Permit ��_
, CITY OF TIGARD
DEVELOPMENT
g
/3/25 Hall BAvd, Tigard, QR97@@3c /97
PARCEL: 291028D-01200 dkh
SITE ADDRESS... :12825 SW PACIFIC HWY . 4 kmo
SUBDIVISION • ^NO.TlGARDVlLLE-AD0lTlON MEND. Z0NlNG:C-6
•^BLOCK • LOT :8 JURISDICTION: TIG
Project. Descriptinn;^'lnstalliog a permanent 18 sq. ft. wall sign
___
---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.. : 1
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---
69 — 20o amp...... : 0 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
CIRCLE K — BP OIL type amount by date recpt
12825' SW PACIFIC HWY• PRMT $ 40.00. JH 04/18/97 97=-293476
TIGARD OR 97223 5PCT $ 2.00 JH 04/18/97 97-293476
Phone #:
Contractor: —
RAMSAY SIGNS $ 42.00 TOTAL
9160 SE 74TH AVE
„' REQUIRED INSPECTIONS
__
PORTLAND OR 97206 • Elect' 1 Service
Phone #: 503-777-4555 Elect'l Final
Reg 6900634
|
This permit is issued subject to the regulations contained in the • -- V
Tigard Municipal Code, State of .Ore. Specialty Codos'and all other Permitt�e 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 fur�more.
.\������ ~ ~w_,��_
than 180-days. 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
SIGNATURE OF SUPR.'ELEC'N: ' DATE:
'` C7
LICENSE NO:
Call for inspection — 639-4175
Community Development ELECTRICAL PERMIT APPLICATION
f
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # F - b2, L
..
4 ' 40 0.1 f ' _� Phone (503) 639 -4171 Date Issued q- iq i
A FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by , �i�
Inspection (503) 639 -4175
1. Job Address: k ,r, �7 4. Complete Fee Schedule Below:
Name of Development -4-_ - /� - ' 1 3 j ci2(X Number of Inspections per permit allowed
Address / 1 z- 5 i0 I C-r).(4 / Service included: Items Cost(ea) Sum
�" 1 l 4a. Residential - unit
City/State/Zip � c r r Q (�� r 1 Per
1000 sq. ft. or less $110.00 4
Name (or name f business) C"� -�-' r D V � .Q Each additional 500 sq. ft. or 1
portion thereof $25.00
Commercial 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 Ko-- ,,.o . .4 200 amps or less $60.00 2
Addr 3_1 (");, -- --7 , >.C�
' -, .. -r 201 amps to 400 amps $80 00 2
401 a to 600 amps $120.00
City � lf �Y.Q State 1 Zip Li - 7 ,:,?Ci 601 amps to 1000 amps $180.00 2
Phone No. ( ` 0 3 ) -7 ---/ '-) S.T Over 1000 amps or volts $340.00 2
Contractor's License No. O. c, il.4 ; S C / « / Reconnect only $50.00
Contractor's Board Reg. No. ) :1.../. ) 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n h , „ .,,__ ,,,v. 200 amps or less $50.00 2
l
License No. S) S "hone No. // c S 5- 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00
(`� Over 600 amps to 1000 vo
2b. For owner installations: Co 97 7 T 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 branch circuit $35.00 2
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 L f ') , ere)
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 inspectio $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 $ I M , d6
5% Surcharge (.05 X total fees) $ a 0l.)
•
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 $
wortlkond. \.tai m..,*
6/9/00 Activities for Case #: ELC97 -00246
3:35:34 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes � ®
ELCC001 Application received 4/23/97 4/18/97 JH RECD BON 4/23/97
ELCC003 Permit created 4/23/97 4/23/97 B PASS BON 4/23/97
ELCC730 Elect'I Service 4/23/97 BON 4/23/97
ELCC799 Elect'I Final 4/23/97 VLN 10/2/98 Request for research to Chuck
D. 10/2/98.
ELCC500 (F)Issue permit 4/24/97 B PASS BON 4/24/97
ELCC590 Expired by limitation 5/4/00 HAP DONE No Hold AKJ 5/4/00
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