Permit CITY OF TI G A R D ELECTRICAL PERMIT
4 00 A, DEVELOPMENT SERVICES PERMIT #: ELC98 -0751
�'�I� 1 3125SWHallBlvd .,Tigard,OR97223(503)639 -4171 N�p DATE ISSUED: 01/05/99
®0� 'ARCEL 1S136CD- 01600
SITE ADDRESS... :11674 SW PACIFIC HWY
SUBDIVISION • ZONING:C —G
BLOCK • LOT • JURISDICTION: TIG
Pro.j ect De scr i pt ion : Standard TV & Appliance freestanding sign
- -- 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..: 1
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FAR..: 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/0 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
STANDARD TV type amount by date recpt
11674 SW PACIFIC HWY PRMT $ 40.00 JSD 12/29/98 98- 311801
TIGARD OR 97223 PLCK $ 10.00 JSD 12/29/98 98- 311801
Phone #:
Contractor:
RAMSAY.SIGNS $ 50.00 TOTAL
9160 SE 74TH AVE
REQUIRED INSPECTIONS
PORTLAND OR 97206 Ceiling Cover Elect'1 Service
Phone #: 777 -4555 Wal Cover Elect'1 Final
Reg #..: 000634
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 th. days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rul-: are -t rth in OAR 952-' through OAR 952 'i.1 -1987. You may obtain a copy
of these rules or direct questions to OUNC cal ing 03)24 -1987.
41111111
Permittee Signatur- r Issued B .
r
dir
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 : DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + ++ + + + + + + + + + + + + + + + + + + + + + + + ++
1 !�
-. . „_
CITY OF TIGARD Electrical Permit Application Plan Check # _
13125 SW HALL BLVD. Rec'd By 41111 '
Date Rec'd Ci "
TIGARD OR 97223
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Permit # CL� - 0 . 7 - 1
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business)CS�it/ D 4 2::. - 7E/ Service included: Items Cost Sum
Address / /lam 7/ �• a. c �G' /fib. l4- 4a. Residential - per unit
City/State/Zip - -� 1000 sq. ft. or less $110.00 4
ty p I7� Residential / �� Each additional 500 sq. ft. or
Commercial lal 1=1 Limited thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all cult licenses) lll��J 4b. Services or Feeders
Electrical Contractor /' 7S ��� Q.54 ` / Installation, alteration, or relocation
/ 200 amps or less - $60.00 2
Add D .5; 5/r7/ /v 201 amps to 400 amps $80.00 2
City 71 A /' O State 0 Zip - O - 401 amps to 600 amps $120.00 2
Phone No. (3 73) 7 7 7 - {S`s S 601 amps to 1000 amps $180.00 2
Job No. 44 - d ( 5 , o /- Over 1000 amps or volts - $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. Exp.Date
Ex .Date 40 2
ORS Reg. No � - f 4c. Temporary Services or Feeders
COT Busi ax or Metro No. T7 Exp. at ' J/ At E? Installation, alteration, or relocation
200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec 'n . 0 �, 401 amps to 600 amps $100.00 2
/ Over 600 amps to 1000 volts,
License No. <F50 ,.52
Exp.Date e://7 see "b" above.
Phone No. 77 .S
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 circui
$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 Q 2
Each sign or outline lighting 2{ $40.00 .
`fd 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. S. Fees: ��
Not required for temporary construction services. 5a. Enter total of above fees $ � _
5% Surcharge (.05 X total fees) $ ^
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 $ r9U
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY «.y
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # o c
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
6/9/00 Activities for Case #: ELC98 -00751
3:32:15 PM
e°1 Assigned Hold Updated ®
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received • 12/29/98 JSD PASS JSD 12/30/98 Came in w /SGN98 -0175 an
BUP...
ELCC003 Permit created 12/30/98 JSD PASS JSD 12/30/98 This accompanied the SGN and
BUP to the CPEs... to be issued
with SGN and BUP permits. jsd
ELCC700 Ceiling Cover JSD 12/30/98
ELCC720 Wall Cover JSD 12/30/98
ELCC730 Elect'l Service JSD 12/30/98
ELCC799 Elect'I Final • JSD 12/30/98
ELCC500 (F)Issue permit 1/5/99 JSD PASS JSD 1/5/99
ELCA920 Miscellaneous action 2/16/00 JMT DONE No Hold JMT 2/16/00 research inspection request
ELCC590 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
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