Permit � I PERMIT
OF TIGARD PERMIT TI #: ELC96 -0275
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 05/01 /96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 2S102CB -03101
SITE ADDRESS...: 12950 SW PACIFIC HWY #3A
SUBDIVISION • FREWINGS ORCHARD TRACTS ZONING:C -G
BLOCK • LOT •21
Project Description: First 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 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
EDWARD JONES type amount by date recpt
12950 SW PACIFIC HWY #3A PRMT $ 35.00 B 05/01/96 96- 278828
SPCT $ 1.75 B 05/01/96 96- 278828
TIGARD OR 97223
Phone #:
Contractor:
METZGER ELECTRIC INC $ 36.75 TOTAL
8730 SW LEHMAN ST
REQUIRED INSPECTIONS ---
TIGARD OR 97223 Ceiling Cover Elect' 1 Service
Phone #: 503 -244 -9025 Wall Cover Elect' 1 Final
Reg #.. : 96805
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm'ee Signature
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started Moak
within 180 days of issuance, or if work is suspended for more
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 •-
c
SIGNATURE OF SUPR. ELEC' N : evu aft , l Cv
lkfr DATE: 5 -1-4 6
LICENSE NO:
Call for inspection - 639 -4175
,
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # ei�v'j1, -02_75
l � � .., � Date Issued - I - q 6
,��in
�� li Phone (503) 639 -4171
CITY OF TIGARD FAX (503) 684 -7297
TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: II -1-1 s ems ... ,-,i �
b `r A 4. Complete Fee Schedule Below:
Name of Development fell - ccaA e S Number Of Inspections per permit allowed
Siu 1+ - e-
Address a SO S. (.c) .'Ac 1 Ct c_ N t,,, j . 3 A Service included: Items Cost(ea) Sum
City /State /Zip Uce rc. 0 r 9 13 a 4a. Residential - per unit
U �((� 1000 sq. ft. or less $110.00 4
Name (or name of business) F,tl��a r` A a'aNA T'S Each additional 500 sq. ft. or
� portion thereof $25.00 1
Commercial I Residential 111 Limited Energy $25.00
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
( e 4b. Services or Feeders
Installation, alteration, or relocation
Electrical Contractor
�9 �I . P CA' f t SU 200 amps or less $60.00 2
Address''1 `AO S L.) .. L-c In wash c4 - 201 amps to 400 amps $80.00 2
City T' i dr a - c. State b c Zip9.'1 c 3 401 amps to 600 amps $120.00 2
No." jt--� u 5 601 amps to 1000 amps $180.00 2
Phone No. l ^ 9 Da Over 1000 amps or volts $340.00 2
Job NO. 0 1 3 1 Co Reconnect only $50.00 2
contractor's license NO. "A 4 - 161 1 C- 4c. Temporary Services or Feeders
Contractor's Board Reg. No. 09 Co O S Installation, alteration, or relocation 2
Signature of Supr. Elec'n 200 amps or less 2
License No. 3∎ 3 0 Phone No. D 4u-qba 201 amps to 400 amps $50.00 2
401 amps to 600 amps $75.00
Over 600 amps to 1000 volts $100.00
. 2b. For owner installations: see „ b „ above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou
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 f $35.00 3_5_
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 $36.00
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:
5a. Enter total of above fees $ 3 �
NOTICE 5% Surcharge (.05 X total fees)
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 3 (c . t
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. w°rdkomdeNeleo- ❑ Trust Account #
$
prm.app
Balance Due $ 3 t . 1 5
4/10/00 Activities for Case #: .ELC96 -00275
7:01:53 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 APPlication received 5/1/96 5/1/96 B RECD BON 5/1/96
ELCC003 Permit created 5/1/96 5/1/96 B PEND BON 5/1/96
ELCC500 (F)Issue permit 5/1/96 B PASS BON 5/1/96
ELCC800 Case Finaled - 5/3/96 MJR YES MJR 5/6/96
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CITY OF TIGARD BUILDING INSPECTION NOTICE �q--
Inspection Line: 639 -4175 Business Phone: 639 -4171 , I
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation CEP
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: _ .3 f / (p A.M. P.M. Entry:
Address: /D P
Tenant: Ste: MST:
y Li _ % ' o�— BUP:
Con /Own: MEC:
E �^ ELM:
) ' ELC:
THE FOLLOWING CORR IONS ARE REQUIRED: ELR:
,.±7CP i C ---i4-4.--74---
c Innspector: ,�'/ r c—�v ` R LI Date: y 1) �X
APPROVED _ DISAPPROVED /CALL FOR REINSP. i lp CO