Permit •
CITY OF TIGARD ELECTRICAL PERMIT
��a� °-d� 4 6 DEVELOPMENT SERVICES PERMIT #: ELC97 -0530
rill DATE ISSUED 08/06/97
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L. • 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 11.1 ESC - 004012{
SITE ADDRESS... :14485 SW 100TH AVE 44 4;IN
S;JDDIVISION. a n- :TIGARDVILLE HEIGHTS e/ ZONING: R - -3o 5
BLOCfioan.s,. - -. a LOT.n.s,..n...n.:1.9 � JURISDICTION: TIG
Pro.j ect Description: Add first branch circuit.
---RESIDENTIAL UNIT -- -- ---TEMP SRVC /FEEDERS - - -- ------- MISCELLANEOUS-- . - -_--
1000 SF OR LESS....: 0 0 - 200 amp.......: 0 PUMP/IRRIGATION....: 0
EACH ADD'L 5O0SF...: 0 201 - 400 amp.......: 0 SIGN /OUT LINE LTG -.: 0
LIMITED ENERGY.. -..: 0 401 - 600 amp.- a.. -.: 0 SIGNAL/PANEL.......: 0
MANF- HM/ SVC /FDR..: 0 6014-amps-1000 volts.: 0 MINOR LABEL (1O)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS- - - --•- ---ADD'L INSPECTIONS--- -
0 - 200 amp......: 0 W /SERVICE OR FEEDER: 0 PER INSPECTION.. -.a: 0
201 - 400 amp. - - . n o : 0 1st W/O SRVC OR FDR.: 1 PER HOUR. n ... o e a - ..: 0
401 - 6O0 amp.. -.n.: 0 EA ADD'L BRNCH CIRC: 0 IN PLANT...........: 0
601 - 1000 amp.....: 0 -- PLAN REVIEW SECTION----------
10001 amp/volt.....: 0 > =4 RES UNITS.- ...a..: > 600 VOLT NOMINAL..:
Reconnect only.. - - .: 0 SVC /FDR ) = 225 AMPS..: CLASS AREA /SPEC OCC. :
Owner: ---------- ------------------ - ____..__ FEES ____..._ - -_
JOSE UNTALAN type amount by date recpt
14485 SW 100TH AVENUE PRMT $ 35.00 GEO 08/06/97 97- 297996
TIGARD OR 97224 5PCT $ 1°75 GEO 08/06/97 97- 297996
Phone #:
Contractor: - - -- -- -- -- - - --
GRF ELECTRIC $ 36.75 TOTAL
15460 SE PARADISE LN
- -- REQUIRED INSPECTIONS ---
MULINO OR 97042 Rough -in Elect' 1 Service
Phone #: 503 -829 -4146 Underground Cove Elect' 1 Final
Reg c.: 00 1015
- - Th-i -s per -oit-- i- s- i- s3sed- subject-- ta- tl:e -r e-gula ions -c oat -aitred- rn- tl►e- T -i-Bard unieipa3- C- edel- 5t-at- e -of- dregon- Speci-ai;-y-Codes arrd- al-- 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 core 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 -A-0010 through CAR 952- Nl -I987. You cay obtain a copy
::: f th rules or direct questions to OUNC by calling (503)246 -1987. //
tt ee Signature: _ Issued 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: 3 o6 3 s
++ +4.4. I.+ + +-r•+.4.++-1--{- ++ F4.4.++4.4.4. t.4.+4.++ + +-i +.4.-W + + + +-1 +.4.4.4.4.44. . +4.4. + + + + +-1 + + + + + ++ ++ + + ++-h-F + +++
Call 639-4175 by 6:O0 p.m. for an inspection needed the next business day
++++++++++++ + + + ++ + + + + ++ + + + + + +-+• + + + + + + + + + ++ + + + +-o- + + ++ + + + + + + + + + + + + + ++ ++ -I- + + + + + + ++ + ++
id
08/06/1997 08:27 5038295747 GRF ELECTRIC PAGE 01
1 ^-
CITY OF TIGARD Electrical Permit Application Plan Check e
1 SW HALL BLVD. Recd By
TIGARD OR 97223 Date Reed
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit frOte9; - 0,730
Fax (503) 684 -7297
Incomplete or illegible will not be accepted called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development 1 1 Number of inspections per permit allowed
Name (or name H of business) Jose... U nt0..l t Service Included: Items Cost Sum
Address ) `} k OS S w (tX) Is 4e. Residential - per unit ,
Ci /State/Zi ci I L 1000 sq. n. or less 8111).00 4
ty P • Each additional 500 sq, ft. or
Commercial ❑ Residential ® portion thereof $25.00 1 -
UmRed Energy $25.00
-
Eacf1 ManurO Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder 868.00 2
(Attach copy of all current licenses) lb. Services or Feeders
Electrical Co tractor G t2 �{ u 1C - Installation, alteration, or relocation
200 amps or less $80,00 2
Address t i? S • Patr ∎ ,3 � ft 201 amps to 400 amps 580,00
City - & r1 State IL Zip W Z � 401 amps to 600 amps $120.00 2
Phone No. t? R"2 - `>? 601 amps to 1000 amps $180.00 2 -
Job No. r.i. c C p Over 1 000 amps or volts - $340.00 2
Reconnect only 550.00 2
Elec. Cont. Lice. No. - Exp.Date
OR State CCB Reg. No. A? 15 �, Exp.Date_ >s 40. Temporary services or Feeders
COT Business Tax or Metro No. 3 471 Exp.Date Al 1 47 Installation, alteration, or relocation
200 amps leas $50.00 2
Signature of Supr. Elec'n / 201 1 to amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
O ver 800 amps to 1000 volts,
L icense No. ' Exp.Date /0 t I's see ••b" above.
