Permit CITY OF TIGARD ELECIRICAL PPERMIT
T ='
E C 424
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 06/28/96
13125 SW Hell Blvd. Tigard, Oregon 97223.8199 503) 639 -4171
1S2-10'8 t 40 PARCEL: 2S 1 10DB -00200
SITE ADDRESS.... _ _.-_
SUBDIVISION • WILLOW BROOK FARM ZONING:R -25
BLOCK LOT -8
Project Description: Installing a temp service or feeder for a multi— family
apartment complex.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 1 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 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
NORTH VALLY ELECTRIC type amount by date recpt
PO BOX 222 PRMT $ 50.00 CJS 06/28/96 96- 281174
SPCT $ 2.50 CJS 06/28/96 96- 581174
WOODBURN OR 97071
Phone #: 1503 -982 -5916
Contractor: -- - --
NORTH VALLEY ELECTRIC INC $ 52.50 TOTAL
PO BOX `22
REQUIRED INSPECTIONS
WOODBURN OR 97071 Elect'1 Service
Phone #: 503 - 982 -5916 Elect' 1 Final
Reg #..: 88302
This persit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signature
applicable laws. All work will be done in accordance with
approved plans. This persit will expire if work is not started ff
within 180 days of issuance, or if work is suspended for lore d n Ctf ieS Sc h M , a t
than 180 days. Issued 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 : n'lcc, /PG/ DATE: K-i-a-e- 9•
LICENSE NO:
Call for inspection — 639 -4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 9r- a 9 ll 7 ii
O , Permit # 9G -dyay
,) i I Phone (503) 639 -4171 Date Issued 6- a S -9G
^.r F FAX (503) 684 -7297 - ChM.. / /74--
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by Ch o VIPs
Inspection (503) 639 -4175
1. Job A ss: as I ? _ 4 . Complete Fee Schedule Below:
Na of Development1aX I of 9 v ° ► e-box -tojeg+t Number of Inspections per permit allowed
A ress ? a.sl /o Pc -oo 9m v rvice included: Items Cost(ea) Sum
Ci State/Zip " q ck rcQ 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
-
Each additional 500 sq. ft. or
Name (o of business) portion thereof $25.00 1
Commercial ❑ Residential ar Limited Energy $25.00
Each Manurd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
N `' � E ( � ,-- Inst0ao p or les on, or relocation 2
Electrical Contractor o A C a l le.A� e • � 200 0 amps or less $60.00 2
Address ? . 0 • 6 x a-9-.2- ` I 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2 -
City 100 r ,,Q . b u {21t State OR- Zip q 101 i 601 amps to 1000 amps $180.00 2 -
Phone No. ($o3) q 9.1 - s9 / i, Over 1000 amps or volts $340.00 2
Contractor's Licen a No. €2 (4 -3 oa G Reconnect only $50.00 -
Contractor's Board Reg. No. F183 O -. 4c. Temporary Services or Feeders
Installation, alteration, or relocation c 2
2
►� /� �� 200 amps or less ' $50.00 7 0 2
Signature of Su r. Elec'R� %�J/ 201 amps to 400 amps $�s.00
License No. O 00 - s hone No. 98a-5 401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner installations: see - b• above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip Each branch circuit or feeder lee $5.00 2
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $35.00
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 ins $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 $ S
5% Surcharge (.05 X total fees) $ 5 =
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ Sam
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 $ 5 -
COMMENCED. ❑ Trust Account # $
Balance Due $ _a-
a raEbondoNa4°prnapp
Page No. 1 CASE HISTORY FOR CASE NO.: ELC96 -0424
NORTH VALLY ELECTRIC
15268 SW ROYALTY PKWY Unit: A
07/20/98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
ELCB001 Application Received / / / / 06/28/96 RECD CJS 06/28/96 CJS
ELCB003 Permit created / / / / 06/28/96 PEND CJS 06/28/96 cos
ELCB500 (F) issue permit / / / / 06/28/96 PASS CJS 06/28/96 CJS
ELCB510 (F) Reprint permit / / / / 06/28/96 06/28/96 CJS
ELCB510 (F) Reprint permit / / / / 06/28/96 06/28/96 CJS
ELCB730 Elect.). Service 06/28/96 / / 07/01/96 PASS MJR 07/01/96 MJR
ELCC800 Case Finaled / / / / 07/01/96 PASS MJR 07/01/96 MJR
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