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Permit ELECTRICAL PERMIT . ./ � —� ��� OF � � ���� PERMIT #: ELC95-0521 1N �� � �� � � ����~�p DATE ISSUED: 11/03/95 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SWHall Blvd. Tigard, Oregon e722308199 (503) 539-4171 PARCEL: 2S102BA-690200 SITE ADDRESS...: 12045 SW 95TH AVE SUBDIVISION....: NO.TIGARDVILLE ADDITION AMEND. ZONING:R-25 BLOCK..........: LOT...... ....... :61 Project Description: Install temp service __ ---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- MISCELLANEOUS 1000 SF OR LESS....: 0 0 — 200 amp ^ 1 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 : 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/O 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 ---- ---- LANDMARK DEVELOPMENT CORP. type amount by date recpt 9990 SW GREENBURG RD PRMT $ 50.00 JSD 11/03/95 95-272510 SUITE 101 5PCT $ 2.50 JSD 11/03/95 95-272510 PORTLAND OR 97223 Phone #: 620-4427 Contractor: — • — — CONTRACTOR NOT ON FILE $ 52.50 TOTAL ��^/� T�� �� / ------- REQUIRED INSPECTIONS -- Electrical Servi Phone #: _ ___ . _ Reg #..: • This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Dre, Specialty Codes and all other Pe `" .ttee S ignature 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 ���m����~ _,^' `' ~~`'^ � ' __ _ than 180 days. Is ued 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 / ' ^ f., Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. :---2--C �,- ��� I Tigard, OR 97223 Permit # 404 ��� Date Issued / /- 3 -- c-C A ii Phone (503) 639 -4171 FAX (503) 684 -7297 CITY OF TIGARD TDD No. (503) 684 -2772 Inspection (503) 639 -4175 1. Job Address: 4. Complete Fee Schedule Below: ) Name of Development D0ib1 /V) PA4 --, Number of Inspections per permit allowed Address /204 s1� � 9 ,t�. ' 4 Cc " i Service included: Items Cost(ea) Sum City /State /Zip // r a.4 Q /l, 9 /72 Z 3 4a. Residential - per unit n y � y�� 1000 sq. ft. or less $110.00 4 f u PA' Name (or name o siness) s n') W / t ,57. Each additional 500 sq. ft. or portion thereof $25.00 Commercial ❑ Residential X. Limited Energy $25.00 1 Each Manufd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: . 4b. Services or Feeders Electrical Contractor S1,t4t'/ -e) eilecivic Installation, alteration, or relocation $60.00 2 200 amps or less Address Z 6 5- i std L ' dam, - . 201 amps to 400 amps $80.00 2 City :!..e.., 401 amps to 600 amps $120.00 2 LEI State (��, Zip 601 amps to 1000 amps $180.00 2 Phone No. (p 4-3 -- 52. Over 1000 amps or volts $340.00 2 Job NO. Reconnect only $50.00 2 contractor's license NO. 3 4 -. ' 1Q 4c. Temporary Services or Feeders Contractor's Board Reg. fyraa 3 Installation, alteration, or relocation ©d Signature of Su r. Elec' ` 200 amps or less c/ So 2 Lic No. / 3,.. Phone No.6 77 201 amps to 400 amps $50.00 2 401 amps to 600 amps $75.00 Over 600 amps to 1000 volts $100.00 . 2b. For owner installations: see "b" above. 4d. Branch Circuits Print Owner's Name New, alteration or extension per pane Address a) The fee for branch circuits with purchase of service or feeder fee. 2 City State Zip Each branch circuit $5.00 Phone No. b) The fee for branch circuits withou The installation is being made on property I own which is purchase of service or feeder fee. 2 First branch circuit $35.00 2 not intended for sale, lease or rent. 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 $40.00 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: 5a. Enter total of above fees NOTICE 5% Surcharge (.05 X total fees) $ '7,, ' j 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. word \comdeNeiec- ❑ Trust Account # $ prm.app 9 c � FE � Balance Due $ 17 a e' 6/16/00 Activities for Case #: ELC95 -00521 2:09:09 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ELCA001 Application received 11/3/95 JSD PASS JD 11/3/95 ELCA003 Permit created 11/3/95 JSD PASS JD 11/3/95 ELCA500 (F) Issue permit • 11/3/95 JSD PASS JD 11/3/95 ELCA920 Miscellaneous action 11/6/95 MJR TEMP MJR 11/8/95 ELCA800 Case finaled 8/14/96 MJR PASS MJR 8/14/96 Page 1 of 1