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Permit CITY OF T R D ELECTRICAL PERMIT . DEVELOPMENT SERVICES PERMIT #: ELC97 -0801 :: DATE ISSUED: 12/05l97 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS...:11156 SW 130TH AVE tiPbb PARCEL: 1 S 133DA -09300 SUBDIVISION....:CASTLES AT BRITTANY ZONING:R-7 PD BLOCK LOT °023 JURISDICTION: TIG Pro j ect Description : Add five (5) branch circuits to an existing single family dwelling. - -- RESIDENTIAL UN - - -- -- -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 LTMITED ENERGY • 0 401 - 600 amp • 0 SIGNAL /PANEL - 0 MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (1O)...: 0 - - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- - 0 - LOO 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: 4 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 •- MARGERY E JOHNSON type amount by date recpt 11156 SW 130TH AVE PRMT $ 55.00 GEO 12/05/97 97- 301489 TIGARD OR 97223 SPCT $ 2.75 GEO 12/05/97 97- 301489 Phone #: Contractor: HORIZON ELECTRIC CO $ 57.75 TOTAL 5657 N WILBUR AVE REQUIRED INSPECTIONS PORTLAND OR 97217 • Elect'1 Service Phone #: 628 -8787 Elect' 1 Final Reg #..: 000973 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 -,.a1 -0010 through OAR .952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by calling (503)246 -1987. Permittee Signature: i -" / of 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 : 1 a r DATE: 5 - 17 — LICENSE NO: , +++++++++++++++++++++++++++++++++++- 1-++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day ++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ CITY OFiTIGARD Electrical Permit Application Plan Check # 13125 SW HALL BLVD. Rec'd By TIGARD OR 97223 Date Recd Date to P.E. Phone (503) 639 -4171, x304 Date to DST Inspection (503) 639 -4175 Print or Type Permit #.6 4 --©$O/ Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called 1. Job Address: °� 4. Complete Fee Schedule Below: Name of Development IW t r?r \'L I )vl_ \ L) ° 7())) Number of Inspections per permit allowed Name (or name of business) Lb i �( 4_..ls \ Service included: Items Cost Sum I Address I ( I :6 _ 5 vo. V 1� 0 4a. Residential - per unit p(� q� /� 1000 sq. ft. or less $110.00 4 City /State /Zip , �" -" v b 1 0R, Each additional 500 sq. ft. or I Commercial El Residential portion thereof $25.00 1 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 c rrent licenses) 4b. Services or Feeders Electrical Contractor 111L i k , � p ' Installation, alteration, or relocation A 200 amps or less $60.00 2 Address j� i o v` , 1 L U . t. , 201 amps to 400 amps $80.00 2 City CSZ State ® f/2 Zip 7 '2-. i 7 401 amps to 600 amps $120.00 2 Phone No. � 1 CO 601 amps to 1000 amps $180:00 2 Job No. Over 1000 amps or volts $340.00 2 Elec. Cont. Lice. No. Exp.Date I I -41:4 Reconnect only $50.00 2 OR State CCB Reg. No. Exp.Date t-- "( ci ^/ 4c. Temporary Services or Feeders COT Business Tax or Metro No. "'IF 50 Exp.Date 6' i' X Installation, alteration, or relocation • 200 amps or less $50.00 2 Signature of Supr. Elec'n (, ([C.L lSA 201 amps to 400 am $75.00 2 - c �� 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, .. License No. Ex Date see "b" above. Phone No. 2� ' - $SS/ 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. ; �� 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: 5 ,�. 1 ^ Not required for temporary construction services. 5a. Enter total of above fees $ 5% Surcharge (.05 X total fees) $ Z .25 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 ` c' TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ 5Zt eJ Total balance Due I: \OSTS \ELC96.APP Rev 9/96 6/6/00 Activities for Case #: ELC97 -00801 2:14:01 PM EXPI� Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes • ELCA001 Application received 12/5/97 GEO RECD GEO 12/5/97 ELCA003 Permit created 12/5/97 GEO PASS GEO 12/5/97 ELCA730 Elect'I Service 12/5/97 12/8/97 MJR PASS J*H 12/16/97 ELCA799 Elect'I Final 12/5/97 GEO 12/5/97 ELCA500 (F) Issue permit 12/5/97 GEO PASS GEO 12/5/97 • ELCA700 Rough -in 3/11/98 CD FAIL J*H 3/11/98 No power to floor receptacle. ELCA580 Expired by limitation 6/5/00 HAP DONE No Hold AKJ 6/5/00 • Page 1 of 1