Permit r . CITY OF T D ELECTRICAL PERM
�
DEVELOPMENT 9 SERVICES DATE ISSUED: ELC97-0219
PARCEL: 2S110DB -00200
SITE ADDRESS... :15292 SW ROYALTY PKWY #D
SUBDIVISION °WILLOWBROOK FARM /ARBOR HEIGHTS ZONING:R -25
BLOCK • LOT :8 JURISDICTION: TIG
Project Description : instl 1 service /feeder and 10 branch circuits
- -- 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 • 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 • 1 W /SERVICE OR FEEDER: 10 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
SECURITY CAPITAL PACIFIC TRUST type amount by date recpt
330 112TH AVE NE PRMT $ 110.00 JMH 05/14/97 97- 294231
STE 201 PLCK $ 27.50 JMH 05/14/97 97- 294231
BELLEVUE WA 98004 5PCT $ 5.50 JMH 05/14/97 97- 294231
Phone #: F2O6- 451 -2692
Contractor:
NORTH VALLEY ELECTRIC INC $ 143.00 TOTAL
PO BOX 444
REQUIRED INSPECTIONS
SWEETHOME OR 97386 Ceiling Cover Underground Cove
Phone #: 541 - 982 -5916 Wall Cover Elect'l Service
Reg #..: 000883
This permit is issued subject to the regulations contained in the fl dL
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm itt 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 C
than 180 days. I ed By
OWNER INSTALLATIO 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. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type q
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit - / /
Fax (503) 684 -7297 Called
1. Job Address: I 4. Complete Fee Schedule Below:
Name of Development A r boy I�te -i y1,l 43 Number of Inspections per permit allowed
Name (or name of business) 13 I cat3 I> Service included: Items Cost Sum -
Address j Sac' . / � S w , c Ro 1- Pk W U 4ap sq. ft. o per unit $110.00 4
T
City /State /Zip 1 Qn vcQ t 0 V z .Bw J J Each additional 500 sq. ft. or
Commercial l Q Residential 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 current l 4b. Services or Feeders
Electrical Contractor Mo rvYvl lJ4 1 i•ed. 6 tec t-12 it t =kc . Installation, alteration, or relocation
Address �•O ,`p 0>< y LA" V 200 amps or less I $60.00 (00. 2
201 amps to 400 amps $80.00 2 -
City S1, State DP Zip 9 , a�0 401 amps to 600 amps $120.00 2
Phone No. 1 -Rt' -vs-7,, - S. 3b a 601 amps to 1000 amps - $180.00 2
Job No. 1 a S fl Over 1000 amps or volts - $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. a y -,3 Dac Exp.Date 10 - 1- 9
OR State CCB Reg. No. 8k30-.1._ Exp.Date I - 1'4 -q 5 4c. Temporary Services or Feeders
COT Business Tax or Metro No. cf'7 • /3 Ti Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n . - `��,/� amps to 400 amps $75.00 2
- 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No liDOb - Exp.Date /0- 1 -9 q see "b" above.
Phone No. / - k9& - yam- 5.30 a
4d. Branch Circuits
New, alteration or extension per panel
213. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
SO Q , Oa
Address Each branch circuit 10 $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 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. 5. Fees:
Not required for temporary construction services. 5a. Enter total of above fees $ / / 0 .00
5% Surcharge (.05 X total fees) $ S'50
NOTICE Subtotal $ 1 1 51 SO
5b. Enter 25% of line 5a for 47.S°
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $ Iy
N 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 $
!x/.3.00
1: \DSTS \ELC96.APP Rev 9/96
Page No. 1 CASE HISTORY FOR CASE NO.: ELC97 -0219
• ARBOR HEIGHTS APARTMENTS
15292 SW ROYALTY PKWY Unit: D
07/20/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
ELCA500 (F) Issue permit / / / / 05/20/97 this is a re -do of tidemark dump /tat PASS TAT 05/20/97 TAT
ELCC001 Application received 04/11/97 / / 04/11/97 RECD TAT 04/30/97 J +H
ELCC003 Permit created 04/11/97 / / 04/11/97 04/11/97 TAT
ELCC700 Ceiling Cover 04/11/97 / / / / 04/11/97 TAT
ELCC720 Wall Cover 04/11/97 / / / / 04/11/97 TAT
ELCC725 Underground Cover 04/11/97 / / / / 04/11/97 TAT
ELCC730 Elect'l Service 04/11/97 / / 10/28/97 PASS MJR 11/04/97 MJR
ELCC799 Elect'l Final 04/11/97 / / 10/28/97 PASS MJR 11/04/97 MJR
ELCC800 Case Finaled / / / / 10/28/97 PASS MJR 11/04/97 MJR