Phone No. CSo 672-4 � - * � i
4d. Branch Circuits
New. alteration or extension per panel
2b. For owner Installations: a) The fee for branch circuits wire
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circui $5.00 2 -
b) The lee tar branch circuits
City_ State Zip _ wHlwutpurchase of - - - - --
- Phone No. - service or feeler fee. B c7
First branch circuit $35.00 5" 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
Owner's Signature (S or feeder not Inducted)
9 Each pump or Irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (If required):* Signal otrauh(s) or a limited energy
panel, alteration or extension 540.00 2
Miner Labels (10) 5100.00
Please check appropriate Item and enter fee In section S8.
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: 35. oO
Not required for temporary construction seMces. 6a. Enter total or above tees $
5% Surcharge (.0.5 X total fees) $ 1 =1f
NOTICE • Subtotal $
6b. Enter 25% of line 50 for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if reauirad (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Wubtotil $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. Trust Account tr (-W , 75-
T $ balance Due
i; i
CITY OF TIGARD Electrical Permit Application Plan Check#
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DS
Inspection (503) 639 -4175 Print or Type Permit # 4-t - (2- 7 - 053 F.
Fax (503) 684 7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development 1 Number of Inspections per permit allowed
Name (or name of business) JoS� til,� +C�.la -v-� Service included: Items Cost Sum
I
Address )' S 0 I DO ('4' " 4a. Residential - per unit
City/State/Zip `C o ,d d q I LZ4 1000 sq. ft. or less $110.00 4
ty p �\ Each additional 500 sq. ft. or
Commercial ❑ Residential I� portion thereof $25.00 1
Limited 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) ae 4b. Services or Feeders
Electrical Contractor c 12C E i.e c- i M C- Installation, alteration, or relocation
Address 15 4190 5 . Pa - rapt ;=-542- 1-h 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City V A L L - A p State c- Zip 9 7UI _ 401 amps to 600 amps $120.00 2
Phone No. • CS63) R7.- ° f - q't "Hp 601 amps to 1000 amps $180.00 2
Job No. J-t e G Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. D-(a' R7.RGExp.Date to /2 //! 7
OR State CCB Reg. No. k0 f ci 4 3 Exp.Date 8'//1 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 3 47a Exp.Date .4/ / f f 7 Installation, alteration, or relocation
$50.00 2
200 amps or le
Signature of Supr. Elec'n 401 amps to 600 amps $75.00
100.00 2
Over 600 amps to 1000 volts,
License No. 3o0 3 S Exp.Date / (t gg see "b" above.
Phone No. CS 03) Szg - l'
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 circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee. I 3 �j d c7
_- - _ - - 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: 35 ao
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ I .15
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 # $ C 75
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
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6/16/00 Activities for Case #: ELC97 -00530
3:02:25 PM $4.46,
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 8/6/97 8/6/97 GEO 8/6/97
ELCA003 Permit created 8/6/97 8/6/97 GEO 8/6/97
ELCA700 Rough -in 8/6/97 GEO 8/6/97
ELCA725 Underground Cover 8/6/97 GEO 8/6/97
ELCA730 Elect'I Service 8/6/97 GEO 8/6/97
ELCA799 Elect'I Final 8/6/97 GEO 8/6/97
ELCA500 (F) Issue permit 8/6/97 GEO PASS GEO 8/6/97
ELCA920 Miscellaneous action 2/18/00 JMT DONE I No Hold JMT 2/18/00 research inspection request
ELCA580 Expired by limitation 5/7/00 HAP DONE No Hold AKJ 5/7/00
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