Permit A .: CITY OF T ELECTRICAL PERMIT
T
1 DEVELOPMENT SERVICES DATE I SSG D ` C 03/08/97 �'- --?
� I� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
PARCEL; RCEL e 2S 1.'C'.E1D -.. 15-.'
8T•' =7.17,93—..:12740 E!.;i I +UY
i_ PACIFIC .. °
C ' t �; � FRE CS CR � f'`-1 7 !
�_ �D'� 3.:1 °,� :. 1... _ _ o ; �-• �a�.4.. :.,� :C;S ...raC,{•�, „'2D TRACTS zC., � C .:
B=.— —...,..E LOT:.,_,.,... .. a2. JURISDICTION: - 'IC
Pru j ect :esci pt is on : Installing first branch circuit and 4 add' I branch circuits
• •- RESIDEn :T.IFL UNIT- -- - - --- --- TEKP SRVC /FEEDERS - - ---- ----•-•- MISCELLANEOUS--- - -•- --
1000 SF OR LESS.... E 0 0 - 200 amp. ...... t 0 PUMP / IRRIGATION.. - . E 0
EACH ADD' L 502iSl'= ... 0 201 - 400 e; m p... , , , .. 0 SIGN /OUT LINE. L G, , . 0
LIMITED ;!MERCY_ ... , . 0 4021 - SOO ;imp....... 0 0 SIGNAL/PANEL.......: 0
MANF. HM/ SVC /C=DR, _ 0 6014-a,mps -10O0 volts.: 0 MINOR LABEL ! 10) ., - . ° ;'I
----SERVICE/FEEDER---- - - -- BRANCH CIRCUITS - - - - -- -- -ADD' L INSPECTIONS--
0 - 200 amp...... E 0 W/S _RV ICE OR FEEDER E 0 PER INSPECTION..:, . E +7'
201 - 400 amps ..... o 0 1st W/0 SRVC OR F'DR. E 1 PER HOUR.. , .... , e . e o '?
401 - 600 amp......: 0 EA ADD' L. BRNCH C I PC 4 4 I N PLRNT .. _ .... , , .. 17'
601 -- 1 000 aaco p..... E 0 ----- -• - - -- -PLAN REVIEW SECTION----- -- - - - - --
10001 am7 /volt..... a 0 ) =4 RES UVITS„.. , ... _ , > 600 VOLT NOi'Il01
Reconnect only..... 0 SVC /EDR >= 225 AMPS..: CLASS AREA /SPEC OCC.
Owner ° -------- - - -• -- . _.
ROSE GOSPODINOVIC type amount by date recpt
12770 SW PACIFIC HWY PR!.T $ 55.00 B 08/08/97 97-
•TIGARD OR 97223 _ 5PCT a 5.75 B 08/2+5/97 97- 298080
Phone
•
Contract o r e -- ----- - - - - -- -- •-
WEBER ELECTRIC IOC $ 57= 75 TOTAL
14524 SW CHARDONNAY AVE
REQUIRED INSPECTIONS - •- - - ----
TIGARD OR 97224 Cei.lino Cover Elect'1 Service
Phoi vfip, 579-5168 Wall Cover Elect' 1 Final
Reg w.. a 004406
This peroit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This porL,it will expire if work is not started within. 180
days of issuance, or if work is suspended for :,ore than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through CAR 352 43l -1987. You Say obtain a copy
of these rules or direct questions to DUC by calling (513)246 -1987.
remit: tee Signature:: WG / - Issued Zy ��.
- - - - -• -- --------- - -• - - -- •OWNER INSTALLATION ONLY -• - - -- --
he installation is being made on property I own w :lic_h is not intzrded For
sale, lease, or rent
OWNE_R'.S SIGNATURE: __ - DATE°
.. - ----.-.-_---- - .- ___._..- _._._- .- .- _. -._- CONTRACT'O'R INSTALLATION ONLY- _.__.._._.___...._._.. _.. - •----- .._....._..__._.
