Permit ELECTRICAL PERMIT "~�~
dITY � TIGARD
DATE ISSUED: 11/28/95
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223"8199 (503) 639-4171 PARCEL: 2S104CA-02700
SITE ADDRESS...: 13543 SW LAUREN LN
SUBDIVISION....: HILLSHIRE ZONING:R-7 PD
BLOCK..........: LOT.............:027
Project Description:
---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- -----MISCELLANEOUS
1000 SF OR LESS ^ 1 0 — 200 amp • 0 PUMP/IRRIGATION....: 0
EACH ADD'L 500SF. . . : 8 201 — 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......: 0 W/SERVICE OR FEEDER: 0 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
1000+ amp/volt.....: 0 >=4 RES UNITS........: > 600 VOLT NOMINAL..:
Reconnect only ^ 0 SVC/FDR >= 225 AMPS..: CLASS AREA/SPEC OCC. :
Owner: --- -- FEES ----
MAHSEN TORABI type y date recpt
270 SW FERNWSOON WAY PRMT $ 310.00 dSD 11/28/95 95-273290
5PCT $ 15.50 JSD 11/28/95 95-273290
BEAVERTON OR 97005
Phone #: 626-7287
Contractor: — — — —
H & R ELECTRIC INC $ 325.50 TOTAL
4130 SW 117TH STE 441
— REQUIRED INSPECTIONS —
BEAVERTON OR 97005 Ceiling Cover Elect'l Service
Phone #: Wall Cover Elect'l Final
Reg #..
This permit is issued subject to the regulations contained in the /41.--4; ^.w"
Tigard Municipal Code, State of Ore. Specialty Codes and all other . erm ' tee ' >enature
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. I/�sued B1y
---- ---- --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 SUER. ELEC'N: DATE:
LICENSE NO:
Call for inspection — 639-4175 •
- -' - - -- - '-- - ---- —
l
R
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. /+ Q 6 -3 Tigard, OR 97223 Permit - L
Date Issued / '
--Al , Ip
A,1„, 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:
" -u$f Number of Inspections per Name of Development f C,a y� permit allowed
P P P
Address 1 �'1 ) 5 Pr ti . L 4 v R E !v Service included: ,Z 0044 Cost(ea) Sum
City /State /Zip 1 64/2-i) 0 4 4a. Residential - per unit
1000 sq. ft. or less f ,»Q 4
Name (or name of business) Each additional 500 sq. ft. or �0o /110,00 portion thereof 3 �2 00 / 00 y i
Commercial ❑ Residential [t f Limited Energy $25.00
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
E. 4b. Services or Feeders
Electrical Contractor j i 1 /3 C L& CT /T/ C , I alteration, or relocation
200 amps or less $60.00 2
Address t ll b u I it.' in tl T14 201 amps to 400 amps $80.00 2
City BC- UBF l`� �A1 State� Zip y�?�, 40 1 amps to 600 amps $120.00 2
$180.00 2
601 amps to 1000 amps
Phone No. 4 i;�r • W f 6 / Over 1000 amps or volts $340.00 2
Job NO. Reconnect only $50.00 2
contractor's license NO. - 6 1 4 . - - a i a 'C. 4c. Temporary Services or Feeders
Contractor's Board Reg. No. t 77 kb : Installation, alteration, or relocation
Signature of Supr. Elec'n 41,, i ffr4 �'' 200 amps or less 2
License No. chi
I.��lG� "r r ,,rl!� p
'6 Phone No. /b2 L l (fi i 201 amps to 400 amps $50.00 401 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 $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. 2
First additional circuit brt $$5.00
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: 1o'
5a. Enter total of above fees $ .a,�� '- NOTICE 5% Surcharge (.05 X total fees) 13 a s'
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
5b. Enter 25% of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Plan Review if required (Sec.3) $ I ----1 CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal
Y
A PERIOD OF 180 DAYS AT AN TIME AFTER WORK IS $
COMMENCED. word\comdeNe ❑ Trust Account #
$
prm.aPD
Balance Due �
I
7/22/99 Activities for Case #: ELC95 -00573
2:38:55 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 APPlication received 11/22/95 11/22/95 JSD PASS JD 11/22/95
ELCA003 Permit created 11/22/95 11/22/95 JSD PASS JD 11/22/95
ELCA799 Elect'I Final 11/22/95 2/14/96 MJR FAIL MJR 2/14/96 to -volt requires permit & label
thermo. needs connector
reinspection fee required
ELCA400 (F) Ready to issue 11/22/95 JSD PASS JD 11/22/95 Need CCB and Electrical
license info.
ELCA500 (F) Issue permit 11/28/95 JSD PASS JD 11/28/95
ELCA720 Wall Cover 11/29/95 MJR PASS MJR 11/30/95
ELCA730 Elect Service 11/29/95 MJR FAIL MJR 11/30/95 ground to rebar
ELCA730 Elect'I Service 11/30/95 MJR FAIL MJR 11/30/95
ELCA730 Elect'I Service 12/1/95 MJR PASS MJR 12/1/95
ELCA8o0 Case finaled 2/16/96 GS APP GES 2/16/96
ELCA799 Elect'I Final 2/16/96 GS APP GES 2/16/96
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