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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC97 -0776 ^ .� 1104 DEVELOPMENT SERVICES DATE ISSUED: 11/21/97 -4171 PARCEL: 2S114AB- 01.201 SITE ADDRESS...:16283 SW 92ND AVE SUBDIVISION • ZONING:R -4.5 BLOCK • LOT JURISDICTION: TIG Project Description: Temporary service - -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS 1000 SF OR LESS....: 0 0 — 200 amp • 1 PUMP /IRRIGATION • 0 EACH ADD'L 5O0SF...: 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 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 ALLAN MILLS type amount by date recpt 2772 S.W. 84TH PLACE PRMT $ 50.00 JSD 11/21/97 97-301145 PORTLAND OR 97225 SPCT $ 2.50 JSD 11/21/97 97- 301145 Phone #: Contractor: -- OWNER $ 52.50 TOTAL REQUIRED INSPECTIONS Elect' 1 Service Phone #: Elect'l Final Reg #.. : 999999 This permit 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 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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001-0010 through OAR 952-00 `3: You may obtain a copy of these rules or direct questions to t3., by cal 1in (503)246 - 1987. t Permittee Signature: , I � 1 11`- g � . �� „� sued B y: - - -- OWNER INSTALLATION ONLY ' ' -- The installation is being made on property I own which i's not in for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: ++++++++++++++++++++++++++++++++++++- F++++++++++++ + + + ++ + +-I + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 7:00 p.m. for an in needed the next business day +++++++++++++++++++++++++++++++++++++++*+++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ �a CITY OF TIGARD Electrical Permit Application Plan Check # : 13125 SW HALL BLVD. Rec'd By -j TIGARD OR 97223 Date Rec'd / o` Date to P.E. Phone (503) 639 -4171, x304 Date to DST Print or Type Inspection (503) 639 -4175 Permit # (� 1--CCI - G -- C Fax (503) 684 7297 Incomplete or illegible will not be accepted Called C.- 1, Job Address: /6,2 ag 5 ). 9 . "� 1 4i2 4. Complete Fee Schedule Below: Name of Development ,, ` "�✓ u� / Number of Inspections per permit allowed - Name (or name of business) 7" / ! � /4'l (` s Service included: Items Cost Sum Address 2-77 w " 8z(_ 4a. Residential - per unit _ � r !-' 1000 sq. ft. or less $110.00 4 City/State/Zip 1-611_7 t ©�, /�Z� Each additional 500 sq. ft. or Commercial El Residential portion thereof $25.00 1 L imited Energy $25.00 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 Installation, alteration, or relocation 200 amps or less $60.00 2 Address 201 amps to 400 amps $80.00 2 City State Zip 401 amps to 600 amps $120.00 2 Phone No. 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. Exp.Date OR State CCB Reg. No. Exp.Date 4c. Temporary Services or Feeders COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation . 200 amps or less i $50.00 2 201 amps to 400 amps 75.00 Signature of Supr. Elec'n 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 ins - llations: a) The fee for branch circuits with /`, /1 /) 1 ( S purchase of service or Print Owner's Na - 1 (I N �/ feeder fee. Address _ _ _ I , Each branch circuit $5.00 2 City . d* / State • , Zip !r b) The fee for branch circuits t y _ without purchase of r � / Phone No. do - /e. 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 . n . P 4e. Miscellaneous / 7:---"...e (Service or feeder not included) Owner's Signatur �t /� 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 $ /� 5% Surcharge (.05 X total fees) $ 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 # Total balance Due $ LI----, I: \DSTS \ELC96.APP Rev 9/96 CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171 Date Requested: / 2 9 7 A.M. P.M. MST: Location: / G 3 9.2.. ) BUP: Tenant: Suite: Bldg: MEC: Contractor: Phone: PLM: Owner: Phone: ELC: q 7 - D L rj 7Z ELR: SIT: BUILDING BLDG (con't) PLUMBING MECHANICAL ELEC SITE Site Post/Beam Post/Beam Post/Beam we f, ervice Sewer /Storm Footing Roof UndFl/Slab Rough -In Ceiling -1- p Water Line Slab Framing Top Out Gas Line Rough -In UG Sprinlder 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 Approved Approved Appr /Sdwlk Not Approved Not Approved Not Approved o roved Not Approved FINAL FINAL FINAL FINAL O Call for reinspects O Reinspection fee of $ required before next inspection 0 Unable to inspect Inspector: P� Date: 2--- V� 9 Page of 6/6/00 Activities for Case #: ELC97 -00776 1:26:56 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ELCA001 Application received 11/21/97 JSD PASS JD 11/21/97 ELCA003 Permit created 11/21/97 JSD PASS JD 11/21/97 ELCA730 Elect'I Service 12/2/97 MJR PASS MJR 12/3/97 mark neutral and change ground clamp ELCA799 Elect'I Final 12/5/97 BRP PASS J *H 12/9/97 ELCA500 (F) Issue permit 11/21/97 JSD PASS JD 11/21/97 ELCA730 Elect'I Service 12/3/97 BRP FAIL J *H 12/4/97 Corrections not done. ELCA800 Case finaled 12/9/97 BRP PASS J *H 12/9/97 Page 1 of 1