Permit CITY OF TIGARD ELECTRICAL PERMIT
1 DEVELOPMENT SERVICES PERMIT t: ELC98 -0319
— L. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/12/98
PARCEL: 1S133DD -10700
SITE ADDRE SS...: 1 1 932 SW 1 25TH CT
SUBDIVISION. ...: V I LL_AGE AT SUMMER LAKE PARK 4 ZON I NG : R -4. 5
BLOCK..........: L0T .............:144 JURISDICTION: TIG
Project Description : Electric alteration to SF residence.
- -- RESIDENTIAL UNIT - - - -- -- -TEMP SRVC /FEEDERS - - -- - - - -- MISCELLANEOUS
1000 SF OR L_ESS....: 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 0CC. :
Owner: ____.._ _. _ - FEES ----------
ROBBIE KING type amount by date recpt
11932 SW 125TH CT PRMT $ 35.00 DLH 06/10/98 98-306418
PORTLAND OR 97223 5PCT $ 1.75 DLH 06/10/98 98- 306418
Phone #:
Contractor: _- • __ --
TRI -CITY ELECTRIC $ 36.75 TOTAL
PO BOX 68797
REQUIRED INSPECTIONS -----
MIL.WAUKIE OR 97267 Rough -in Elect' 1 Final
Phone #: 659 -8222 Elect'l Service
Reg #..: 50888
This pereit 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 perait will expire if work is not started within 180
days of issuance, or if work is suspended for nore 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 - 881- M0 through ORR 952 - 001-1987. You eay obtain a copy
of these rules or direct questions to OUNC by calling (503)246- 1987.
Permittee Signature: /Wit- 1 - - 1 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 - - - -.- .- 92--/2t
SIGNATURE OF SUPR. ELEC' N : O/ ' /9AAG/ C.9.7 ON / DATE : LICENSE NO: 'V 5' -S
-t +++++++++++++++++++++ + ++ + + + + + ++ ++ + ++ ++ + ++++ ++ ++ ++ +++ i- + + ++ +-f + + + ++ + + + + + + + + + + +•i ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++ + + + + + + +++ +++ + + ++ ++ + + + ++ + + + ++ + ++ f- +-1 + + + + + + + ++
RECEIVED
(CITY OF,TIGARD Electrical Permit Application Plan Check #
13425 SW HALL BLVD. Rec'd By --7:L/74 JUN 1 0 19gu Date Rec'd //D /9,p
TIGARD OR 97223 Date to P.E.
Phone (503) 639 -4171, x304 COMMUNITY DEVEL fd Date to DST
Print or Type / /'' II
Inspection (503) 639 -4175 Permit #�L2 9�P- 4-3/ 9
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development 1 - 1 -'MtNA E I R ___po E_ 8 vc_loP norr Number of Inspections per permit allowed
Name (or name of business) b \ E 1Si l Ca Service included: Items Cost Sum
Address 1' i Pb ), S . VV • 1 IS 1 C, i 4a. Residential - per unit
1000 City/State/Zip T C:1 �nS d O 2 � j �] L Z .. Each additional it or less $110.00 4
ty p Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial ❑ Residential
Li mited 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 •�i3 ; C 1: .-�
�e. Co • Installation, alteration, or relocation
200 amps or less $60.00 2
Address d • 60X l0�"1 7 201 amps to 400 amps $80.00 2
City M t_AJJ 0-k._1-, e. State O R Zip 9'7,2_4 '7 401 amps to 600 amps $120.00 2
Phone No. C" a3 4,5 $ 1-1-1- 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 5 g g 8" Exp.Date 4, / 24 9 g /
t, Reconnect only $50.00 2
OR State CCB Reg. No. 3- -I 4 0 Exp.Date 10 r / rr T i� 4c. Temporary Services or Feeders
COT Business Tax or Metro Notznt+. st. 0 - Exp.Date 9 ti /9 I Installation, alteration, or relocation
200 amps or less $50.00 2
201 Signature of Supr. Elec'n- a • --a--- 401 amps to 600 amps $100.00 2
� �
Over 600 amps to 1000 volts,
License No. a--
-' -1 O S . Exp.Date see °b" above.
Phone No. 4.5 - g�--
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. ,... 0
First branch circuit / $35.00 S - 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: _
Not required for temporary construction services. 5a. Enter total of above fees $ 3 0
5% Surcharge (.05 X total fees) $ I S
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 # $ 3 e.e. 7
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96 , _D / 0 �_
6/19/00 Activities for Case #: ELC98 -00319
2:02:36 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 6/10/98 DLH RECD DLH 6/10/98
ELCA003 Permit created 6/10/98 DLH DONE DLH 6/10/98
ELCA400 (F) Ready to issue 6/10/98 DLH PASS KJP 6/12/98 Need electrical supervisor's
license information before
issuing permit. I requested this
info be faxed on 06/10/98. dlh
Received elec. super. license
06/12/98. dlh
ELCA500 (F) Issue permit 6/12/98 DLH DONE KJP 6/12/98
ELCA799 Elect'I Final 6/17/98 CD PASS CD 6/17/98 wiring of a/c unit.
ELCA800 Case finaled 6/17/98 KS PASS J *H 6/17/98
•
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