SIGNATURE OF SUPR- ELEC' N r �� - DATE o Q =Q- _ . - - - --
LICENSE NOS
LA! •J___ : ' JJ. L l J..1.- :_ALJ..-�..i.._l-.. J t lJ... t J_
-'--r : --P -� -' -� , , - . :...�...�- . � -.- -: v..i : -•4_
. i.- i �..�.. --ire -i- �-v-, �- 4•�• -F-F�- r�i- -r^F•-, f-- F•-F-. -1- -1••-� � 'F -l- �--'r'r
1:. '.l 639- 1.175 „y 6s7:0 pZ :l :: for a
iZ; ,t ..iiipacti i'.eecer the next business day
- : - +-- -4- -: -: -!.. . -4-4 - :— +.4- i -A- 4 -I'-i Y• i- ±÷ 1- 4.4.4. + J_ J . + + .- 4 - : -4- - +-}.+-i 1f._ .++ 1-4. .r4-4- 1- +.- 4.- ._F.+_f_F -1-4 -{- i•+ -f'-F- . :•_I +
CITY OF TIGARD Electrical Permit Application Plan Check
13125 SW HALL BLVD. Rec'd By jD �
TIGARD OR 97223 Date Rec'd -`f
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST T G
Inspection (503) 639 -4175 Print or Type `
Permit # iiiii ►ice
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of inspections per permit allowed
Name (or name of business) ea or.) / rJ- A. yo L `S Service included: Items Cost Sum
I
Address /274D SW PQc, c 1-41.) 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip 7 /Q/SLr� ("/e 9 Each additional 500 sq. tt. or
Commercial/ JJ Residential ❑ Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of .11 urrent licenses) 4b. Services or Feeders
Installation, alteration, or relocation
Electrical Contractor - 200 amps or less $60.00 2
Address 14 4 S C.Ine,rr-.1e,,,,,,, Avp 201 amps to 400 amps $80.00 2
City 7 g tv eA State OA Zip 9 7 2_2A 401 amps to 600 amps $120.00 2
Phone No. 3 •- 5 5' /(, 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 34- 442 C. Exp.Date 10- /- ? 7
OR State CCB Reg. No. 440117 Exp.Date (, A - 98' 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 5 Exp.Date 7 - /-9R Installation, alteration, or relocation
200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec'n 47l-. -j 401 amps to 600 amps $100.00 2
�
e Over 600 amps to 1000 volts,
�f
License No. 4028 S Exp.Date /O - / -9T see "b" above.
Phone No. 503- - 79- 5 /Q
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 circ $5.00 2
City State Zip b) The fee for branch circuits
tY p without purchase of
Phone No. service or feeder fee.
First branch circuit I $35.00 3 6.00 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 20, 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: 55, vD
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ 57 7S
NOTICE Subtotal $
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 # $ 5Z 7S
Total balance Due
I: \DSTS\ELC96 APP Rev 9/96
•
6/16/99 Activities for Case #: ELC97 -00536
2:13:47 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 8/8/97 B RECD DST 8/8/97 •
ELCC003 Permit created 8/8/97 B PASS DST 8/8/97
ELCC700 Ceiling Cover 8/13/97 BRP PASS MJR 8/13/97 remove unused wire
ELCC720 Wall Cover 8/13/97 BRP PASS MJR 8/13/97
ELCC799 Elect'I Final 8/26/97 BRP PASS J'H 8/28/97
ELCC500 (F)Issue permit 8/8/97 B PASS DST 8/8/97
ELCC800 Case Finaled 8/26/97 BRP PASS J'H 8/29/97
Page 1 of 1
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CITY OF TIGARD BUILDING INSPECTION DIVISION
_1 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171 •
Date Requested: U - .2 - 9 7
eq P.M. MST:
Location: L2/4 O So/ i / BUP:
Tenant: c - 4 ' 1 / � Suiit - e: Bldg: / MEC:
Contractor: Phone: 'Aar c7 7 ?- 37 h, PLM:
Owner: Phone: /� yam/ //� ELC: 97-o536
��-f �S.S ,5E d / " ' G, C &f S /� 1.16 ELR:
of _/ , A di∎t /. �/ a L� / \ SIT:
BUILDING BLDG (con't) PLUMBING / MECHANICAL SITE
Site Post/Beam Post/Beam Post/Beam Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approv-a - Approved
Appr /Sdwlk Not Approved Not Approved Not Approved lnm . 'roved Not Approved
FINAL FINAL FINAL FLNAL FINAL
i /N9- h6C
O Call for reinspection Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: Date: F' A.0 - 97 Page of