Permit 1/21/00 Activities for Case #: ELC95 -00402
4:18:28 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 APPlication received 9/20/95 CJS RECD TMP 1/24/96
ELCC003 Permit created 9/20/95 CJS PEND TMP 1/24/96
ELCC799 Elect'l Final 9/20/95 9/20/95 MJR YES MJR 2/12/96
ELCC500 (F)Issue permit 9/20/95 CJS PASS TMP 1/24/96
ELCC800 Case Finaled 9/20/95 MJR YES MJR 3/7/96
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?O -7 Fiza I»/ mike R--dc/ l/
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 9s a7o 7 3
, � Permit # -t 49'- ( Et:G 9." - oyoZ
, � ( � ` f Phone (503) 639 -4171 Date Issued 9- ,a0 -9S"
FAX (503) 684-7297 -<" Issued
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by �' /c°f S�/
Inspection (503) 639 -4175
N
1. Job Address: _ 15570 �� �/ 4. Complete Fee Schedule Below:
Name of Development I I t < P6O/'nen) �lr Number of Inspections per permit allowed
Address 1 -3� ,/ 13 rr ` aEt /belt t /rl41 Service included: Items Cost(ea) Sum
City /State/Zip 17aA-1Z1) . nr< 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
Name (or name of business) ii Each additional 500 sq. ft. or
portion thereof $25.00 1
CommercialJ Residential ❑ Limited Energy $25.00
(((\\ Each Manufd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders
� Installation, alteration, or relocation 2
Electric Contractor '1 Z * L , ( ( ��i dnt) G e .-ca 200 amps or less $60.00 2
-
Address -)3o e 456 201 amps to 400 amps $80.00 2
i a l l SON v' it c State() Zi 9 O 1-0 401 amps to 600 amps $120.00 2
C - tyl I P 601 amps to 1000 amps $180.00
-
Phone No. s :, 2...-Z.- Over 1000 amps or volts $340.00 2
Contractor's License No. -Z68CC / Reconnect only $50.00
- Contractor's Board Reg. No. , /// 4c. Temporary Services or Feeders
ird g p - Installation, alteration, or relocation 1 $50.00 2
Signature of Su r. Elec'n 200 amps or less S0 - 2
License No. 348 3S Phone •r 201 amps to 400 amps $75.00 2
/ 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
City State Zip purchase of service or feeder lee. 1 r- 2 D. 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 $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
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
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4 or more residential units in one structure M inor 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 $ t(n
5% Surcharge (.05 X total fees) $ 3 . -
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 4., 3 .
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 # $ _F:37
Balance Due $ A3.
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