Permit CITY OFTIGARD
,� .,,, DEVELOPMENT SERVICES ELECTRICAL PERMIT
�M11'I PERMIT # : ELC96-0710
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11 / 05 / 96
PARCEL: 2S110DC -00200
SITE ADDRESS...: 15660 SW PACIFIC HWY #3
SUBDIVISION • WILLOW BROOK FARM ZONING:C —G
BLOCK • LOT •11
Project Description: INSTALLING PUMP /IRRIGATION CIRCLE
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 1
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 • 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
RELAX THE BACK type amount by date recpt
15660 SW PACIFIC HWY PRMT $ 40.00 TAT 11/05/96 96- 286136
5PCT $ 2.00 TAT 11/05/96 96- 286136
TIGARD OR 97223
Phone #:
Contractor:
ES & A INC $ 42.00 TOTAL
1210 OAK PATCH RD
REQUIRED INSPECTIONS
EUGENE OR 97042 Ceiling Cover Underground Cove
Phone #: 541- 485 -5546 Wall Cover Elect'1 Service
Reg #..: 11128E
This permit is issued subject to the regulations contained in the '4774.(.6.4L
Tigard Municipal Code, State of Ore. Specialty Codes and all other Per • ee 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/4.
than 180 days. ssued 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 : DATE:
LICENSE NO:
Call for inspection — 639 -4175
iik,
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Y Tigard, OR 97223 Permit # q - 6 lb
. „:. ,�.`'il Phone (503) 639 -4171 Date Issued /i/-79' f,
I>�,..II_'
- FAX (503) 684 -7297 •
CITY OF TIGARD TDD No. (503) 6842772
• Inspection (503) 639 -4175 -
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Address 1 to'oO 4 -3 ,50 Pacer I -},,j Service included: Items Cost(ea) Sum
City /State/Zip A,ro . Oft r) a,�'� 4a. Residential - per unit
���JJJ �p 1000 sq. ft. or $110.00 4
-
Name (or nam of business) lie lAsc IC 1-214'7,t(--- Each additional 500 sq. rt. or
portion thereof $25.00
Commercial Residential ❑ United Energy $25.00 1
Each Menurd Home or Modular
2a. Contractor installation only: Dwelling saw Frieder 2
4b. Services or Feeders
Electrical Contractor F 4-1A Inattention, alteration. atrelocation
200 amps or less 360.00 2
Addres 4-1a .c .c t., Lrrk 0 I D4 201 amps to 400 amps $eo.00 2
-
City r 'DX State C§(\ _ Zip 9 - 1 11,3 401 arc 10 800 amps 3120.00 2
Phone No. S $-� 9 I t. 601 a to 1000 $140.00 2
over 1000 amps or volts 3340.00 2
Job NO. Reeonnectanly $50.00 2
contractor's license NO. 11 4'L7.(o 4c. Temporary Services or Feeders
Contractor's Board Reg. No. S Installation. alteration. or relocation
Signature of Sur. Eiaen 200 amps or less 2
- License No. S I Cs P 201 amps to 400 � 00 2
401 amps to 600 amps $75.00
-
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see If above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) the fee for `ranch circuits with
City State Zip purefraso of sondes or feeder fee 2
Phone No. b) �� circuits without $5.00
The installation is being made on property I own which is posehas.of service or feeder fn. 2
F branch 335.00 2
First circuit -
not intended for sale, lease or rent. Each additional branch ciratit 35.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Eaa, gi circle ___1_
or gin circle $40.00 ` O - 2
Each sign or outline lighting $40.00
Signal circuit(3) 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) 3100.00
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 descr 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:
NOTICE 5a. Enter total of above fees
5% Surcharge (.05 X total fees) $ L -
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subfot $
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. .Qavmde.,.w ❑ Trust Account #
vrm•oo $
Balance Due $ Li 'y
Page No. 1 CASE HISTORY FOR CASE NO.: ELC96 -0710
RELAX THE BACK
l
15660 SW PACIFIC HWY Unit: 3
09/02/98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
-- -- --- -- - - - - -- - --
ELCC001 Application received / / / / 11/05/96 PASS TAT 11/05/96 TAT
ELCC003 Permit created / / / / 11/05/96 PASS TAT 11/05/96 TAT
ELCC500 (F)Issue permit / / / / 11/05/96 PASS TAT 11/05/96 TAT
ELCC560 Permit Voided / / / / 09/02/98 09/02/98 JT
ELCC700 Ceiling Cover 11/05/96 / / / / 11/05/96 TAT
ELCC720 Wall Cover 11/05/96 / / / / 11/05/96 TAT
ELCC725 Underground Cover 11/05/96 / / / / 11/05/96 TAT
ELCC730 Elect'1 Service 11/05/96 / / / / 11/05/96 TAT
ELCC799 Elect'1 Final 11/05/96 / / / / 11/05/96 TAT
ELCC920 Miscellaneous action / / / / 07/31/98 pump or irrigation permit not applicable VOID CD 07/31/98 CD
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