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Permit CITY OF 1 I G A R D ELECTRICAL PERMIT PERMIT #: ELC2000 -00459 1611 n�1 DEVELOPMENT Tigard, o SERV (503) 6 -4171 ACES • DATE ISSUED: 8/11 /00 13125 SW Hall PARCEL: 2S1 12 B D -04300 SITE ADDRESS: 14827 SW 79TH AVE • SUBDIVISION: RAZE MEADOWS ZONING: R -4.5 BLOCK: LOT : 025 JURISDICTION: TIG Project Description: INSTALLATION OF (1) BRANCH CIRCUIT W/O FEEDER RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL: MANF HMI SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: MOUNTAIN, DONALD A ROSE CITY ELECTRIC CO INC 11065 SW LUCAS DR 4012 NE CULLY BLVD TUALATIN, OR 97062 PORTLAND, OR 97213 Phone: Phone: 287 -6164 Reg #: SUP 2127S LIC 00003567 • ELE 26 -113C FEES Required Inspections Type By Date Amount Receipt Elect'I Final . PRMT GWL 8/11/00 $37.50 0004418 5PCT GWL 8/11/00 $3.00 0004418 Total $40.50 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 rules . adopted by the Oregon Utility Notification Center. Those rules a re set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -1987. PERMITTEE'S SIGNATURE ISSUED BY: 1 6 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: DATE: LICENSE NO: Call 639 -4175 by 7:OOpm for an inspection the next business day ^. OF TIGARD Plan Check # r li Electrical Permit A f 25 Sw HALL BLVD. Rec'd By TIGARD OR 97223 AUG Date Rec'd iti�+ 0 �� ©� Date to P.E. Phone (503) 639 -4171, x304 Inspection ( ection 503 ) 639 -4175 Print of 1t U NITY D EVELOP Er Date to DST Permit # g f 4. 10 00 - 00.4 Sy Fax (503) 598 - 1960 Incomplete or illegible will not be accepte Called 1. Job Address: 4. Complete Fee Schedule Below: • Name of Development Number of Inspections per permit allowed Name (or name of business) . _ ) Service included: Items Cost Sum l' gari 4 Address , .. I 4a. Residential - per unit City/State/Zip 1000 sq. ft. or less $ 117.75 4 ry p / ,� Each additional 500 sq. ft. or portion thereof $ 26.25 1 Commercial ❑ Residential RI Limited Energy $ 60.00 Each Manufd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2 (Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders information for COT data base). S '( Installation, alteration, or relocation Electrical Contractor O 2 / CJ Q ( t c.,C Ih ^_ 2 00 amps or less $ 64.25 2 Addres 0 1 & ilteffligiff 201 amps to 400 amps $ 85.50 2 401 amps to 600 amps $ 128.50 2 City A ,l A.■, State � lam' Zip i el 601 amps to 1000 amps $ 192.50 2 Phone No. 0 ), ' A lY / � ' 7 Over 1000 amps or volts $ 363.75 2 Job No. ) 5 y 3 � / / n v Reconnect only $ 53.50 2 Elec. Cont. Lice. No. /A - Il i V Exp.Date UV/ / 6& .4c. Temporary Services or Feeders OR State CCB Reg. No. ,35 (0 7 O Exp.Date / / / .2 oi Ua Installation, alteration, or relocation COT Business Tax or Metro No. .• !O .' •.D . 200 amps or less $ 53.50 2 201 amps to 400 amps $ 80.25 2 Signature of Su r. El , �q /' / � 401 amps to 600 amps $ 107.00 2 SI g P Over 600 amps to 1000 volts, • � � - S Ex p.Date /o //� see "b" above. 2 License No. 4d. Branch Circuits Phone No. d - If f (e q 11. New, alteration,or extension per panel a) The fee for branch circuits 2b. For owner installations: with purchase of service or feeder fee. Print Owner's Name Each branch circuit $ 5.35 2 Address b) The fee for branch circuits without purchase of service City State Zip or feeder fee. Phone No. First branch circuit / $ 37.50 3 Each additional branch circuit $ 5.35 The installation is being made on property I own which is not 4e. Miscellaneous intended for sale, lease or rent. . (Service or feeder not included) Each pump or irrigation circle $ 42.75 Owner's Signature Each sign or outline lighting $ 42.75 Signal circuit(s) or a limited energy • panel, alteration or extension $ 60.00 3. Plan Review section (if required):* Minor Labels (10) $ 107.00 Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over 4 or more residential units in one structure the allowable in any of the above Service and feeder 225 amps or more Per inspection $ 50.00 Per hour $ 50.00 System over 600 volts nominal In Plant $ 59.00 Classified area or structure containing special occupancy as described in N.E.C. Chapter 5 5. Fees: a i 5a. Enter total of above fees $ 3 7 * Submit 2 sets of plans with application where any of the above apply. c (a Surcharge (.05 X total fees) $ mod"`' Not required for temporary construction services. S total $ 5b. Enter 25% of line 5a for NOTICE Plan Review if required (Sec. 3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust. Account # Y AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ y0 / i:\dsts\forrns\electric.doc 5/7/01 Activities for Case #: ELC2000 -00459 2:31:35 PM a, Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ; ELCA800 Case Finaled 9/28/00 CD DONE No Hold AMS 5/7/01 ELCA001 Application received 8/3/00 GWL RECD No Hold GWL 8/11/00 ELCA003 Permit created 8/11/00 GWL DONE No Hold GWL 8/11/00 ELCA799 Elect'I Final 9/28/00 CD PASS No Hold AMS 5/7/01 Entered per CD's signoff on card, no insp. report found in file. AMS ELCA500 (F) Issue permit 8/11/00 GWL DONE No Hold GWL 8/11/00 ELCA510 (F) Reprint permit 8/22/00 ZZZ DONE No Hold ZZZ 8/22/00 , 4111 ralillW % 1 Page 1 of 1