Permit - A, - CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00227
, .� k DEVELOPMENT SERVICES DATE ISSUED: 4/15/99
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639 -4171 PARCEL: 1S134DB -04700
SITE ADDRESS: 11100 SW 109TH AVE
SUBDIVISION: CARNAHANS ADDITION . 0 ' ZONING: R -4.5
BLOCK: LOT : 009 9OURISDICTION: TIG
Project Description: Add two (2) branch circuits. �- ti
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:
MICHEAL FLORA WEST SIDE ELECTRIC CO INC
11100 SW 109TH AVE 1834 SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Phone:
Reg #: 21Z1-150306
SUP 1556s
ELE 26 -135C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT GEO 4/15/99 $40.00 99- 314540 Elect'I Final
5PCT GEO 4/15/99 $2.00 99- 314540
Total $42.00
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. / / f/ifilf
Permit Signature: / Issued By:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE: 157 y f
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
APR -14 -99 08:37 AM WEST SIDE ELECTRIC 503 736 0677 P.01
RECEIVED
CITY OF TIGARD APR 1:A. 1999 Electrical Permit Application Plan Check 0
13125 SW HALL BLVD. Rec'd By -
TIGARD OR 9722$ 'MDNIT" DEVELOPMENT Date Recd _
Date to P.E.
,Phone (503) 639 -4171, x304 Date too T
Inspection (503) 639 -4175 Print or Type Permit # 0e- / /VI - afA
Fax (503) 684.7297 Incomplete or Illegible will not be accepted Caned
1, Job Address: 4. Complete Fee Schedule Below:
Name of Development _ Number of Inspections per permit allowed
Name (or name of business) /r /i<` e " / Nei ef Service Included: Items Cost Sum
Address /PLO 0 Sur / 9 >`4 /9/44.-. 4a. Residential - per unit
City /State/Zp T /1 � ;, ci d� '`i 72 Z T 1000 sq. ft. or less $110.00 ' 4
O Each additional 500 sq. It. or
portion thereof $25.00 1
Commercial ❑ Residential ® Limited Energy - $25.00
Each Manurd Home or Modular
2a. Contractor installation only: Duelling Service or Feeder $68.00 2
(Attach copy of all current ice es / / 4b. Services or Feedera
;Electrical Co actor . ,t f / C Cf/ Installation, alteration, or relocation
a�� 200 amps or less _.__. $60.00 2
AddreS r �.7�� 201 amps to 400 amps $80.00 - 2
City or &' State AM zip 'ZM` 401 amps to 600 amps - $120.00 2
Phone No. .2 - /IV ' 601 amps to 1000 amps 8180.00 2
Job No. 4 // 3 -TV a Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No, 26 _ /i, Exp.Date_ Reconnect only $50.00 2
OR State CCB Reg. No._ 13 6 Exp.Date 4c, Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date installation, alteration, or relocation
200 amps or less 850.00 2
Signature of Supr. EIeCn� 201 amps to 400 amps 575.00 2
-
401 amps lo 600 amps 8100.00 2
-
Over 600 amps to 1000 volts,
License Nc /S Exp.Date see "b" above.
Phone Nr 23/ / 5-2' 4d. Drench Circuits
• New, alteration or extension per panel
2b. For owner installations: a) The tee for branch circuits with
purchase of service or
Print Owner's Name feeder tee.
Address Each branch circuit $5.00 2
City State Zip b) The fee for branch circuits
without purchase of
Phone No. service or feeder fee.
First branch circuit L $35.00 3 S 2
The Installation Is being made on property I own which Is not Each additional branch circuit L S6.0o S 2
intended for sale, lease or rent, 40. Miscellaneous
Signature (Service or feeder not included)
Owner's Si
g Each pump or Irrigation circle $40.00
Each sign or outline $40.00 2
• Signal circuits) or a limited energ
3. Plan Review section (if required): panel, alteration or extension - 540.00 2
Minor Labels (10) $100.00
_ _
Please check appropriate Item and enter fee In section 5B.
4 or more residential units In one structure 41. Each additional Inspection over
Service and feeder 226 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 - S ' S ' A
Pl
* Submit 2 sets of plans with application where any of the above apply. S. Fees: `d
Not required for temporary construction services. Se. Enter total of above tees S Z -
5% Surcharge (.05 X total fees) $
NOTICk Subtotal
6b. Enter 25% of line Ca for $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review I r e (Sec.3) $
T7i;S5 t,E 1JIEI�CicAWli't4fr 8, CONSTRUCTION W Subtotal
15 SUSPENDED OR ABANDONED 0DAYS FOR OR A PERIOD IF OF 180 DAYS OR AT ANY ORK Trust Account N / 3 � y Z.
, TIME AFTER WORK IS COMMENCED. $
Total balance Due pros 7-
6/19/00 Activities for Case #: ELC1999 -00227
1:47:31 PM
4.
Assigned Hold Updated '�
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes 0
ELCA001 Application received 4/15/99 GEO No Hold GEO 4/15/99 O
ELCA003 Permit created 4/15/99 GEO No Hold GEO 4/15/99
ELCA730 Elect'I Service 4/15/99 4/15/99 No Hold GEO 4/15/99
ELCA799 Elect'I Final 4/15/99 4/15/99 No Hold GEO 4/15/99
ELCA500 (F) Issue permit 4/15/99 GEO DONE No Hold GEO 4/15/99
ELCA920 Miscellaneous action 2/23/00 JMT DONE No Hold JMT 2/23/00 research inspection request
ELCA580 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
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