Permit CITY O F TI G A R D PERMIT #: ELC98I
4
DEVELOPMENT SERVICES DATE ISSUED: 08/03/98
• II ' I� f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 F�
S9 ARCEL: 291O3CD -02300
SITE ADDRESS...:13735 SW 116TH PL
SUBDIVISION •HOLLYTREE G:R -4.5
BLOCK •01 LOT •009 JUR SDICTION: TIG
Project Description : Alteration to electrical service for residence.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY : 0 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANE. 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: 1 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
MIKE SMITH & LIZ SMITH type amount by date recpt
13735 SW 116TH PL PRMT $ 40.00 DLH 08/03/98 98- 307943
TIGARD OR 97223 5PCT $ 2.00 DLH 08/03/98 98- 307943
Phone #:
Contractor:
CLIMATE CONTROL $ 42.00 TOTAL
3315 NW 26TH AVE
REQUIRED INSPECTIONS
PORTLAND OR 97210 Rough —in Elect'l Final
Phone #: 223 -4393 Elect'l Service
Reg #..: 000621
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 188
days of issuance, or if work is suspended for more than 188 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 - 081 -8810 through OAR 952- 881 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (583)246 -1987.
Permittee Signature: '9/t7 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: /09 DATE:
CONTRACTOR INSTALLATION ON LY
SIGNATURE OF SUP R. ELEC' N : O / .W/ DATE: �.0
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
L
R IAkin RE CEIVED
AuS - 31999
ETy D EVELOPMENY plan Check # A, '/
CITY OF TIGARD Electrical PermitcAppliCatlOn
13125 SW HALL BLVD. Rec'd By - G
Date Recd cV -
TIGARD OR 97223 I Date to P.E. Al/ '
Phone (503) 639 4171, x304 / Date to DST
Inspection (503) 639 -4175 Print or Type Permit # EZC 9rP -o y/ '7
Fax (503) 684 - 7297 Incomplete or illegible will not be accepted Called
7. Job Address: 11 SYnki'L 4, Complete Fee Schedule Below:
! r Name of Development Vr 112 ✓ Number of inspections per permit allowed
I
Name (or name of business) 011----
I v� ('t'✓�� / Service Included: Items Cost Sum ,
Address (3 7 51/0 4a. Residential - per unit
-
1000 sq. It. or less $110.00 4
City/State/Zip � iiA .4. 72 Each addltionat 500 sq. ft. or
l portion thereat $25.00 1
Commercial ❑ 4 Residentia
Limited Energy $25.00
Each Manuf d Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
I Ilce s 4b. Services or Feeders
(Attach copy of rluirrentet I n o I alteration, ration, or relocation Electrical Contractor Address 3 2 )15 1) Z 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City St to Zip 7,� / () 401 amps to 600 amps - $120.00 2
Phone o. ZE -- 93 601 amps to 1000 amps $180.00 2
Over 1000 amps or volts $340.00 2
- Job No.
g /y7 ,/ Reconnect only $50.00 2
Elec. Cont. Lice. No. . - Exp.Date I 'h. -
OR State GCB Reg. No. • s / • Exp.Date 0 PIS: 4c. Temporary Services or Feeders
COT Business Tax or Metro No. F` Exp.Date 174 Installation, alteration, or relocation
0 ', 200 amps or less $50.00 2
-
Signature of Su
Si r. Elec` !� ' /' 201 amps to 400 amps - $75.00 2
g p 401 amps to 600 amps $100.00 2
/� f Over 600 amps to 1000 volts,
License Nt. _ <) \ �� Ex .Date 6 J see "b" above.
Phone Nr 2' .- - q
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 27
0
City State_ Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $ t) 2
The installation is being made on property I own which is not Each additional branch circuit I $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 i • $40.00 2
Minor Labels (101 $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: / 71
Not required for temporary construction services. 5a. Enter total of above fees $ V - -`
5% Surcharge (.05 X total tees) $
NOTICE Subtotal $
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 # Y�
$
Total balance Due
IA TS\ELC96.APP Rev 9/96
Z 00 U IVDLL .d0 [.LID 096T 865 £05 XVd £Z : 60 OHM 86 /6Z /L0
5/30/00 Activities for Case #: ELC98 -00447
3:12:20 PM Xp
FD
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 8/3/98 DLH RECD DLH 8/3/98
ELCA003 Permit created 8/3/98 DLH DONE DLH 8/3/98
ELCA700 Rough -in DLH 8/3/98
ELCA730 Elect'I Service DLH 8/3/98
ELCA799 Elect'I Final DLH 8/3/98
ELCA500 (F) Issue permit 8/3/98 DLH DONE DLH 8/3/98
ELCA845 Request inspection research 3/27/00 JMT DONE No Hold JMT 3/27/00
ELCA580 Expired by limitation 4/18/00 HAP DONE No Hold AKJ 4/18/00
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