Permit CITY PERMIT OF T ELECTRICAL PERMIT #: ELC96 -0419
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 06/26/96
13125 l W Hell Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 1S134BD -00401
SITE ADDRESS...: 12272 SW SCHOLLS FERRY RD
SUBDIVISION • ZONING:
BLOCK LOT •
Project Description: Installing a 25 sq. ft. permanent wall sign — outline light
ing
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 500SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 1
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
GREENWAY PUB type amount by date recpt
12272 SW SCHOLLS FERRY RD PRMT $ 40.00 B 06/25/96 96 -280991
SPCT $ 2.00 B 06/25/96 96- 280991
TIGARD OR 97223
Phone #:
Contractor: — ` —
I-5 SIGNS, I NC ` $ 42. 00 TOTAL
3005 MARVIN RD NE
REQUIRED INSPECTIONS
OLYMPIA WA 98516 Ceiling Cover Elect' 1 Service
Phone #: 360- 459 -3200 \ Wall Cover Elect' 1 Final
Reg #..: 064900
This permit 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 permit will expire if work is not started `--.)
within 180 days of issuance, or if work is suspended for more �>
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 , QQVLY
SIGNATURE OF SUPR. ELEC' N: 0171.- I Oh _ �AA x DATE : V 2-6"46'
LICENSE NO:
Call for inspection — 639 -4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
- hil i'i'' Permit # Fa. �Iv -- 0q -- 0q Iq
4 11 Phone (503) 639 -4171 Date Issued � Z - (-�f (o
n ��
41, � FAX (503) 684 -7297 1 .1V10-1/ �
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by
Inspection (503) 639 -4175
1. Job Address: /� /� 4. Complete Fee Schedule Below:
Name of Development Grec1 ,Q P1 Number of Inspections per permit allowed
Address /2 7,„? ` . W �Y' fit-) #s j-e /50 /� / , Service included: Items Cost(ea) Sum
/�� 4
City/State/Zip ��GZt �, "ol 4a. Residential -per unit
//�� �' �' 1000 sq. ft. or less $110.00
Name (or name of business)ereent 1
Each po rtion thereof sq. heerere of f $25.00
1
-
portion
Commercial 154 Residential ❑ Limited Energy $25.00
Each Manurd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor „-1 - s
5 " 020�S 200 amps or less $60.00 2
Address h')aJ - 1 /N') 7PGZ it/E- 201 amps to 400 amps $80.00 2
Cf m/O / Q Sta ), -- Zipq R' 5 ,
401 amps to 1000 amps $180.00 2
600 amps 5120.00
ty � p 1 � 601 amps to 1
Phone ?6() - 659 -SOD Over 1000 amps or volts $340.00 2
- Contractor's License No. � T.ea C�6 Reconnect only $50.00
Contractor's Board Reg. No. �o'�f 9 00 4c. Temporary Services or Feeders
3'7 -5 /�j CL 5 Installation, alteration, or relocation 2
Signature of'/'7` Sup Elec'n idrA 1, y ,/ 200 amps or less $50.00 2
7
License No. 51 Phone No %O -7'59 - 201 amps to 400 amps $75.00 2
401 amps to 600 amps $100.00
3 .200 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 purchase of service or feeder fee. 2
Each branch circuit $5.00
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. 2
First branch circuit $35.00 2
not intended for sale, lease or rent.
Each additional branch circuit $5.00
-
Owner' 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 tc $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 $
5% Surcharge (.05 X total fees) $ _
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
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. ❑ Trust Account # $
Balance Due $ 4/2, OO
wo,dbpn . ela°prm.app
Page No. 1 CASE HISTORY FOR CASE NO.: ELC96 -0419
GREENWAY PUB
12272 SW SCHOLLS FERRY RD
08/10/98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
- - -- - -- -- - - - - -- - --
ELCC001 Application received 06/26/96 / / 06/20/96 RECD MAI 06/26/96 BON
ELCC003 Permit created 06/26/96 / / 06/26/96 PEND B 06/26/96 BON
ELCC500 (F)Issue permit / / / / 06/26/96 PASS B 06/26/96 BON
ELCC560 Permit Voided / / / / 05/12/98 VOID CD 05/12/98 J *H
ELCC799 Elect'1 Final 06/26/96 / / 05/12/98 New owners, sign is old. No knowledge VOID CD 05/12/98 J *H
of replacement. Permit has expired.
•
Page No. 1 CASE HISTORY FOR CASE NO.: ELC96 -0419
GREENWAY PUB _
12272 SW SCHOLLS FERRY RD
05/26/98
Action Description Req/ Schd/ find/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
ELCC001 Application received 06/26/96 / / 06/20/96 RECD MAI 06/26/96 BON
ELCC003 Permit created 06/26/96 / / 06/26/96 . PEND B 06/26/96 BON
ELCC500 (F)Issue permit / / / / 06/26/96 PASS B 06/26/96 BON
ELCC560 Permit Voided / / / / 05/12/98 VOID CD 05/12/98 J *H
ELCC799 Elect'l Final 06/26/96 / / 05/12/98 New owners, sign is old. No knowledge VOID CD 05/12/98 J *H
of replacement. Permit has expired.
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