Permit Y _
CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
11,;1l1 PERMIT #: ELC96 -0720
!9 13125 SW Hail Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 11/07/96,
PARCEL: 1S134CD -01600
SITE ADDRESS. .. -:. 11770 •SW KATHERINE ST
SUBDIVr- IS°ION,. s:.o Ie..ER.ON•i..HEIGHTS ZONING: R -4. 5
•BLOCK LOT— — ..... :51
• Proj ect..'. De,scr:.i'ipt i on >, . INSTALL. BRANCH. CIRCUITS
- -- RESIDENTIAL UNIT----- ----TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 'SF OR LESS...` .: 0 0' ' - • 200 amp. - .....: 0 PUMP /IRRIGATION„ ...: 0
EACH ADD' L 50OSF...: 0 ' 201. - 400 am p.. o ....: 0. ; SIGN /OUT LINE LTG..: 0
LIMITED ENERGY - 0 401 - 600 amp - 0 SIGNAL /PANEL - 0
MANF. HM/ SVC /FDR..•': ' 0. ^. 60:1 +aam•ps-1000 : vo It s. •:. 0 . . MINOR LABEL (10) ...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD' L INSPECTIONS-- -
0 - 200 amp....:. : , 0 : . ' °,,•..; /SERV ICE "OR FEEDER:, 0 „ PER INSPECTION.....: 0
201 - 400 amp......: 0 1st W/O SRVC OR FDR.: 1 PER HOUR...........: 0
401 - 600 amp. a e. 0 • t.: •ER,IADD"?'L • BRNCH'- C.I.RC: • 0•• ... IN PLANT ° 0
601 - 1000 amp.....: 0 PLAN REVIEW SECTION
1000 +. amp/ voIt .0 '), • 600- VOLT NOMINAL..
Reconnect only.....: 0 SVC /FDR )= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: - ._ „ - -. .,. _ FEES-, .
KAY SHIRK type amount by date recpt
• 11770 KATHRINE. . '- . - .PRM•p • ' +; 35..00..ITAT..:11/07/96 96- 286265 •
5PCT $ 1.75 TAT 11/07/96 96- 286265
TIGARD OR 97223
Phone #: 646 -2500.
Contractor: -- --
WESTSIDE ELECTRIC $ 36.75 TOTAL
7518 SW MACADAM AVE
• • - - - -•- REQUIRED INSPECTIONS
PORTLAND OR 97219 Ceiling Cover Underground Cove
Phone #: 503 -245 -3385 .; , • :Wall Cover , .... Elect' l Service .
Reg #... 13306
This permit is issued subject to the 'r -egulations•contained-•in the- ' / / A _
Tigard Municipal Code, State of'Or^e. Specialty Codes: all other Perm i t Signature
applicable laws. All work will be done in accordance with
approved plans. This permit' will expire if' work its -not started
within 180' days of issuance, -or-if work- is suspended '. for °rmore.•
than 180 days. • : • . , ... • ; , u I s _i e d By. ;..,
OWNER INSTALLATION ONLY - -- -- - -. - --
The, installation 'is , being• made 'on'' property.,--. I, own which, is. not,- intended for . ,.;,...
sale, lease, or rent. • 0
• OWNER'S SIGNATURE: • , _ DATE: .
CONTRACTOR INSTALLATION ONLY - -- - - - --
SIGNATURE OF SUPR. ELEC'N: DATE:
,LICENSE NO:
Call, for inspect 63974175
„„'' Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. �1G7
Tigard, OR 97223 Permit # � LC- l� ^b ?zO
�ixA l\ aDate Issued /q1/% �l 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:
Name of Development �� Number of Inspections per permit allowed
Address � / 20 S /( / /y p../ /,J2. � �
/ Service included: Items Cost(ea) Sum
City /State /Zip / lr Clr41 Ole 7z. 0 4a. Residential - per unit
/ / // /I 1000 sq. ft. or less $110.00
4
Name (or name of business) s %1 //° (Q /&47O a Each additional 500 sq. ft. or
��-- portion thereof $25.00
Commercial El (-
Residential W' 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
Installation, alteration, or relocation
Electrical Contractor piffi
`! <C,Ir' / ` 200 amps or less $60.00 2
Address - 201 amps to 400 amps $80.00 2
j ``��,{ CCf � Qr', -r. $120.00 2
i1/? zip }
City - �� State fa p 401 amps to 600 amps / 601 amps to 1000 amps $180.00 2
Phone No. 2-9. r - 3 r 4 r Over 1000 amps or volts $340.00 2
Job NO. //4/° f,� /O / l ..S � Reconnect only $50.00 2
e contractor's license NO. - /J- 4c. Temporary Services or Feeders
Contractor's Board Reg. No. 31,E 6 Installation, alteration, or relocation
Signature of Supr. Elec'n 4 - 200 amps or less 2
License No. /..C.377..5 Phone No. G frf - 33,n- 201 amps to 400 amps $50.00
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
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
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. t� 2
Ea
a additional br
not intended for sale, lease or rent. Eat ddch ca brt I $$5.00 J
l 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 $55.00
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 $
NOTICE 5% Surcharge (.05 X total fees) $ _ �
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. 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. wo<meomdev\eiec- Trust Account # �� 7S
$ prm.app
Balance Due
5/19/99 Activities for Case #: ELC96 -00720
2:36:18 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 11/7/96 TAT PASS DST 11/7/96 •
ELCA003 Permit created 11/7/96 TAT PASS • DST 11/7/96
ELCA700 Ceiling Cover 11/7/96 DST 11/7/96 .
ELCA720 Wall Cover 11/7/96 11/12/98 CD FAIL CD 11/12/98 visited site, left notice to
schedule for final inspection.
ELCA725 Underground Cover 11/7/96 DST 11/7/96
ELCA730 Elect'I Service 11/7/96 DST 11/7/96
ELCA799 Elect'I Final 11/7/96 JMT NOTE JT 10/30/98 inspection request (research)
sent to Chuck D
ELCA500 (F) Issue permit 11/7/96 TAT PASS DST 11/7/96
ELCA799 Elect'I Final 1/12/99. CD PASS CD 1/12/99 furnace change over & hook up
ELCA800 Case finaled 1/19/99 JT 1/19/99
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