Permit [
A__ CITY OF TIGARD
ELECTRICAL PERMIT
DEVELOPMENT SERVICES ------' -'-''' --'--'--- PERMIT #: ELC97-0307
hi!. 13125 SVK Hall Blv�Tigard, OR 97223 (503)639-4171 DATE ISSUED: 05/27/97
PARCEL: 2S114BB-13300
SITE ADDRESS...:16382 SW 104TH AVE
SUBDIVISION ^SWANSONS GLEN NO.2 ZONING:R-12 PD
BLOCK ^ LOT ^74 JURISDICTION: TIG
Project Description: ios±\ 1 branch circuit // joh # ?
- --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 — 2690 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
SHARA SUDBERT type amount by date recpt
16382 SW 104TH ST PRMT $ 35.00 TAT 05/27/97 97-295106
TIGARD OR 97223 5PCT $ 1.75 TAT 05/27/97 97-295106
Phone #:
•
Contractor:
GRF ELECTRIC $ 36.75 TOTAL
15460 SE PARADISE LN
REQUIRED INSPECTIONS
__
MULINO OR 97042 Ceiling Cover Underground Cove
Phone #: 503-829-4146 Wall Cover Elect'l Service
Reg #.. : 001015
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Pe Signa .1r4
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 ' 4^/ ^ / /af
than 18N days. 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
-
: 7 //
/�� . - '--�
SIGNATURE OF SUPR. ELEC'N: /Y �i DATE ��- ~� /-� �
��
LICENSE NO: ,} �
Call for inspection — 639-4175
— - '~'
CItY-OFTIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
Date Recd
TIGARD OR 97223 Date to P.E.
Phone (503) 639 -4171, x304 Date to DST /�//���!
Inspection (503) 639 -4175 Print or Type Permit # _ - �`ftl.
Fax (503) 684 -7297
Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development S 5 et-1- Number of Inspections per permit allowed
Name (or name of business) S i Gt " V�'" Gt 5 A.000 Z Service included: Items Cost Sum
C['
Address 1 5 W 1 0 i 4 a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip 1 C G . r �� Each additional 500 sq. ft. or
Commercial ❑ Residential E 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 licens s 4b. Services or Feeders
Electrical Contractor f 7 ICE P_ •s-C---) Installation, alteration, or relocation
�/ `" S. 200 amps or less $60.00 2
Address
15-Y l/ r' Y a P� A ; 201 amps to 400 amps $80.00 2
City /IA 14 t ►r,.p State ()'f_ Zip 7 U 401 amps to 600 amps $120.00 2
Phone No. 9a- 9 -LE( Lf- Go' 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. a6-V1 C- Exp.Date
OR State CCB Reg. No. I L)I✓`" Exp.Date 8' ( 4 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 3 • Exp.Date of / q 7 Installation, alteration, or relocation
�� 200 amps or less $50.00 2
Si nature of Sur. Elec'n �U /, v 201 amps to 400 amps $5.00 2
g p p 401 amps to 600 amps $100.00 2
CO Over 600 amps to 1000 volts,
License No. 3 ( 3- S Exp.Date /6 ! Cl g see "b" above.
Phone No.
- c 4-(`, 4d. Branch Circuits
l Y' 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. / e r
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: 3 --
Not required for temporary construction services. 5a. Enter total of above fees $ I - r ^
5% Surcharge (.05 X total fees) $ J
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 , j'�rust Account # � S
TIME AFTER WORK IS COMMENCED. /- $
Total balance Due
I: \DSTS\ELC96.APP Rev 9/96
05/30/2000 Activities for Case #: ELC97 -00307
10:20:53 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 05/27/1997 05/27/1997 TAT 05/27/1997
ELCA003 Permit created 05/27/1997 05/27/1997 TAT 05/27/1997
ELCA799 Elect' Final _ 05/27/1997 05/27/1997 TLP PASS J *H 05/28/1997
ELCA500 (F) Issue permit 05/27/1997 TAT PASS TAT 05/27/1997
ELCA800 Case finaled 05/27/1997 JMH PASS J *H 05/28/1997 JMH
Page 1 of 1
(z, (1,f
D � J CITY OF TIGARD BUILDING INSPECTION DIVISION
Q i
24-Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: J i D'1 \ 91 A.M. * P.M. MST:
Location: I CY 3 g Z 1 6 q- lq-1 BUP:
Tenant: Suite: Bldg: MEC: 7 7 a 1,31
Contractor: Phone: 6 2-0 6 O`q, PLM: q
: Phone: ELC: / 7-0 -
• ELR:
SIT:
BUILDING BLDG (con't) PLUMBING C
G4BII�AL SITE
Site Post/Beam Post/Beam Post earn Cover Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceil' 1: Water Line
Slab Framing Top Out Gas Line • ough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct - . . . = t Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr eat Pump 4 .
Approved Approved _ pprove _ •proved Approved
Appr /Sdwlk Not Approved Not Approved oved oved Not Approved
FINAL FINAL FINAL INAL FINAL
•
s 1
• 7 ,,\
((..),./ cy
O Call for reins do O Reinspection fee of $ required before next inspection O Unable to inspect
I/ Inspector: Date: J / 0 / g7 Page of