Permit Aho CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
� Q i PERMIT it: ELC97 -0046
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171 DATE ISSUED: 01/24/97
PARCEL: 28104CD- 10600
SITE ADDRESS...: 13697 SW TRACY PL
SUBDIVISION ° HILLSHIRE ESTATES NO. 2 ZONING:R -7 PD
BLOCK LOT -105
Project Description: 1 LIMITED ENERGY
- -- 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 - 1 401 — 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.: 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
WINWOOD HOMES type amount by date recpt
13697 SW TRACY PLACE PRMT $ 25.00 TAT 01/24/97 97- 289450
SPCT $ 1.25 TAT 01/24/97 97- 289450
TIGARD OR 97223
Phone #:
Contractor:
CEDAR LANDSCAPE $ 26.25 TOTAL
14375 SW PATRICIA
REGQUIRED INSPECTIONS
HILLSBORO OR 97123 Ceiling Cover Underground Cove
Phone #: 503 -628 -3411 Wall Cover Elect'1 Service
Reg #... 5843
This permit is issued subject to the regulations contained in the Ia..A.€_ t(/I -
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm i t t i gnat ur
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 L_AIK, _.4 . A.41 .
than 18! days. I s _ ed 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
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call for inspection — 639 -4175
(- WY Y OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By - IT '
TIGARD OR 97223 Date Rec'd 002
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # -[� r'O
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development t Uvr7 H 1(L C �S I - 2- Number of Inspections per permit allowed
Name (or name of business) ‘/...11t10 W ocre, I'P Oin E5 Service included: Items Cost Sum
Address `?j (o c l 1 Std 1 ' 2 .4 rCAy ?LIcf 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State/Zip I I G A'Iu7 , 0 et..- Each additional 500 sq. ft. or
Commercial ❑ Residential Limited Energy / $25.00 - -on
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor c C -19A7.- L .A 5 r . � 14c. Installation, alteration, or relocation
Address 1 u
;7'- 5) Q/v v-A c A
� a 0` 200 amps or less $60.00 2 -
City �t tA s �rto State 00-- Zip 9 712 201 amps to 400 amps $80.00 2
3 401 amps to 600 amps $120.00 2
Phone No. CoZf - 411% 601 amps to 1000 amps - $180.00 2
Job No. 7737105 Over 1000 amps or volts - $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. Exp.Date
OR State CCB Reg. No. .5043 Exp.Date (r3o '1 4c. Temporary Services or Feeders
COT Business Tax or Metro o. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n /t 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No.
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 bran circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit $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. 5. Fees:
Not required for temporary construction services. 5a. Enter total of above fees $ _oJ
5% Surcharge (.05 X total fees) $ I L S
NOTICE Subtotal $ 2.(.. .
5b. Enter 25% of line 5a 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 Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # 26.15-
Total balance Due $
I \DSTS \ELC96.APP Rev 9/96
_
RECEIVED
JAN 2 4 1997
COMMUNITY DEVELOPMENT
11/19/1999 Activities for Case #: ELC97 -00046
1:05:51 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 01/24/1997 01/24/1997 TAT 01/24/1997
ELCA003 Permit created 01/24/1997 01/24/1997 TAT 01/24/1997
ELCA700 Ceiling Cover 01/24/1997 TAT 01/24/1997
ELCA720 Wall Cover 01/24/1997 TAT 01/24/1997
ELCA725 Underground Cover 01/24/1997 TAT 01/24/1997
ELCA730 Elect'l Service 01/24/1997 TAT 01/24/1997
ELCA799 Elect'I Final 01/24/1997 11/09/1999 GS PASS GES 11/09/1999 passed by review
ELCA500 (F) Issue permit 01/24/1997 TAT PASS TAT 01/24/1997
ELCA920 Miscellaneous action 08/20/1998 CD FAIL CD 08/20/1998 visited site, left notice to
schedule for inspection
ELCA920 Miscellaneous action 04/27/1999 AKJ DONE No Hold AKJ 04/27/1999 inactivity letter sent
ELCA800 Case finaled 11/19/1999 JMT DONE No Hold JMT 11/19/1999
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