Permit A CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00683
, DEVELOPMENT SERVICES DATE ISSUED: 11/15/1999
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S133AC -KNOW1
SITE ADDRESS: 10751 SW 130TH AVE
SUBDIVISION: KNOWLEDGE BEGINNINGS DAYCARE C ZONING: R -25
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Temp power pole (200 AMP service).
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BURTON GRABHORN SEVEN PEAKS ELECTRIC
14493 SE 82NE AVE 1748 NE MEERKAT AVE
PORTLAND, OR 972 BEND, OR 97701
Phone: Phone:
Reg #: LIC 135301
ELE 9 -227C
SUP 4539S
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT DST 11/15/199 $53.50 989 - 319757 Elect'l Final
5PCT DST 11/15/199, $4.28 989 - 319757 ORIG
Total $57.78
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 may obtain copies of these rules or direct questions to OUNC at (503)
246 - 1987. PERMITTEES SIGNATURE / f&(/ 1 ,, SUED BY: s •
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:
IfV1�
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N:X V ' 1
N U u // -7.---9.-
DATE:
LICENSE NO: '15-39- S
Call 639 -4175 by 7:00pm for an inspection the next business day
,
CITY OF TIGARD Electrical Permit Application Plan Check#
13125 SW HALL BLVD. Recd By
- TIGARD OR 97223 Date Recd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type permit # f i'/ -&T 3
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development IAIU6UJL SI- Bg.6/0 JI /JC--S Number of Inspections per permit allowed
Name (or name of business) ��) ,r �f Service included: Items Cost Sum
Address / 07 3 / � ID l 3 / �1 4a. Residential - per unit
City /State /Zip t, l b1 0 1000 sq. ft. or less $ 117.75 4
Each additional 500 sq. ft. or
portion thereof $ 26.75 1
Commercial Residential ❑ Limited Energy $ 60.00
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). 1, ,1 ��.�
I y� 1- IC Installation, alteration, or relocation
Electrical Contractor S $ . EC � 200 amps or less $ 64.25 2
Address 1 f '1 ! ' it) g • k ' 201 amps to 400 amps $ 85.50 2
t 401 amps to 600 amps $ 128.50 2
City State �2 ! Zlp 7 �� f 601 amps to 1000 amps $ 192.50 2
Phone No. 4'f( 3&? -6 I Over 1000 amps or volts $ 363.75 2
Job No. Reconnect only $ 53.50 2
Elec. Cont. Lice. No. ¶- Z2-7 _- Exp.Date hO 0 Cr 4c. Temporary Services or Feeders
OR State CCB Reg. No. t '35 3o 1 Exp.Date 9 -a7-of Installation, alteration, or relocation
COT Business Tax or Metro No. Exp.Date 200 amps or less / $ 53.50 7 -3 • 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n Q(G)C, 1t>"--' / 401 amps to 600 amps $ 1 00.00 2
p y L Over 600 amps to 1000 volts,
License No.
�S3 1 S Exp.Date (2C l Q' s "b" above.
• Phone No,cif j 3$q -.5 (o i 4d. Branch Circuits
New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit $ 37.50
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
3. Plan Review section (if required):*
panel, alteration or extension $ 60.00
Minor Labels bels (10) $ 100.00
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 $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees:
5a. Enter total of above fees $ 5
* Submit 2 sets of plans with application where any of the above apply. 8% Surcharge (.08 X total fees) $ «
Not required for temporary construction services. Subtotal $ ' v
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account #
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ ,/ T. v
i:\dsts\forms\electric.doc
04/28/2000 Activities for Case #: ELC1999 -00683
8:45:03 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 11/15/1999 GEO RECD No Hold GEO 11/15/1999
ELCC003 Permit created 11/15/1999 GEO DONE No Hold GEO 11/15/1999
ELCC730 Elect'I Service 11/16/1999 BP PASS No Hold VT 11/16/1999 temporary service - Pass
ELCC799 Elect'I Final 11/16/1999 BP PASS No Hold VT 11/16/1999
ELCC500 (F)Issue permit 11/15/1999 GEO DONE No Hold DST 11/15/1999
ELCA800 Case finaled 11/16/1999 BP PASS No Hold VT 11/16/1999
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