Permit ELECTRICAL PERMIT
' � ��� OF � PERMIT #: ELC96-0243 ��~�'� � 0K ��� � � DATE ISSUED: 04/18/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639-4171 PARCEL: 2S1140D-00101
SITE ADDRESS...: 17005 SW 92ND AVE
SUBDIVISION ^ ZONING:
BLOCK.......... LOT.............: '
Project Description: Installing one service or feeder to 200 amps and three bran
ch
circuits.
---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......: 1 W/SERVICE OR FEEDER: 3 PER INSPECTION ^ 0
201 — 400 amp......: 0 1st W/O SRVC OR FDR.: 0 PER HOUR...........: 0 .
401 — 600 amp ~ 0 EA ADD'L BRNCH CIRC: 0 IN PLANT.,.........: 0
601 — 1000 amp.....: 0 -- PLAN REVIEW SECTION----------------
16900+ amp/volt.....: 0 >=4 RES UNITS........: > 600 VOLT NOMINAL..:
Reconnect only ^ 0 SVC/FDR >= 225 AMPS..: CLASS AREA/SPEC OCC. :
Own'er: — ----- — FEES --- -----
CITY OF TIGARD type amount by date recpt
13125 SW HALL BLVD PRMT $ 75.00 CJS 04/18/96 96-278363
P. O. BOX 23397 5PCT $ 3.75 CJS 04/18/96 96-278363
TIGARD OR 97223
Phone #: 503-639-4171
Contractor: —
PHOENIX ELECTRIC CO $ 78.75 TOTAL
PO BOX 1432
-- REQUIRED INSPECTIONS -------
TUALATIN OR 97062 Wall Cover Elect'l Final
Phone #: 503-692-5882 Elect'l Service
Reg #..: 52288
This permit is issued subject to the regulations contained in the _
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signature
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 ^—Aczr L "I •C -
thao 18N days. 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��^� �/' * DATE: ��-�~�- ��
�� — ,
LICENSE NO: _
Call for inspection — 639-4175
•
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Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # ELC96 -c)3
Am4111610 Date Issued S/- /8- 96
� Phone (503) 639 -4171
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: ' 4. Complete Fee Schedule Below: .
1
Name of Development \ C`iC c. - 4, - 4"V Number of Inspections per permit allowed
Address \n-c(5 n(,J pl t ici b( Service included: . Items Cost(ea) Sum
City /State /Zip C { P\ 4a. Residential - per unit
i V 1000 sq. ft. or less $110.00 4
Name (or name of business) E portionithereof00 sq. ft. or $25.00
Commercial Resideral Limited Energy $25.00 1
Each Manurd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor ' stallation only:
4b. Services or Feeders
C7l-
Electrical Contractor a I nstallation, alteration, or relocation
c. : 1 200 amps or less I $60.00 1pD . 2
AddressIS k.3 Ti o r .e..y r 201 amps to 400 amps $80.00 2
City State (" r Zip r }' .- 401 amps to 600 amps $120.00 2
Phone /9 6 01 amps to 1000 amps $180.00
3 - /9 q i Over 1000 amps or volts $340.00 2
�
Job NO. 3N.5 - . Reconnect only $50.00 2
contractor's license NO. , ?4/ 74"9 4c. Temporary Services or Feeders
Contractor's Board Reg. No. 1/4.57:-2 J Installation, alteration, or relocation 2
Signature of Supr. Elec'n t 200 amps or less 2
License No. e-lie-/p S Crhone No. � loC7l� � c� 401 amps to 600 amps $75.00 2
Over 600 amps to 1000 volts $100.00
. 2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
2
City State Zip
purchase of service or feeder feed{ C7�
Each branch circuit �1 $5.00 1, • ---
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
First branch circuit $35.00
not intended for sale, lease or rent.
Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00
Signal circuit(s) or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40.00
4 or more residential units in one structure Minor Labels (10) $100.00
Service and feeder 225 amps or more
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
In Plant $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees: gy p_
5a. Enter total of above fees $ 5
NOTICE 5% Surcharge (.05 X total fees) $ lig
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Sb. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. word,c°mdeveiec- ❑ Trust Account #
$
prm.app
Balance Due
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech. C4 l
PIbg.Und /Flr /Slab Plbg. Top Out Insulation 0e) li
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg. J �
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: - A.M. P.M. Entry:
Address: (.. — 1 O O S
Tenant: Ste: MST:
BUP:
Con /Own: /_ ..1—'.44 , 4 - . MEC:
PLM:
ELC: 9 d 2-4.4 3
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
EZ% - 6 LS (
E C G 9-`k
, i 4-,e. r _ z--- 1 ," 1 c,- ` Sc'rilf t , f c c
/ /
A
Inspector: 2 2 ( i Date: �-
,APPROVED DISAPPROVED /CALL FOR REINSP. CO
10/7/99 Activities for Case #: ELC96 -00243
2:28:02 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 4/18/96 CJS RECD CJS 4/18/96
ELCC003 Permit created 4/18/96 CJS PEND CJS 4/18/96
ELCC500 (F)lssue permit 4/18/96 CJS PASS CJS 4/18/96
ELCC800 Case Finaled 5/8/96 MJR YES MJR 5/9/96
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