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Permit CITY F T I G A R D ELECTRICAL PERMIT pi; DEVELOPMENT SERVICES PERMIT #: ELC1999 -00312 D ATE ISSUED: 5/25/99 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 6K1- k #1./:// PARCEL: 2S103DC -00803 SITE ADDRESS: 13530 SW 115TH AVE � SUBDIVISION: VIRGINIA ACRES O 9 ZONING: R -3.5 BLOCK: LOT : 001 �SDICTION: TIG Project Description: Installation of one branch circuit. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL: MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: ROBERT MILLS ALL ELECTRICAL SERVICE 13530 SW 115TH AVE PO BOX 68712 TIGARD, OR 97223 OAK GROVE, OR 97268 -0712 Phone: Phone: 626 -6831 Reg #: SUP 4313S LIC 124045 ELE 26 -963C FEES Required Inspections Type By Date Amount Receipt Elect'l Service PRMT DST 5/25/99 $35.00 99- 315656 Elect'l Final 5PCT DST 5/25/99 $1.75 99- 315656 Total $36.75 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You ma obtain co• • - - Wiles or direct questions to OUNC at (503) 246 -1987. Permit Signature: Iss -d By: l i / i 1 . i .1i . 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: 9 / CONTRACTOR INST • LATION ONLY SIGNATURE OF SUPR. ELEC'N: A./ • - , i� A. / DATE: .*-/ V P' r LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day CITY OF TIGARD Electrical Permit Application Plan Eck 13125 SW HALL BLVD. Rec' y TIGARD OR 97223 Date Recd 5 'a3 l Date to P.E. ----- Phone (503) 639 -4171, x304 Print or Type Date to DST Inspection (503) 639 -4175 Permit# ELCW99. 3i2 - Fax (503) 598 -1960 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development 6 6, 1 + f l S Number of Inspections per permit allowed Name (or name of business) ^ Service included: Items Cost Sum Address a) 3 13 © '5 (.) 11 A VIZ_ 4a. Residential - per unit • 1000 sq. ft. or less $110.00 4 City/State /Zip 1 / /I ; _ ,_ Each additional 500 sq. ft. or V portion thereof $25.00 1 Commercial ❑ Residential ❑ Limited Energy $25.00 Each Manufd Home or Modular Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: (Attach copy of all current license 4b. Services or Feeders Electrical Contractor ' _. /" ,1 Installation, alteration, or relocation 200 amps or less - $60.00 2 Address - I 0. , ■ 201 amps to 400 amps - $80.00 2 City ,° • , , , State OR Zip # -`1 401 amps to 600 amps - $120.00 2 Pho e No. 6 r .. ,. 6 cii j 601 amps to 1000 amps - $180.00 2 Over 1000 amps or volts - $340.00 2 Job No. Reconnect only - $50.00 2 Elec. Cont. Lice. No. ,Q/-^ q63 L Exp.Date OR State CCB Reg. No. ) 0 15 Exp.Date 4c. Temporary Services or Feeders COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation 200 amps or less $50.00 2 Signature of Su r. Elec'n r . / . 201 amps to 400 amps $ 100.0 2 9 P _ . _ 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License No. 4/ 3/ 3 j Exp.Date see "b" above. Phone No. 62, - 6 � / 4d. Branch Circuits / -- 9 , L/ f/ - l a on s: 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 $35.00 3 2 Each additional branch circuit $5.00 2 The installation is being made on property I own which is not 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):* Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over 4 or more residential units in one structure the allowable in any of the above Service and feeder 225 amps or more Per inspection $35.00 System over 600 volts nominal Per hour $55.00 Classified area or structure containing special occupancy In Plant $55.00 as described in N.E.C. Chapter 5 5. Fees: * Submit 2 sets of plans with application where any of the above apply. 5a. Enter total of above fees $ Not required for temporary construction services. 5% Surcharge (.05 X total fees) $ Subtotal $ NOTICE 5b. Enter 25% of line 5a for Plan Review if required (Sec.3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Subtotal $ NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY ❑ Trust Account # TIME AFTER WORK IS COMMENCED. Total balance Due $ I: \DST \ELEC98.DOC REV 4/98 5/30/00 Activities for Case #: ELC1999 -00312 2:01:00 PM tiop Assigned Hold Updated �� Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes ELCA001 Application received 5/25/99 DEB DONE No Hold DST 5/25/99 ELCA003 Permit created 5/25/99 DEB DONE No Hold DST 5/25/99 ELCA730 Elect'I Service 5/25/99 5/25/99 No Hold DST 5/25/99 ELCA799 Elect'I Final 5/25/99 5/25/99 No Hold DST 5/25/99 ELCA500 (F) Issue permit 5/25/99 DEB DONE No Hold DST 5/25/99 ELCA845 Request inspection research 3/27/00 JMT DONE No Hold JMT 3/27/00 ELCA580 Expired by limitation 4/18/00 HAP DONE No Hold AKJ 4/18/00 Page 1 of 1