Permit ELECTRICAL PERMIT ^.
CI1Y � TIGARD
DATE ISSUED: 08/15/96
, COMMUNITY DEVELOPMENT DEPARTMENT
1y1ounw Hall Blvd. Tigard, Oregon mroou°o1mm (503) 639-4171 PARCEL, 19135AB-00100
, SITE ADDRESS...: 10255 SW 90TH AVE
SUBDIVISION ^ TOWN OF METZGER ZONING:R-4.5
BLOCK ^ LOT ....... ......:5
Project Description: Installing 1 service or feeder and 23 branch 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 ^ 2 W/SERVICE OR FEEDER: 23 PER INSPECTION : 0
201 — 400 amp ^ 1 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.
Owner: — FEES -----
METZERG ELEMENTARY type amount by • date recpt
10255 SW 90TH AVE PRMT $ 315.00 CJS 96-282239
PLCK $ 78.75 CJS 08/07/96 96-282662
TIGARD OR 97223 5PCT $ 15.75 CJS 96-282239
Phone #
Contractor: -- — — ------
FARNHAM ELECTRICAL CO. $ 409.50 TOTAL
1050 LAFAYETTE AVE
REQUIRED INSPECTIONS
MCMINNVILLE OR 97223 Wall Cover Elect'l Final
Phone #: 503-472-2186 Elect'l Service
Reg #..: 01217
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
than 180 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: 01a /^n—, DATE: 6 5 -96"
LICENSE NO: ___
Call for inspection — 639-4175
��.
4 ;q Community Development ELECTRICAL PERMIT APPLICATION
° 13125 SW Hall Blvd.
Tigard, OR 97223 Permit # t LC96-0'19/
(.. .0'e ,x�ray �• Date Issued g- /5
��I� Phone (503) 639 -4171
"'` FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: l // 4. Complete Fee Schedule Below:
rE" /Z
Name of Development a El? �cf4ocL Number of Inspections per permit allowed
Address / 022 55 5V 90 Service included: Items Cost(ea) Sum
City /State /Zip I a R L LA ntC1 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) Each additional 500 sq. ft. or
portion thereof $25.00
Commercial Residential ❑ Limited Energy $25.00 1
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Ric Installation, alteration, or relocation
Electrical Contractor F i A a G < I C 200 amps or less 2 $60.00 /, 2 0 ° - 2
Address )0 5n A I E 1 E VE 201 amps to 400 amps I $80.00 fie G° 2
City 1/ chi .v a y State OR Zip Cf 7 122 • 401 amps to 600 amps $120.00 2
I 2 p / 601 amps to 1000 amps $180.00 2
Phone No. 5O, 41 G - 21 O!) Over 1000 amps or volts $340.00 2
Job NO. CIA- 3 2 Reconnect only $50.00 2
contractor's license NO. .A- :1 C.. 4c. Temporary Services or Feeders
Contractor's Board Reg. No. •. I Installation, alteration, or relocation
Signature of Supr. Elec'n ./ _ fr rArr W 200 amps or less 2
License No. I Sc17 - 5 Phone 1 o. 47 2 -21 34, 201 amps to 400 amps $50.00 2
401 amps to 600 amps $75.00
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
purchase of service or feeder fee. 2
City State Zip Each branch circuit 23 $5.00 1/$
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 additional circuit $35.00
not intended for sale, lease or rent.
Each addftional 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:
5a. Enter total of above fees
$1
NOTICE 5% Surcharge (.05 X total fees) $ /�j
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 3?()ZS
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for 75
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $ 78 -
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. wordcon,dev\eIec- ❑ Trust Account #
prm.app
Balance Due $ 1 109 56
�REvl ou_s 1. 20 4 ?
T t,O L 7uE 20; Is-
5/12/99 Activities for Case #: ELC96 -00491
9:44:57 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received • 7/23/96 CJS RECD CJS 7/29/96
ELCC003 Permit created 7/29/96 CJS PEND CJS 7/29/96
ELCC730 Elect'I Service 7/29/96 8/20/96 CVB PASS MJR 9/3/96
ELCC115 Routed to Plans Examiner 8/7/96 CJS ROUT CJS 8/7/96
ELCC120 Plans Approved /Routed to DSTs 8/14/96 MJR PASS MJR 8/14/96
ELCC500 (F)Issue permit 8/15/96 CJS PASS CJS 8/15/96
ELCC800 Case Finaled 11/27/96 MJR PASS MJR 11/27/96
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