Permit ELECTRICAL PERMIT
CITY � TIGARD PERMIT #: ELC96-0250 DATE ISSUED: 04/19/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 Oregon 97223.8199 (503) oum��r� .
Tigard, ' PARCEL: 2S1140D-00101
SITE ADDRESS...: 17005 SW 92ND AVE
SUBDIVISION ^ ZONING:
BLOCK..........: LOT.............:
Project Description: INstall one service or feeder and one branch circuit.
__
---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 LTB. . : 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 : 1 W/SERVICE OR FEEDER: 1 PER INSPECTION : 0
201 - 400 amp...... : 0 1st W/O SRVC OR FDR. : 0 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 ---
CITY OF TIGARD type amount by date recpt
13125 SW HALL BLVD PRMT $ 65.00 CJS 04/19/96 96-278412
P. O. BOX 23397 5PCT $ 3.25 CJS 04/19/96 96-278412
TIGARD OR 972p3
Phone #: 503-639-4171
Contractor: -------- ----
JACK REESE $ 68.25 TOTAL
. 16310 SE RHONE
• REQUIRED INSPECTIONS -
PORTLAND OR 97236 Wall Cover Elect'l Final
Phone #: Elect'l Service
Reg #..: SPVSR
This permit is issued subject to the regulations contained in the •
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signature
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 sore __ �'�/�r/e' '~-/m�|~��- -- th 180 da Issued
• --- - 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: �� �/ '� u» ~ . t , DATE: 9-'9
LICENSE NO •
Call for inspection - 639-4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # c36 - 0.7P" //a
, � �, Permit # ELCq(- o S'n
Al i , Phone (503) 639 -4171 Date Issued y /9- 96
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by Cdr - /er S�1 n��'c>'f
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development (ji-r, -CL4 Number of Inspections per permit allowed
Address 1 T(5X0 Ft.. "►aY- Service included: Items Cost(ea) Sum
City /State/Zip V T i-C \ 1 Or q a2-3 4a. Residential - per unit 4
1000 sq. ft. or less $11060
-
Each additional 500 sq. ft. or
Name (or n. e o business) Q C.) .I,
� tIQ portion thereof $25.00 1
►� 1 Limited Energy $25.00
Commercial Residential Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68.00
-
2a. Contractor installation only:
' 4b. Services or Feeders
Installation, alteration, or relocation II..�� 0° 2
Electrical Contractor \-\() a' • ' • f I � = i 200 amps or less $60.00 L • 2
Address • .` 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00
City i, . , State Zip 601 amps to 1000 amps $180.00 2 -
Phone N.. 3 , ‘ Over 1000 amps or volts $340.00 2
Contractor's License No. 5-,-,7,- -, Reconn on $50.00
Contractor's Board Reg. No. ,� 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n 200 amps or less $50.00 2
License No. e-//€ one of No.4 g ( / -3 ... 201 amps to 400 amps $75.00
401 amps to 600 amps $100.00
-
Over 600 amps to 1000 volts
2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. �Zf) 2
Each branch circuit -1.- $5.00
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $35.00 -
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40 00 2 . - Each sign or outline lighting $40.00
-
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40 00
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
-
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees: n p
NOTICE 5a. Enter total of above fees $ L 5 .
5% Surcharge (.05 X total fees) $ 3 • oa -
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b . Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. ❑ Trust Account # $
Balance Due $ LK. -
3( �L 7� - 3 01 5 - \Ct _
watl`con de,A4ecprm.epp
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech. Cj )
PIbg.Und /Flr /Slab Plbg. Top Out Insulation S 3
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: S ) g (.1 c° A.M. P.M. Entry:
Address: . 0 0 4 .� 1
Tenant: Ste: MST:
BUP:
-
Con /Own: .f q., . MEC:
PLM:
ELC:9 , 0 2- 4 4 3
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
`>7Z% — 6 -s
EZG f 4 - oa,so
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., - 6 / C r- �'
C r / c>5 -.-/ "--r.j
Inspector: j 7 ' f C - �,e Date: 7� -- � 7
X APPROVED _ DISAPPROVED /CALL FOR REINSP. b CO
,_. c..._(.7
10/7/99 Activities for Case #: ELC96 -00250
2:28:17 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC003 Permit created 4/19/96 CJS PEND CJS 4/19/96
ELCC001 Application received 4/19/96 CJS RECD CJS 4/19/96
ELCC500 (F)Issue permit 4/19/96 CJS PASS CJS 4/19/96
ELCC800 Case Finaled 5/9/96 MJR YES MJR 5/9/96
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