Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC98 -0257
�i�"' ����`' ' DATE ISSUED: 05/ 15/98
' 1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-417L
PARCEL: 2S11OAB -02202
SITE ADDRESS...:14305 SW 112TH AVE q
SUBDIVISION • COLE'S ACRES �ZONING : R -4. 5
BLOCK • LOT •008 CO JURISDICTION: TIG
Project Description: Adkisson
- -- 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: 1 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
DONNA ADKISSON type amount by date recpt
14305 SW 112TH AVE PRMT $ 40.00 JSD 05/15/98 98- 305791
TIGARD OR 97223 -0000 5PCT $ 2.00 JSD 05/15/98 98- 305791
Phone #: 620 -6797
Contractor:
NORTHWEST ELECTRICAL SPECIALT $ 42.00 TOTAL
ROYAL EDWARD STEARNS II
616 SE 69TH CT REQUIRED INSPECTIONS
HILLSBORO OR 97123 Rough —in Elect' 1 Final
Phone #: 848 -8678 Elect'1 Service
Reg #..: 001213
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 perait will expire if work i not started within 188
days of issuance, or if work is suspended for sore than 1: days. ATTENTION: Oregon law requires you to f ow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 881 -8010 through OAR 952 -081 1987. You lay obtain a copy
of these rules or direct questions to OUNC by calling 15831246 -1987.
Permittee Signature: k, /. I _ OOM '4 Issued B . dil lt
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 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd /9-- A
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit# 6 t. C4 tv5-7
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called 0 C i L
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development \ Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum
�� J
Address 1 - I JuU I I c � 4a. Residential - per unit
1000 sq. ft. City/State/Zip T i • C ., ^ ` Ote- Eac h ad d it io o r less $110.00 4
CI (`,l -U Cif � (..�� Each additional 500 sq. ft. or
portion thereof $25.00 1 -
Commercial El Residential 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) 4b. Services or Feeders
Electrical Contractor Mil l ) FLF� I ( C �P o_ Installation, alteration, or relocation
Address LS I l D SE LC2} - Y1 - i. • 20 amps less $60.00 2
� �_ 201 1 amps t to o 400 amps $80.00 2
City HA. Aj SI-- e ' -rt State ZipG - 1 1 - 401 amps to 600 amps $120.00 2
Phone No. - 5. 8tp18 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Dec. Cont. Lice. No. �{ 45OC.. Exp.Date / �j `� Reconnect onl $50.00 2
OR State CCB Reg. No. ) ZI 3 2S Exp.Date -/ .2 /av 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Da. Installation, alteration, or relocation
_ _ 200 amps or less $50.00 2
Signature of Supr. Elec'n �i 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 7/.,-- Exp.Date ♦ see "b" above.
Phone No. 9ff :3-s 3
4d. Branch Circuits
New, alteration or extension per panel
211 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.
First branch circuit I $35.00 2
The installation is being made on property I own which is not Each additional branch circuit I $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: N °.
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 � 0
TIME AFTER WORK IS COMMENCED. CI Trust Account # L
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96
6/19/00 Activities for Case #: ELC98 -00257
1:53:33 PM
tth
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 5/15/98 JSD PASS JSD 5/15/98 ' �
ELCA003 Permit created 5/15/98 JSD PASS JSD 5/15/98
ELCA700 Rough -in JSD 5/15/98
ELCA730 Elect'I Service JSD 5/15/98
ELCA799 Elect'I Final NOTE JT 1/13/99 1/13/99 inspection request
(research) sent to Chuck
ELCA500 (F) Issue permit 5/15/98 JSD PASS JSD 5/15/98
ELCA920 Miscellaneous action 3/17/99 WDJ MAIL WDJ 3/17/99
ELCA920 Miscellaneous action 4/28/99 AKJ DONE No Hold AKJ 4/28/99 inactivity letter sent
ELCA920 Miscellaneous action 2/23/00 JMT DONE No Hold JMT 2/23/00 SECOND RESEARCH
INSPECTION REQUEST
ELCA580 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
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