Permit � . , .• • . -
,
CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC97-0697
�� ATE ISSUED: 10/20/97
=�- -'� �t�����B�,��tC���� (503)639-4171
' PARCEL: 2S103BC-04900
SITE ADDRESS— :12G25 SW 124TH AVE
SUBDIVISION....:BROOKWAY ONING:R-4.5
BLOCK..........: LOT ^003 NOJURISDICTION: TIG
Project Description: Installing gas furnace and gas piping
'
---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 ENER8Y.... . : 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: 3 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 ----
BRUCE SHULTS type amount by date recpt
12625 SW 124TH AVE PRMT $ 50.00 B 10/20/97 97-300183
TIGARD OR 97223 5PCT $ 2.50 B 10/20/97 97-300183
Phone #:
Contractor: ---- -
OWNER $ 52.50 TOTAL
� REQUIRED INSPECTIONS -----
__
Rough-in Elect'l Final
Phone #: Elect'l Service
Reg #..: 999999
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-w10 through OAR 952-001-1987. You may obtain a copy
of these rules or direct questions OUNC by calling (503)246-1987.
' ' --' ''" J
Permittee Signature Issued By: 'IP^ ' �_-_
A
--------OWNER INSTALLATION ONLY
The installation is being made on pr""erty I own which is not intended for
sale, lease, or rent / vK | `
V
OWNER' S SIGNATURE: ����� • |
�_ DATE
/ --- ------- `^ c.,._.10.1
CONTRACTOR INSTALLATION ONLY ---
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
CITY Electrical Permit Application Plan Check • ,
13125 SW HALL BLVD. Recd By �tT Mitt : Y
TIGARD OR 97223 Date Recd 1
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639-4175 Incomplete or illegible will not be accepted Permit # E� �/,� 1� -b�
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Developmen grail Number of Inspections per permit allowed
-
Name (or name of business) 3 R V C Q 514%-i 1- 7 S Service included: Items Cost Sum
Address 1 Z- Cp 2 5 S w 1 Z 4 / il 4 - F. 4a. Residential - per unit ..
1000 sq. ft. or less $110.00 4
City/State /Z 7 . cite 191 C R 97 223 Each additional 500 sq. ft. or
❑ portion thereof $25.00 1
Commercial ❑ Residential
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
Electrical Contractor Installation, alteration, or relocation
200 amps or less $60.00 2
Address 201 amps to 400 amps $80.00 2
City State Zip 401 amps to 600 amps $120.00 2
Phone No. 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. Exp.Date .
OR State CCB Reg. No. Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Su r. Elec`n 201 amps to 400 amps $75.00 2
g p 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No.
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 6rioV C [- L. Sy1 v (7 5 feeder fee.
Address 12 c2 Z..S S W 1 ( ( 7 4 v Each branch circuit $5.00 2
^-� b) The fee for branch circuits
1
City t 9 ctvc, State G Zip 9 7 1_ 23 without purchase of
Phone No./ t-) - 5-.7 0 - Col"' n w -73c) -Z q y service or feeder fee.
First branch circuit l $35.00 3 2
The installation is being made on property I o n which is not Each additional branch circuit $5.00 15 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature V)!,, A-- 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: `J � / b 00
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ .5-0
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 # GJ Z •
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
6/19/00 Activities for Case #: ELC97 -00697
1:59:41 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 10/20/97 B RECD BON 10/20/97
ELCA003 Permit created 10/20/97 B DONE BON 10/20/97
ELCA700 Rough -in 10/23/97 BRP PASS J *H 10/23/97 Note: Smoke alarm in kitchen
not in hallway.
ELCA730 Elect'I Service BON 10/20/97
ELCA799 Elect'I Final BON 10/20/97
ELCA500 (F) Issue permit 10/20/97 B PASS BON 10/20/97
ELCA845 Request inspection research 6/8/00 JMT DONE No Hold JMT 6/8/00
ELCA580 Expired by limitation 6/11/00 HAP DONE No Hold AKJ 6/11/00
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