the allowable in any of the above
as desr;ribod in N E C Chapter 5 Per hour insperfl
$'15 0o
_
Per h $55 00
In Plant _- $55 00
Submit 2 sets of plane with applicatior where any of the above `
apply. Not required for rnmporary ,on ltuctloti services. j, Fees:
NOTICE 5a. Enter total of above fees $ '55.L
5%Surcharge(.05 X total fees) $ 1-1-5
PERMITS BECOME VOID IF WORK OR CONSTRUCTION SublofN $ -18121 }5
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 $
COMMENCED. ❑ Trust Accountill $
Balance Due $
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