Permit 4 CITY OF TIGARD
,, �� j Iil DEVELOPMENT SERVICES ELECTRICAL PERMIT
�i DATE ISSUED: 04 /29/97
,(:‘,10. DATE
PARCEL: 2S111AD -08200
SITE ADDRESS...:O89O5 SW REILING ST 1p SUBDIVISION •SCHECKLA PARK ESTATES ZONING:R -4.5
BLOCK • LOT .9 O JURISDICTION: TIG
Project Description: INSTL LIMITED ENERGY PANEL
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS : 0 0 — 200 amp ' • 0 PUMP /IRRIGATION : 0
EACH ADD'L 5O0SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 1 401 — 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
JOHN STEINER type amount by date recpt
8905 SW REILING ST PRMT $ 40.00 TAT 04/29/97 97- 293852
TIGARD OR 97223 5PCT $ 2.00 TAT 04/29/97 97- 293852
Phone #:
Contractor:
PHILLIPS ELECTRONICS $ 42.00 TOTAL
(DBA FOR MASTER ALARM L. L. C. )
1110 NW FLANDERS REQUIRED INSPECTIONS
PORTLAND OR 97209 Ceiling Cover Underground Cove
Phone #: 227 -0571 Wall Cover Elect'1 Service
Reg #..: 000433
This permit is issued subject to the regulations contained in the C— " . ' 2 ' l ,atA
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permitt�€� 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 I - - L II w
than 180 days. I s s• e d By /
OWNER INSTALLATION ONLY i
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 c412,9--97
SIGNATURE OF SUPR. ELEC' N : DATE:
LICENSE NO: .3 zei LsL
Call for inspection — 639 -4175
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # 6 LC 7 62..5
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) / / / , Service included: Items Cost Sum
Address 1/ thJ s / 4-4 - 11-" 7 "7 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State/Zip Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial ❑ Residential m Limited Energy $237OC' Z-d
Each Manuf d Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all cur y 11 ./7' es) 4b. Services or Feeders
Electrical Contractor Installation, alteration, or relocation
Address / 1/0 - 200 amps or less $60.00 2
df 201 amps to 400 amps $80.00 2
City s.- �^d State 61 Zip ' VZ*
7 401 amps to 600 amps $120.00 2
Phone No. 2 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No.
3 LLI ' Exp.Date Reconnect only $50.00 2
A
OR State CCB Reg. No. ' 3 Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
of Su
Si nature Elec'n 201 amps to 400 amps $75.00 2
Signature p r. Elecn `�' 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 30 Exp.Date /0 9? see °b" above.
Phone No. .z. 2-7 -4.47 1
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 tee 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 circuit $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 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 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 $ -4_
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 $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
--&---
Total balance Due $
I:\DSTS \ELC96.APP Rev 9/96
5/19/00 Activities for Case #: ELC97 -00255
2:45:03 PM EXPIRED
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCA001 Application received 4/29/97 4/29/97 TAT 4/29/97
ELCA003 Permit created 4/29/97 4/29/97 TAT 4/29/97
ELCA700 Ceiling Cover 4/29/97 TAT 4/29/97
ELCA720 Wall Cover 4/29/97 TAT 4/29/97
ELCA725 Underground Cover 4/29/97 TAT 4/29/97
ELCA730 Elect'I Service 4/29/97 TAT 4/29/97
ELCA799 Elect'I Final 4/29/97 TAT 4/29/97
ELCA500 (F) Issue permit 4/29/97 TAT PASS TAT 4/29/97
ELCA580 Expired by limitation 5/4/00 HAP DONE No Hold AKJ 5/4/00
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