Permit A
CITY OF TIGARD
ELECTRICAL PERMIT
PERMIT #: ELC1999 -00338
DEVELOPMENT SERVICES DATE ISSUED: 6/8/99
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
• PARCEL: 2S111AA -06300
SITE ADDRESS: 14357 SW 90TH AVE 4
SUBDIVISION: GREENSWARD PARK NO. 2 ® ZONING: R -4.5
BLOCK: LOT : 049 J ISDICTION: TIG
Project Description: First branch circuit and one add'I branch circuit
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 HM/ 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: 1 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:
JIM WILSON TICE ELECTRIC
14357 SW 90TH AVE . 2139 SE BELMONT ST
TIGARD, OR 97224 PO BOX 15009
PORTLAND, OR 97215
Phone: Phone: 233 - 8801
Reg #: LIC 00000166
SUP 2586S
PLM 2586s
ELE 26 -126C
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT BON 6/8/99 $42.85 99- 315985 Elect'I Final
5PCT BON 6/8/99 $2.14 99- 315985 .
Total $44.99 ORIGINAL
... ,
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 are 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.
Permit Signature: Issued By: / `__,
Dom ( — /
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: Cam- 1(ad Y` DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
RECEIVED
I
CITY Of TIGARD ,JUN 0 7 19 Permit Application Plan Check
13125 SW HALL BLVD. Rec'd By r, --"1/ --"1/ TIGARD OR 97223 COMMOIIIn OEVELUFM Date Recd La _
Date to P.E. N p
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Permit #ELCI "- 00 3N
Fax (503) 684 7297 Incomplete or illegible will no accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) Jim Wilson Service included: Items Cost Sum
Address 14357 SW 90th 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip Tigard OR 97224 Each additional 500 sq. ft. or
` Commercial El Residential ® portion 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 licenses) 4b. Services or Feeders -
Electrical Contractor Tice Electri c Co Installation, alteration, or relocation
200 amps or less $60.00 2 -
Address Pn Pny 1 009 201 amps to 400 amps $80.00 2
City Portland State OR Zip 97293 -5009 401 amps to 600 amps $120.00 2
Phone No. 233 -8801 FAX No_ 872 -8290 601 amps to 1000 amps $180.00 2
Job No. 9q 7347 Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 26 1 Ig6 Exp.Date 6 pant !9g Reconnect only $50.00 2
OR State CCB Reg. No. I Exp.Date / 3 J99 4c. Temporary Services or Feeders
COT Business Tax or Metro No. ' 2014 Exp.Date 01/01/00 Installation, alteration, or relocation
----J 200 amps or less $50.00 2
Signature of Supr. Elec'n_ lG� 201 amps to 400 amps $75.00 100.0 2
2
401 amps to 600 amps $0
2586S 1001 X00 Over 600 amps to 1000 volts,
License Na Exp.Date see °b'° above.
Phone Nc 233 -8801
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name 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. SO
First branch circuit 1 $35.00
The installation is being made on property I own which is not Each additional branch circuit - 'r $5 S , 9$ 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 • y cis
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ 4�y 2
' NOTICE Subtotal $ .
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $ 42. UU
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 #
Total balance Due $ am- q
9
I: \DSTS \ELC96.APP Rev 9/96
6/16/00 Activities for Case #: ELC1999 -00338
1:37:12 PM �11® 4 , 4 (1% *
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 6/7/99 BON RECD No Hold BON 6/8/99 Fee increase. Waiting for
additional fees.
ELCA003 Permit created 6/8/99 BON DONE No Hold BON 6/8/99
ELCA730 Elect'l Service 6/8/99 6/8/99 No Hold BON 6/8/99
ELCA799 Elect'I Final 6/8/99 6/8/99 No Hold BON 6/8/99
ELCA500 (F) Issue permit 6/8/99 BON DONE No Hold BON 6/8/99
ELCA920 Miscellaneous action - 2/15/00 JMT DONE No Hold JMT 2/15/00 research inspection request
ELCA580 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
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