Permit CITY T ELECTRICAL. PERMIT
o � � , DEVELOPMENT 6
Ap
T SERVICES PERMIT #: ELC98 -0403
"� ® � �® �jr� DATE ISSUED: 07/20/98
PARCEL: 1S134CC -02700
SITE ADDRESS...:11985 SW 122ND CT
SUBDIVISION -YE OLDE WINDMILL ZONING:R -4.5
BLOCK LOT -013 JURISDICTION: TIG
Project Descript : Alteration to single family residence. Job No. 713114.
- -- 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
MCDANIEL type amount by date recpt
11985 SW 122ND CT PRMT $ 35.00 DLH 07/20/98 98- 307461
TIGARD OR 97223 5PCT $ 1.75 DLH 07/20/98 98- 307461
Phone #:
Contractor:
WEST SIDE ELECTRIC CO INC • $ 36.75 TOTAL.
1834 SE 8TH AVENUE
• REQU I NSPECT IONS
PORTLAND OR 97214 Rough —in Elect ' 1 Final
Phone #: 231 -1548 Elect'l Service
Reg #..: 000133
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 forth in OAR 952- 001 -0010 through OAR 952 -001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permitt 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 : 471 /9? ) L 4! '3 DATE: ���Oe
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 #
co
13125 SW HALL BLVD. RECEIVED Rec'd By ? , c.49
TIGARD OR 97223 Date Rec'd 7,Z0
Phone (503) 639 -4171, x304 JUL l ( 1 Date to P.E.
Print or Type ` - 1998 'r� � / Date to DST
Inspection (503) 639 -4175 / Permit # CGC. `/ f�- D 5cO3
Fax (503) 684 72x7 Incomplete or illegible)wili:not accepted
yam.__ ...u,t Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
�� �
I
Name (or name of business) ///cAgt27 ith) f '` Service included: Items Cost Sum
Address //9(..0 5k.' /22' 4a. Residential - per unit
City /State /Zip / / QA-G/ (')/.__ 1000 sq. ft. or less $110.00 4
Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial ❑ Residential
Li mited 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 iceryses / /' 4b. Services or Feeders
Electrical Contractor A. 4P.5 current -VC ''v e l O T C Installation, alteration, or relocation
Address / � , 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City or •i State II Zip 401 amps to 600 amps $120.00 - 2
Phone No. 2 - /S • 601 amps to 1000 amps $180.00 2
Job No. 7 /3--C /y L Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. G .- /3 S Exp.Date Reconnect onl $50.00 2
OR State CCB Reg. No. /33 C)t^ 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 Supr. Elec'n Q 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
-
3 Over 600 amps to 1000 volts,
License No / S TS4 3 Exp.Date see "b" above.
Phone Nc 23/ / S-l-/J7 --- 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. J
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:
Not required for temporary construction services. 5a. Enter total of above fees $ J
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
TIME AFTER WORK IS COMMENCED. t� Trust Account # / 3 3 o
Total balance Due r• ---- $ 07
•
5/10/00 Activities for Case #: ELC98 -00403 EXPIRED
1:19:20 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes .
ELCA001 Application received 7/20/98 DLH . RECD DLH 7/20/98
ELCA003 Permit created 7/20/98 DLH DONE DLH 7/20/98
ELCA700 Rough -in DLH 7/20/98
ELCA730 Elect'I Service DLH 7/20/98
ELCA799 Elect'I Final NOTE JT 1/13/99 1/13/99 inspection request
(research) sent to Chuck •
ELCA500 (F) Issue permit 7/20/98 DLH DONE DLH 7/20/98
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
ELCA845 Request inspection research 3/28/00 JMT DONE No Hold JMT 3/28/00 SECOND REQUEST
ELCA580 Expired by limitation 4/18/00 HAP DONE No Hold' AKJ 4/18/00
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