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Permit CITY TIGARD ELECTRICAL PERMIT F. �� - DEVELOPMENT SERVICES 0 + PERMIT #: ELC1999 - 00692 DATE ISSUED: 11/17/99 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 . /, PARCEL: 2S102BD - 01200 SITE ADDRESS: 12825 SW PACIFIC HWY SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND \� .: ZONING: C -G BLOCK: L608 .. JURISDICTION: TIG Proiect Description: Installation of 2 branch circuits. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL: MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: TOSCO CORPORATION HEINTZ ELECTRIC INC PROPERTY TAX DEPT -DC17 6476 HOGAN DR N PO BOX 52085 KEIZER, OR 97303 PHOENIX, AZ 85072 . Phone: Phone: 503 - 304 - 9360 Reg #: ELE 24 -268C LIC 118381 SUP 3731S FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT DEB 11/17/99 $42.85 99- 319820 Elect'I Final 5PCT DEB 11/17/99 $3.43 99- 319820 Total $46.28 . This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is n. - -rfed withiny80 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow ru -s adopted by the Oregdn Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtai copies of these rules ordir •ct questions to OU C at (503) 246 -1987. PERMITTEE'S SIGNATURE / ISS ED BY: , /„ I . 1 / _ � . � , .. � � iii • . OWNER I LLATION ONL 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: X DATE: LICENSE NO: 3 7 5f 6 Call 639 -4175 by 7:00pm for an inspection the next business day CITY OF TIGARD Electrical Permit Application Plan Ch- / � 13125 SW HALL BLVD. Rec'd B TIGARD OR 97223 • Date Rec'd //•--/ 7 Date to P.E. Phone (503) 639 -4171, x304 Date to DST - Inspection (503) 639 -4175 Print of Type Permit# .f't -e/. K-OY,J9,,? Fax (503) 598 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development BI ng- ""' Number of Inspections per permit allowed Name (or name off business) / Service included: Items Cost Sum Address I ? 0 /" .9-C i ri c /k / . 4a. Residential - per unit City /State /Zip 77 (----4.4-0 Da-. 1000 sq. ft. or less $ 117.75 4 Each additional 500 sq. ft. or portion thereof $ 26.75 1 Commercial Residential ❑ Limited Energy $ 60.00 Each Manufd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2 • (Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders information for COT data base). Installation, alteration, or relocation Electrical Contractor /E /•✓f Z 'e-czG /<- roc 200 amps or less $ 64.25 2 Address 6 4/ 76 e ic,a -¢.../ A/Z , ti' 201 amps to 400 amps $ 85.50 2 City ie i2 L S d/Z Zip '/73O f 401 amps to 600 amps $ 128.50 2 tY p 601 amps to 1000 amps $ 192.50 2 Phone No. ©4/- 956° Over 1000 amps or volts $ 363.75 2 Job No. Reconnect only $ 53.50 2 Elec. Cont. Lice. No. v7V ( Exp.Date /0 -o /- °' 4c. Temporary Services or Feeders OR State CCB Reg. No. /1133$ Exp.Date j/- /S G>C' Installation, alteration, or relocation COT Business Tax or Metro No. Ex .Date 200 amps or less $ 53.50 2 / .- '" ./ 201 amps to 400 amps $ 80.25 2 Signature of Supr. Elec'n �E�-C4Bz 401 amps to 600 amps $ 1 00.00 2 Over 600 amps to 1000 volts, 0 � see "b" above. License No. 3 73( - X Exp.Dat /O 1 - /4/ 4d. Branch Circuits Phone No. New, alteration or extension per panel • a) The fee for branch circuits 2b. For owner installations: with purchase of service or feeder fee. Print Owner's Name Each branch circuit $ 5.35 2 Address b) The fee for branch circuits without purchase of service City State Zip or feeder fee. /� -7 Sr) Phone No. First branch circuit / $ 37.50 Ol Each additional branch circuit 0 $ 5.35 , . • £5 The installation is being made on property I own which is not 4e. Miscellaneous • intended for sale, lease or rent. (Service or feeder not included) Each pump or irrigation circle $ 42.75 Owner's Signature Each sign or outline lighting $ 42.75 Signal circuit(s) or a limited energy panel, alteration or extension $ 60.00 3. Plan Review section (if required): * Minor Labels (10) $ 100.00 Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over 4 or more residential units in one structure the allowable in any of the above Service and feeder 225 amps or more Per inspection $ 50.00 Per hour $ 50.00 System over 600 volts nominal In Plant $ 59.00 Classified area or structure containing special occupancy as , described in N.E.C. Chapter 5 5. Fees: ,-- 5a. Enter total of above fees $ * Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ _MI6 Not required for temporary construction services. Subtotal $ 5b. Enter 25% of line 5a for NOTICE Plan Review if required (Sec. 3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # os AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ I is \fists \forms \electric.doc k5. 7 O ? 7 - 3 6/9/00 Activities for Case #: ELC1999 -00692 3:35:16 PM 44._ Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ELCC001 Application received 11/17/99 DEB DONE No Hold DEB 11/17/99 4 $b ELCC003 Permit created 11/17/99 DEB DONE No Hold DEB 11/17/99 ELCC730 Elect'I Service 11/17/99 11/17/99 No Hold DEB 11/17/99 ELCC799 Elect'I Final 11/17/99 11/17/99 No Hold DEB 11/17/99 ELCC500 (F)Issue permit 11/17/99 DEB DONE No Hold DEB 11/17/99 ELCA845 Request inspection research 5/31/00 JMT DONE No Hold JMT 5/31/00 ELCA580 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00 Page 1 of 1