Permit OF CITY TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
PERMIT #: ELC96 -0686
I. . 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
DATE I5SUED: 10/25/96
PARCEL: 2S102BD -00100
SITE ADDRESS...: 12645 SW PACIFIC HWY
SUBDIVISION • NO.TIGARDVILLE ADDITION AMEND. ZONING:R -12
BLOCK • LOT •52
Project Description: LIMITED ENERGY PANEL FOR MODULAR BUILDING
- -- 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 • 1
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
ST ANTHONY'S SCHOOL type amount by date recpt
12645 SW PACIFIC HWY PRMT $ 40.00 JMH 10/25/96 96- 285733
SPCT $ 2.00 JMH 10/25/96 96- 285733
TIGARD OR 97223
Phone #: 639 -4979
Contractor: -•
CONTRACTOR NOT ON FILE $ 42.00 TOTAL
REQUIRED INSPECTIONS
Ceiling Cover Underground Cove
Phone #: Wall Cover Elect' 1 Service
Reg #..
This permit is issued subject to the regulations contained in the 2Avi •-∎ A- • g y
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm i t t e e 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 L� ( /Y (.d
than 180 days. ssued By
OWNER INSTALLATI 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 for inspection - 639 -4175
CITY OF`TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Reed By
TIGARD OR 97223 Date Recd
Date to P.E.
Phone (503) 639 -4171, x304 Print or Type Date to DST
Inspection (503) 639 -4175 Permit # igrS �`C 9ti - D61h
Fax (503) 684 -7297 Incomplete or illegible will not be acce Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) �r AUt°1?(ON`'t 5 S Service included: Items Cost Sum
I
Address 1 2 - G45 Sw ∎or C S C . grar$ .630' 4a. Residential - per unit
City/State/Zip a v O✓
c - 1000 sq. ft. or less $110.00 4
ry p TrrsA Each additional 500 sq. ft. or
Commercial Residential El , portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Homo or Modular
Dwelling Service or Fonder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor Ac,•�p jh �,w�,p r Installation, alteration, or relocation
Address 13 35 ac t'1'tlt tAt,�: 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City t DyLX s State Qv■ Zip on 1_. I. 4 401 amps to 600 amps $120.00 2
Phone No. 23 ■ - t °1 '2_ 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 2 6 -- TISCLdc Exp.Date to - 1 O%) Reconnect only $50.00 2 •
OR State CCB Reg. No. oisfIl 3 6 Exp.Date 1 15' - 611 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 210 °‘ Exp.Date °l -4 1 - 1 Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n - `��-_. 201 amps to 400 amps $75.00 2 -
401 amps to 600 amps $100.00 2
�, • Over 600 amps to 1000 volts,
License No. 5 _i I _ .,1_ LLB ____Exp.Date j5- C 1 c_r_ _ see "b" above.
Phone Nu. 66=5 - 231 - t`n °h• -
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 circui $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
Owner's Signature (Service i
achpump f o ri ri gation c c i r c le ) $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension ✓ $40.00 0. 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. 5. Fees:
Not required for temporary construction services. 5a. Enter total of above fees $ 40 • ov,
5% Surcharge (.05 X total fees) $
NOTICE • Subtotal $ 42• o O
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 $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # • 47,.- oo
Total balance Due $
I:\DSTSIELC98.Arp Rev 9199
05/15/2000 Activities for Case #: ELC96 -00686
2:54:38 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC003 Permit created 10/25/1996 10/25/1996 J *H 10/25/1996
ELCC500 (F)Issue permit 10/25/1996 JMH " PASS J *H 10/25/1996
ELCC800 Case Finaled 10/28/1996 MJR PASS MJR 11/01/1996 MAY NEED OUTSIDE
STROBE & HORN
Page 1 of 1
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.
Plbg.Und /Flr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer ' I nn __Gas Line /' �Qe Appr /Sdwlk Reins.
Other: LAW V O -U / �' — C___ r' N - 1*t ? )
Date: / 0 " 2- 7,(... A.M. P.M. Entry: �(�
Address: / 24 4 j SW q `� z'4'y
Tenant: Se-&-e-&-e Ste:. MST:
Z3 I — 1 15 z Bud:
Con /Own: 7� -2t�� MEC:
PLM:
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THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
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Inspector: ( GYn ey . ( R Le C14 Date). — �0 ^Z
APPROVED DISAPPROVED /CALL FOR REINSP. 460 CO