Permit ''''' 44 CITY OF TIGARD
AmAt DEVELOPMENT SERVICES ELECTRICAL PERMIT
1 ! �I. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE PERMIT ISSUED: 12
4 - 21b.
PARCEL: 1S135DC -04301
SITE ADDRESS... :11950 SW 95TH AVE
SUBDIVISION • �O ZONING:R -4.5
BLOCK • LOT JURISDICTION: TIG
Project De scr i pt ion : Alteration to residential electrical service.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 500SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 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/O SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT : 0
601 — 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
ALYCE THOMSON type amount by date recpt
11950 SW 95TH PRMT $ 35.00 DLH 12/31/98 98- 311854
TIGARD OR 97223 5PCT $ 1.75 DLH 12/31/98 98- 311854
Phone #:
Contractor:
JARMER ELECTRIC INC $ 36.75 TOTAL
5105 SW 45TH AVE
REQUIRED INSPECTIONS
PORTLAND OR 97221 Rough —in Elect'1 Final
Phone #: 246 -5381 Elect'1 Service
Reg #..: 000069
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 - 001-0010 through OAR 952 - 001 - 1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: / Issued By: ,e
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 : 45W /5"" / DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
RECEIVED
CITY OF TIGARD DEC 3 1 19 ectrical Permit Application Plan Check# -
13125 SW HALL BLVD� OMMUNITY D EVELOPMENT Rec'd By - i-H
Date Rec'd /2/3 / 9,"
TIGARD OR 97223
Phone (503) 639-4171, x304 /r Date to P.E. � Date to DST --
Print or Type
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted
Permit# CGC 9,- 4'/S
Fax (503) 684 -7297 Called
1, Job Address: 4. Complete Fee Schedule Below:
Name of Development e i 1 � _ Number of Inspections per permit allowed
Name (or name of business) A I t c a. , NorYt' SD Y) Service included: Items Cost Sum
Address 11 5 S l_A..) 5 4a. Residential - per unit ,
1000 sq. ft. or less $110.00 4
City /State /Zip -F id
r��11 Li
Each additional 500 sq. ft. or
Commercial ❑ Residential aSl 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 current licenses) 4b. Services or Feeders
Installation, alteration, or relocation
Electrical Contractor • . Au 0J k ° - . _ ... , 200 amps or less $60.00 2
• • -SS C, C - 201 amps to 400 amps $80.00 2
C -. ',..__ -__ IMIA State 0 R Zip . J 401 amps to 600 amps $120.00 2
Phone No. c.. 9- to " 5 3S,1 601 amps to 1000 amps $180.00 2
Job No. t (i-5 rn 1 r R 9 t/ Over 1000 amps or volts $340.00 2
-
Elec. Cont. Lice. No. iv - J L} t4 -- Exp.Date i 9 Reconnect only $50.00 2
,
OR State CCB Reg. No. l o C l a 4 Exp.Date 3 9 f 4c. Temporary Services or Feeders
COT Business Tax or Metro No.. .. . _ •. gate 3 I Installation, alteration, or relocation
�'� 200 amps or less $50.00 2
-
Signature of Supr. Elec'n i i����%/ '/ / 201 amps to 400 am $75.00 2 -
401 amps to 600 amps $100.00 2
O Over 600 amps to 1000 volts,
License No. : 'g€1 E ..Date see "b" above.
Phone No._ X 9.4 1., - 3`t5
4d. Branch Circuits
/d/e//o/ New, alteration or extension per panel
2b. For owner installations: / Q a) The fee for branch circuits with
A ft &ISO & •r7 )71•�A _.) purchase of service or
Print Owner's Name feeder fee.
Address Each branch circ $5.00 2 -
City State Zip b) The fee for branch circuits
ty p without purchase of
Phone No. service or feeder fee. �4^
First branch circuit i $35.00 -U • 82) 2
The installation is being made on property I own which is not Each additional branch circuit $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: eQ
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ / � L L
NOTICE Subtotal $ 3 � ,
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 # $
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
6/16/00 Activities for Case #: ELC98 -00754
2:00:13 PM
04.
Assigned Hold Updated A '
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 12/31/98 DLH MAIL DLH 12/31/98 97
ELCA003 Permit created 12/31/98 DLH DONE DLH 12/31/98
ELCA700 Rough -in 1/5/99 BRP FAIL B *P 1/5/99 No access.
ELCA730 Elect'I Service 1/4/99 BRP FAIL B *P 115/99 No access.
ELCA799 Elect'I Final 1/4/99 BRP FAIL B *P 1/5/99 No access.
ELCA500 (F) Issue permit 12/31/98 DLH DONE DLH 12/31/98
ELCA920 Miscellaneous action 2/18/00 JMT DONE No Hold JMT 2/18/00 research inspection request
ELCA580 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
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