Permit .. CITY OF TIGARD ELECTRICAL PERMIT
6
PERMIT #: ELC98 0 ,�
.� � i 'f I
� DEVELOPMENT SERVICES DATE ISSUED: 08/06/98
�� PARCEL: 2S114BB -06300
SITE ADDRESS... :16069 SW 104TH AVE
SUBDIVISION •SWANSONS GLEN � .( 1 41 % , ZONING:R -12 PD
BLOCK • LOT •004 « „f” JURISDICTION: TIG
P r o.j a ct Description : Installation of electrical service to residence for A/C
unit.
- -- 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 • 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.: 1 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
CHERI RAWLINGS type amount by date recpt
16069 SW 104TH AVE PRMT $ 35.00 DLH 08/06/98 98- 308082
TIGARD OR 97224 5PCT $ 1.75 DLH 08/06/98 98- 308082
Phone #:
Contractor:
EVANS ELECTRIC INC $ 36.75 TOTAL
10120 SW NIMBUS AVE
C -3 REQUIRED INSPECTIONS
TIGARD OR 97223 Rough —in Elect'l Final
Phone #: 639 -5572 Elect'l Service
Reg #..: 001048
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 fo • in OAR 952-001-0010 through OAR 952 -661 -1987. You say obtain a copy
of these rules or direct questions to I . calling ( ) ,,. 7.
Permittee Signature: ,LA,/ /, j/.1
Permittee 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: /17/49L DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' N : O-/ ,9/',A- e - %Q110 /
DATE: 1 ,4 j 5(1
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + ++ + + + + + + + + + + + + + + + + + + + + + + ++
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # 1 _ t C 9 e - 0 V 3
-,,'' l' _ Iii'' Phone (503) 639 - 4171 Date Issued i'/� 9
' FAX (503) 684 - 7297
CITY OF TIGARD TDD No. (503) 684 - 2772 Issued by x
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Cif RA14.1 N6 - Number of Inspections per permit allowed
Address (/Q ®p / 5A,1 10 4" ilf E. C� Service included: Items Cost(ea) Sum
City /State/Z , w / ! 7 r- 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
-
Name (or name of business) Each additional 500 sq ft or 1
portion thereof $25.00
Commercial ❑ Residential RI Limited Energy $2500
- Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
1 Installation, alteration, or relocation 2
Electrical Contractor - . -), `� A , t I _ t, _ 200 amps or less $60.00 2
Address 10 \ Z i <s iC� ■ tot\ , as 4 ° Q .e..-'5 201 amps to 400 amps $80.00 2
CI -11 (4�. C'1 State F �,1 _. Zip � 17 Zz 401 amps to 600 amps $120.00 2 - `7 rt p 601 amps to 1000 amps $180.00 2 -
Phone No. lO3 ^�61 z Over 1000 amps or volts $340.00 2
Contractor's License No. t -t- L /d !/9," Reconnect only $50.00
31-1 Contractor's Board Reg. No. a DLIA ct--L *o �7 4c. Temporary Services or Feeders
/� Installation, alteration, or relocation 2
Signature of Supr. Ele n rem // r % 200 amps or less $50.00 2
r $75 00 2
License No.� Z5 Phone N r -� �. 201 amps to 400 amps
401 amps to 600 amps $100.00
/d/. / Over 600 amps to 1000 volts
2b. For owne i s a ations: see 'b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
Phone No. Each branch circuit $5.00
b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. '...? - 2
First branch circuit $35.00 / _l • t ✓` . _ ' 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 $3500
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:
NOTICE 5a. Enter total of above fees $ j -)
5% Surcharge (.05 X total fees) $ _1_4_1-3
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 3 T 5 ----
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. ❑ Trust Account # $
Balance Due $ 46 75"
wad`candoNakcpm.app
6/16/00 Activities for Case #: ELC98 -00463
3:25:16 PM
�I e•
Assigned Hold Updated di)1
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 8/6/98 DLH RECD DLH 8/6/98
ELCA003 Permit created 8/6/98 DLH DONE DLH 8/6/98
ELCA700 Rough -in DLH 8/6/98
ELCA730 Elect'I Service DLH 8/6/98
ELCA799 Elect'I Final DLH 8/6/98
ELCA500 (F) Issue permit 8/6/98 DLH DONE DLH 8/6/98
ELCA920 Miscellaneous action 2/22/00 JMT DONE No Hold JMT 2/22/00 research inspection request
ELCA580 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
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