Permit ELECTRICAL PERMIT
OF TIGARD PERMIT 4 : ELC96 -0460
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 07/22/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 1S136AD -02700
SITE ADDRESS • 07001 SW PINE ST
SUBDIVISION....: VILLA RIDGE ZONING:R -4.5
BLOCK • LOT • S
Project Description: Installing two branch curcuits.
- -- 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 FEED 0 PER INSPECTION • 0
201 — 400 amp • 0 1st W/0 SRVC OR F PER HOUR : 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 6 1 � Eb IN PLANT • 0
601 — 1000 amp 0 PLAN .REV IEw SECTION -- -- - -_.
1000+ amp /volt.....: 0 > =4 RES UNITS........: > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: - - -- FEES - - - - - --
JON BRIDGES type amount by date recpt
7001 SW PINE PRMT $ 40.00 CJS 07/22/96 96- 281745
SPOT $ 2.00 CJS 07/22/96 96- 281745
PORTLAND OR 9722
Phone #:
Contractor: --
OWNER $ 42.00 TOTAL
REQUIRED INSPECTIONS --
Wall Cover Elect'1 Final
Phone #: SEE ABOVE Elect'1 Service
Reg #..:
This permit is issued subject to the regulations contained in the
Tigard, Municipal Code, State of Ore. Specialty Codes and all other Perm itt ee Signature
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within l80 days of issuance, or if work is suspended for sore
than 160 days. Issued $y
- OWNER INSTALLATION ONLY— -- - --
The installation is be' . 9 ma o property I own which is not intended for
sale, lease, or rent. /-
OWNER'S SIGNATURE:
DATE: 202 3L / q// q
•
- - - - -- CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call for inspection — 639 -4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # EL.( (6-0 6
, N I i .�� Date Issued � �
Phone (503) 639 -4171
"''` It•111 FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development � O / V / f� LAO Number of Inspections per permit allowed
Address 7O / S7w / Service included: Items Cost(ea) Sum
City /State /Zip Po'' 7( -4 7 0 I c /7Z2_? 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) TTer./ V • Q lAW S Each additional 500 sq. ft. or
,, portion thereof $25.00
Commercial ❑ Residential Lam/ Limited Energy $25.00 1
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Electrical Contractor Installation alteration, or relocation $60.00
200 amps or less 2
Address 201 amps to 400 amps $80.00 2
20.00 2
City State Zip 401 amps to 600 amps $1 80.00 2
601 amps to 1000 amps
Phone No. Over 1000 amps or volts $340.00 2
Job NO. Reconnect only
$50.00 2
contractor's license NO. 4c. Temporary Services or Feeders
Contractor's Board Reg. No. Installation, alteration, or relocation 2
Signature of Supr. Elec'n 200 amps or less 2
License No. Phone No. 201 amps to 400 am $50.00 2
401 amps to 600 amps $75.00
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see see "b" above.
4d. Branch Circuits
Print Owner's Name T n/ f3 New, alteration or extension per pane
Address , / 5 vu / //v� /� a) The fee for branch circuits with
City (oX7 4'i2 State t�/Q Zip g7z23 purchase of service or feeder fee. 2
•7 Each branch circuit $5.00
Phone No. 2116 - ,39(Y- b) The fee for branch circuits withou 2
The installation is being made on property I own which is purchase of service or feeder fee. Me 2
not intended for sal , lease or rent. First branch circuit / $35.00
Each additional branch circuit r $5.00 S �•
Owner's Signature �, M i d 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 $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:
5a. Enter total of above fees $ 4, 6;2
NOTICE 5% Surcharge (.05 X total fees) $ :2.°O
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. wordkomdMelec- ❑ Trust Account #
$
prm.epp
Balance Due $ y) ,e'
4/10/00 Activities for Case #: ELC96 -00460
5:00:38 PM .
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By . Updated Notes
ELCA001 Application received 7/22/96 CJS RCED CJS 7/22/96
ELCA003 Permit created 7/22/96 CJS PEND CJS 7/22/96
ELCA720 Wall Cover • 7/22/96 CJS 7/22/96
ELCA730 Elect'I Service 7/22/96 CJS 7/22/96
ELCA799 Elect'I Final 7/22/96 CJS 7/22/96
ELCA500 (F) Issue permit 7/22/96 CJS PASS CJS 7/22/96
ELCA580 Expired by limitation 4/6/00 HAP DONE No Hold AKJ 4/6/00
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