Permit C ITY OF TIGARD
I ELECTRICAL PERMIT
PERMIT #: ELC1999 -00395
��;� DEVELOPMENT SERVICES
DATE ISSUED: 7/1/99
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 � f
A PARCEL: 2S111AD -15500
SITE ADDRESS: 09023 SW REILING ST
SUBDIVISION: MALLARD LAKES 4/460NING: R -4.5
BLOCK: LOT : 021 JUCTION: TIG
Project Description: Installation of one branch circuit. Job No. 2067 -532
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: 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:
OLESON, BOB A/PATTI D PHOENIX ELECTRIC CO
9023 SW REILING 7379 SW TECH CENTER DR.
TIGARD, OR 97224 TIGARD, OR 97223
Phone: Phone: 684 -3600
Reg #: LIC 00052288
SUP 4140S
ELE 34 -247C
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT DEB 7/1/99 $37.50 5762 Elect'l Final
5PCT DEB 7/1/99 $2.62 5762
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. Total $40.12
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 not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set fo • • OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
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Permit Signat re: ((� --Th Issued y: �ed
OWNER INSTALLATION ONLY
The installation s b ing 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: . xAP .....41 c i-' DATE:
LICENSE NO: 4// S
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TtGARD Electrical Permit Application Plan Ch
13125 SW HALL BLVD. Rec'd
T Date Rec'd 7�/
TIGARD OR 97223
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # r G�/ 419 4 6
63
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development /n ` Number of Inspections per permit allowed
Name (or name of business) ,4 T (Jvi).P cY 1 ` C- Service included: Items Cost Sum
Address 90a 3 iei /L.. J A/4 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip 174/be-7) i e2/e. Li
7 a a- 3 Each additional 500 sq. ft. or
Commercial ❑ Residential I_l portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach cop II current licen c ) 4b. Services or Feeders
Electrical Contracto, �P,n \�C C h 1 V� (j Installation, alteration, or relocation
Address 13 .74 TE 1 ee:,t�TFz 200 amps to or 400 amps $80.00 2
less $60.00 2
201 amps to
City li4. State n2 Zip 1 a (9-3 401 amps to 600 amps $120.00 2
Phone No. 144- .�t*oo0 601 amps to 1000 amps $180.00 2
Job No. a0�7 573a. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 34--.1-7c Exp.Date Reconnect only $50.00 2
OR State CCB Reg. No. `S-giy Exp.Date 4c. Temporary Services or Feeders •
COT Business Tax or Metro No., 647 Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n �7� 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. --/‘/---/ d-C Exp.Date see "b" above.
Phone No. !' � *: „Vent)
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee. f
First branch circuit r $35.00 00 2
The installation is being made on property I own which is not Each additional branch circui
$5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional Inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. S. Fees: 3 2 i' x - � ° 2
Not required for temporary construction services. 5a. Enter total of above fees $ (0
5% Surcharge (.05 X total fees) $ a'
NOTICE Subtotal $ �
5b. Enter 25% of line 5e for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Sub�A tai G{� $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY U--
J Trust Account # so a b 0
TIME AFTER WORK IS COMMENCED.
Total balance Due a K L
I: \DSTS \ELC96.APP Rev 9/96
6/9/00 Activities for Case #: ELC1999 -00395 0
3:38:49 PM ��
® 4v
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 7/1/99 DEB DONE No Hold DEB 7/1/99
ELCA003 Permit seated 7/1/99 DEB DONE No Hold DEB 7/1/99
ELCA730 Elect'I Service 7/1/99 7/1/99 No Hold DEB 7/1/99
ELCA799 Elect'I Final 7/1/99 7/1/99 No Hold DEB 7/1/99
ELCA500 (F) Issue permit 7/1/99 DEB DONE No Hold SS 7/16/99 Springbrook receipt #
99- 316 -566 .
ELCA845 Request inspection research 5/19/00 ST DONE No Hold ST 5/19/00
ELCA580 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
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