Permit .... CITY OF TI G A R D
ELECTRICAL PERMIT
• �� n ,�ji�, DEVELOPMENT SERVICES PERMIT
PARCEL: 1S135AB -00100
SITE ADDRESS... :10255 SW 90TH AVE
SUBDIVISION -TOWN OF METZGER ZONING:R -4.5
BLOCK..........: LOT °005 JURISDICTION: TIG
Project ,De script Description: Electrical permit for modular unit. Limited energy for fire
alarm.
- -- 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 ENERGY - 0 401 — 600 amp - 0 SIGNAL /PANEL. • 1
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: 0 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
,TIGARD SCHOOL DISTRICT #23J • type amount by date recpt
13137 SW PACIFIC HWY PRMT $ 100.00 B 02/18/99 99- 313020
TIGARD OR 97223 -0000 SPCT $ 5.00 B 02/18/99 99- 313020
Phone #:
Contractor:
ATLAS ELECTRICAL CONTRACTORS $ 105.00 TOTAL
4403 SE ROETHE RD
REQUIRED INSPECTIONS
MILWAUKIE OR 97267 Ceiling Cover Elect'l Service
Phone #: 659 -2212 Wall Cover Elect'l Final
Reg #..: 000015
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- Y10 through OAR 952- 001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1'
Permittee Signat�.ire: Issued By: W
Pr '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.:
Ili CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' N : Orl. )CC v / \ DATE:
LICENSE NO: .
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
1 •
Community Development ELECTRICAL PERMIT APPLICATION
A ...
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # ea-gq - 0 /d0
Otis �lii Phone (503) 639 -4171 Date Issued Z - I`�
t
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by O. � n o W�nOlt. lit^
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development METZGER ELEMENTARY Number of Inspections per permit allowed
Address 10255 SW 90th Avenue Service included: Items Cost(ea) Sum
City /State/Zip Tigard, Oregon 97223 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
-
' Name (or name of business) METZGER ELEMENTARY Each additional 500 sq. ft. or 1
portion thereof $25.00
Commercial El Residential ❑ Limited Energy $25.00 - 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 2
Electrical Contractor Atlas Electrical Electrical 200 amps or less 1 $60.00 60.00 2
Address 4403 SE Roethe Road 201 amps to 400 amps $80.00 2
City Milwaukee State OR Zip 97267 401 amps to 600 amps $120.00 2
City p 601 amps to 1000 amps $180.00 2
Phone No. 659 -2212 Over 1000 amps or volts $340.00 2
Contractor's License No. 3 -2C 10-1-111 Reconnect only $50.00
Contractor's Board Reg. No. 1532 4c. Temporary Services or Feeders
J/ Installation, alteration, or relocation 2
Signature of Supr. Elec'n , ! , 200 amps or less $50.00 2
License No. 2581S D -I -01 Phone No. 201 amps to 400 amps $75.00 2
659 -2212 401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner installations: see "b" above.
Print 4d. Branch Circuits
rint Owner's Name
New, alteration or extension per panel
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit $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 additional circuit $
bit $5.00 2
Each addltional branch circuit $5.00
Owner's Signature . 4e. Miscellaneous
. (Service or feeder not included) 2
• Eac pump or i rri g ation circle $40.00 2
3. Plan Re view section ( if re Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
• P lease check appropriate item and enter fee in. section 5B. panel, alteration or extension 1 $40.00 $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
I Service and feeder 225 amps or more
i 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:
, NOTICE 5a. Enter total of above fees $ Q
5% Surcharge (.05 X total fees) $ 5.00
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ $105.00
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 $ 105.00
1 \ psp
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Page No. 1 CASE HISTORY FOR CASE NO.. ELC99 -0100
TIGARD SCHOOL DISTRICT #23J
10255 SW 90TH AVE
03/26/99
Action Description Reg/ Schd/ End/ Action Notes Disp By Update upd
Code Sent Done Done Date By
ELCC001 Application received / / / / 02/18/99 RECD B 02/18/99 BON
ELCC003 Permit created / / / / 02/18/99 DONE B 02/18/99 BON
ELCC500 (F)Issue permit / / / / 02/18/99 PASS B 02/18/99 DST
ELCC700 Ceiling Cover / / / / / / 02/18/99 BON
ELCC720 Wall Cover / / / / / / 02/18/99 BON
ELCC730 Elect'l Service / / / / 02/19/99 PASS CD 02/19/99 CD
ELCC799 Elect'l Final / / / / 03/03/99 install (2) ground rods & hook up, also FAIL CD 03/04/99 CD 12
ground j -box under modular •
ELCC799 Elect'l Final / / / / 03/05/99 PASS CD 03/05/99 CD
ELCC800 Case Finaled / / / / 03/08/99 03/08/99 VLN
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