Permit CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
PERMIT #: ELC97 -0108
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 02 / 25 / 97
PARCEL: 2S110DB -00200
SITE ADDRESS...: 15199 SW ROYALTY PKWY
SUBDIVISION • WILLOWBROOK FARM /ARBOR HEIGHTS ZONING:R -25
BLOCK LOT :8
Project Description: REC ROOM
- -- 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 • 1
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.: 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
SECURITY CAPITAL PACIFIC TRUST type amount by date recpt
SUITE 201 PRMT $ 40.00 JSD 02/25/97 97- 290802
330 112TH AVE., NE 5PCT $ 2.00 JSD 02/25/97 97- 290802
BELLEVUE WA 98004
Phone #: 206- 451 -9292
Contractor:
ALLEN /FALK INC $ 42.00 TOTAL
9020 SW GEMINI DR
REQUIRED INSPECTIONS
BEAVERTON OR 97008 Ceiling Cover Elect' 1 Final
Phone #: 646 -0533 Wall Cover _
Reg #..: 000472
This peroit is issued subject to the regulations contained in the _
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee 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 for sore
than 180 days. Issued B
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 SIJPR. ELEC' N: DATE:
LICENSE NO:
Call for inspection — 639 -4175
__ _ _ __ _ _ _ • • e r .`r r . r e _ _ _
Community Development
13125 SW Hall Blvd. ELECTRICAL PERMIT APPLICATION
Tigard, OR 97223 Planck/Rec. #
�;. i ; . z Permit #
;� �) Phone (503) 639 -4171 Date Issu rte- S
�''� FAX (503) 684 -7297 ____ )
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by
Inspection (503) 639 -4175
1. Job Address: ( e 1 4. Complete Fee Schedule Below:
Name of Development g,6oe 1/e /j A 71-:5- Number of Inspections per permit allowed
Address /5 St 47 /75f Ar'if wq Service included: Items Cost(ea) Sum
/
City /State/Zip i�a d� // 4a. Residential - per unit 4
1000 eq. ft. or less $110.00
Name (or name of business)
Each ion additional r 500 sq. ft. or 1
portion thereof $25.00
-
Commercial ❑ Residential ❑ Limited Energy $25.00
- Each Maned 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 4ilen /F'! 1 k .2., c. 200 amps or less $60.00 2
g
Address !c' 2- 5v tl0.71 / tOe 201 amps to 400 amps $80.00 2
City 73pi+'ve... State 04' Zip 9 7.1A 8 401 amps to 600 amps - ' 601 amps to 1000 amps $120.00 2 $180.00 2 - Phone No. C" Yt5-- •S'3 -7 Over 1000 amps or volts $340.00 2 -
Contractor's License No. A. . ; Reconnect only $50.00
- Contractor's Board Reg. No. 7�W 4c. Temporary Services or Feeders
/ , fr Installation, alteration, or relocation 2
Signature of Supr. Elec'n - _ ' �� L yam 200 amps or less $50.00 2
License No. 78'/ -s 9 Phone No. ►Zj�, I 201 amps to 400 amps $75.00
401 amps to 600 amps $100.00
• Over 600 amps to 1000 volts
2b. For owner installations: see - b' above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip pu branch circuit e or r � $5.00 2
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
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 / $4o.00 yo
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: .--
�-
NOTICE 5a. Enter total of above fees $ /•
5% Surcharge (.05 X total fees) $ 2,
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 $ `t 2
rpdbpnd.NWC�m.app
_ l .
•
Page No. 1 CASE HISTORY FOR CASE NO.: ELC97 -0108
SECURITY CAPITAL PACIFIC TRUST
• 15199 SW ROYALTY PKWY
05/08/98
Action Description Req/ Schd/ _ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
ELCC001 Application received 02/25/97 / / 02/25/97 PASS JSD 02/25/97 JD
ELCC003 Permit created 02/25/97 / / 02/25/97 PASS JSD 02/25/97 JD
ELCC500 (F)Issue permit / / / / 02/25/97 PASS JSD 02/25/97 JD
ELCC799 Elect'l Final 02/25/97 / / 04/27/97 inspected with MST96 -0091 PASS MJR 07/10/97 RB
ELCC800 Case Finaled / / / / 07/10/97 PASS MJR 07/10/97 RB
•
•
7/27/99 Activities for Case #: ELC97 -00108
.1:56:38 PM
•
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 2 /25/97 2/25/97 JSD PASS JD 2/25/97
ELCC003 Permit created 2/25/97 2/25/97 JSD PASS JD 2/25/97
ELCC799 Elect Final 2/25/97 4/27/97 MJR PASS RB 7/10/97 inspected with MST96 -0091
ELCC500 (F)Issue permit 2/25/97 JSD PASS JD 2/25/97
ELCC800 Case Finaled 7/10/97 MJR PASS RB 7/10/97
•
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