Permit . •
CITY OF TIGARD
,.. ELECTRICAL PERMIT
A dryely,.� DEVELOPMENT SERVICES PERMIT #: ELC98 -0282
- 11. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 05/27/98
PARCEL: 19136AD -06200
SITE ADDRESS...:1142O SW PACIFIC HWY
SUBDIVISION • ZONING:C -G
BLOCK • LOT • JURISDICTION: TIG
Project Description : Electrical TI
- -- 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
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/0 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 OCC.:
Owner: FEES
BLANCHARD, MALCOLM A type amount by date recpt
C/O ADAMS, MICHAEL J PRMT $ 35.00 B 05 /27/98 98- 306058
11420 SW PACIFIC HWY 5PCT $ 1.75 B 05/27/98 98- 306058
TIGARD OR 97223
Phone #:
Contractor:
$ 36.75 TOTAL
REQUIRED INSPECTIONS
Ceiling Cover Elect'l Service
Phone #: Wall Cover Elect'l Final
Reg #• . •
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 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in ORR 952-081 -8018 through OAR 952-001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246-1987.C
Perm itt ee Signature: 011 sari( ca Uhr Plittassued By: 1
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 : ('lt" akatt V\ DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + ++
Call 639 -4175 by 7:00 p.m• for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
MAY -27 -98 WED 11:21 AM PHOENIX ELECTRIC CO FAX NO. 15036843611 P. 02
•
,,...CITY OF TIGARD Electrical Permit Application Plan Check
13125 SW HALL BLVD. pp
Rec'd By �Fh x ^ /
TIGARD OR 97223 Date Rec'd6 6'X
Phone (503) 639 - 4171, x304 Date to P.E.
Inspection (503) 639 -4175 Print or Type Date to DST
Fax (503) 684 -7297 Incomplete or illegible will not be accepted
# 'OIL
Called,
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development41 ,£ 0 0 ,,n.1.ky0 f Number of Inspections per permit allowed
Name (or name of business p Service included:
Items Cost Sum
i 4
Address \ \�-. 0 97.t..4-3 . , t_ G •
t.i,\I 4a. Residential - per unit
City /State/Zi j� C j �� �.).� 1000 sq. It, or less $110.00
Each additional 500 sq. II. or 4
Commercia19 Residential ❑ portion thereof $25.00
Limited Energy $25.00 1
Each Manut d Home or Modular -
2a. Contractor installation only:
Dwelling Service or Feeder $68.00
2
(Attach copyI current licenses 4b. Services or Feeders
Electrical Contracto ..eta - !. , Installation, alteration, or relocation
Add S c c ) , , r -, .N, 1 200 amps or loss $60.00
- .� 201 amps to 400 amps 2
tY State nit p • 0 31 2.00 2
Ci
r,�� 401 amps to 600 amps 5120.00 -
hr.�tu, . •ry � 601 amps to 1000 amps $160.00 2
Phone Na. - -
2
Job No. ') GAD �- ail{ 0 -�, DO 0 Over 1000 amps or volts $340.00
Elec. Cont. Lice. No. -- Dt.V- Exp.Date Reconnect only $50.00 2
OR State CCB Reg. No. 5a- Exp.Date 2
Installation, Temporary Services or Feeders
COT Business Tax or Metro No.
Exp.Date Installation, alteration, or relocation
�7 200 amps or Is $50.00 2
Signature of Supr. Elec'n �7 201 amps to 400 amps $75.00
401 amps to 600 amps 2
Over 600 amps to 1000 volts, $1 2
License Nc' G L O Exp.Date see "e" above.
Phone Nr A - 2
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations:
a) The foe for branch circuits with
Print Owner's Name purchase of service or
feeder fee.
Address Each branch circuit $5
City ate Zip b) The foe for branch circuits 2
Phone No, without purchase of
service or feeder fee.
The installer 's being made on property I own which is not First branch circuit $35,00 - 5 �� 2
Each additional branch circuit $5.00 2
intended for sale, lease or rent.
4e. Miscellaneous
Owner's Signature. (Service or feeder not included)
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
Please check appropriate Item and enter fee in section 513. Minor Labels (10 $100.00
4 or more residential units in one structure
Service and feeder 225 amps or more the Each able additional an Inspe ab over
t
System over 600 volts nominal the allowable In any of the above
-
Classified area or structure containing special occupancy Per inspection $35.00
Per hour
as described In N.E.C. Chapter 5 $55.00
In Plant $55.00
•
* Submit 2 sets of plans with application where any of the above apply. 5. Fees:
Not required for tomparary construction services. 5a. Enter total of above fee
NOTICE
Subtotal Surcharge (.05 X total fees) $ r �ZL
5b. Enter 25% of line 5a for $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if reaulred (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 5
TIME AFTER WORK IS COMMENCED, Trust Account # , _ - ,3 ...
+ Total balance Due $
1
I: Rw W56
T
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Page No. 1 CASE HISTORY FOR CASE NO.: ELC98 -0282
PHOENIX ELECTRIC
11420 SW PACIFIC HWY
07/06/98
Action Description Reg/ Schd/ End/ Action Notes Diep By Update Upd
Code Sent Done Done Date By
ELCC001 Application received / / / / 05/27/98, RECD B 05/27/98 GTR
ELCC003 Permit created / / / / 05/27/98 DONE B 05/27/98 CTR
ELCC500 (F)Iosue permit / / / / 05/27/98 PASS B 05/27/98 CTR
ELCC799 Elect'l Final / / / / 06/04/98 circuit for copy machine. PASS CD 06/04/98 CD
ELCC800 Case Finaled / / / / 06/10/98 PASS CD 06/10/98 J•H
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: 0 /V /gf A.M. P.M. MST:
Location: 0 ZO 1i .0, .
- _ _ BUP:
i
Tenant: Suite: Bldg: MEC:
Contractor. ) Phone: 6 O [ - 77 __ 0 PLM: q �r p
Owner P1tone: C��i�li JJ ELC: `0 'C.l2 -1
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ' LECTRIC : . SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC. .
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt ,
Approved Approved Approved pprov) Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL ( FINA FINAL
0 L Al �in, L , 1Le
�
e- I Q--'
O Call for rein on O Reinspection fee of $ required before next inspection O Unable to inspect
6 Inspector: Date: -ei.vr Page of
1
L