Permit CITY OF TI GARD ELECTRICAL PERMIT
PERMIT #: ELC2000 -00138
1�. DEVELOPMENT SERVICES /) DATE ISSUED: 3/28/00
c '' II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6 }r� PARCEL: 2S101 DD -00600
SITE ADDRESS: 06700 SW SANDBURG ST _ /�/ �1
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: C -P
BLOCK: LOT : 003" Y JURISDICTION: TIG
Project Description: Electrical service for construction trailer for 1 -5 interchangJ ject. Job No. 660.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 15 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: • SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WESTERN FAMILY HOLDING INC SUNDOWN ELECTRIC CO
PO BOX 4057 PO BOX 7158
PORTLAND, OR 97208 BEAVERTON, OR 97007
Phone: Phone: 690 -7675
Reg #: LIC 00067442
SUP 3427S
ELE 37 -445C
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT DEB 3/28/00 $144.50 0000992 Elect'l Final
5PCT DEB 3/28/00 $11.56 0000992
Total $156.06
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty Codes and all other 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. �/J�
PERMITTEE'S SIGNATURE ISSUED B . -C�� J 4)%--1
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:
NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: . _ _ ��/�i DATE:
LICENSE NO: ' 1 7P - 7 $
Call 639 -4175 by 7:00pm for an inspection the business day
crry,oF rflGARD Electrical Permit Application Plan Ch
13125 SW HALL BLVD. Recd �'
TIGARD OR 97223 Date Recd �k
Date to P.E. ----
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Permit #'Z. -- L -Q>l5Q
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development e7 Number of inspections per permit allowed
• Name (or name of business) I l e \Al 1T' ri f a Service included: Items Cost Sum
I
Address 6A0C> S \x-) J 4 b(.,.... ' t 4a. Residential - per unit
Ci /State /Zi �� AQ� U lz 7 22.
3 1000 sq. ft. or less $110.00 4
ty / Each additional 500 sq. ft. or
Commercia(4 Residential El Limited thereof $25.00 1
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 licenses) ` n_ e - 4 4b. Services or Feeders /
Electrical Contractor 5' c) c_6
-.' Elc2 -cG Installation, alteration, or relocation / $r 64, a 5
Address P. c_ gale (5 12-9 200 amps or less 2
201 amps to 400 amps $80.00 2
City Frs>?. � 'D (, p a x State O a.- Zip CV"/ I1 ti °A i Z`1 401 amps to 600 amps $120.00 2
Phone No. Scc'> 35'9 - 0.6.4N 601 amps to 1000 amps $180.00 2
Job No. UNO Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. '37 - 4q5 Exp.Date /f')-O/ ° 00 Reconnect only $50.00 2
OR State CCB Reg. No. 67 Exp.Date 7-/-of 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 4514/ Exp.Date /Z. - 3 / -) Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n C . 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No 3427 - S Exp.Date 10 - 0/ see "b" above.
Phone No 5e>3 3 - 0609
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or l � a S
Print Owner's Name feeder fee. J
Address Each branch circuit 15 $5.66 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 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. 5. Fees:
d CCD
S
Not required for temporary construction services. 5a. Enter total of above fees G � $
°
urcharge (.05 X total fees) 0 /o $
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 # /5�(', O /O
Total balance Due $
I:IDSTS\ELC96.APP Rev 9/96
4/24/00 Activities for Case #: ELC2000 -00138
2:43:38 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 3/28/00 DEB DONE No Hold DEB 3/28/00
ELCC003 Permit created 3/28/00 DEB DONE No Hold DEB 3/28/00
ELCC730 Elect'I Service 3/30/00 CD PASS No Hold AKJ 3/30/00
ELCC799 Elect'l Final No Hold DEB 3/28/00
ELCC500 (F)Issue permit 3/28/00 DEB DONE No Hold DEB 3/28/00
ELCC800 Case Finaled 3/30/00 AKJ DONE No Hold AKJ 3/30/00
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