Permit T
ELECTRICAL PERMIT '
CLTY OF TIGARD PERMIT ° r- P E RM I0630
' DATE ISSUED: 10/04/96
uoMMUNITY DEVELOPMENT DEPARTMENT . ,
13125 SW HBII'BIvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL: 1 136AD- 0581ZIk'1
SITE ADDRESS...,: 11465 SW PACIFIC HWY ,
SUBDIVISION....: , Z ON I NG e C -G ',
BLOC;. LOT......:.... , ..
Project Description: Sign outlining
- - -e - '----- ' - - - -- -
---RESIDENTIAL UNIT -. -=-- . ---TEMP SRVC/FEEDERG -- 17
1000 SF OR LESS....: 0 0 - 200 amp.......: 0 MP /IRRIGATION . 'Zr
EACH ADD' L. 300SF... 0 0 201 -: 400 amp...,...: i7_I SIGN /OUT LINE LTG..: 1
LIMITED ENERGY e 0 401 - amp'.......: 0 SIGNAL /PANEL.......o'0
MANF. . HM/ SVC /FDR..: 0 601.1 -amps- 100 volts.: 0 MINOR LABEL (10) n .. 0 0
----SERVICE/FEEDER---- -• - -- BRANCH- CIRCUITS-- --- - -- ---DD' L INSPECTIONS-- -
0- - 200 amp... , .. e 0 W /?ERV'ICE OR FEEDER: 0 PER INSPECTION.....: 0
201 - 400' ,dip...... a 0 1st W /'O SRVC OR FDR. o 0 ` PER HOUR - 0
401 - 600 amp......: 0 EA ADD'L BRNCH CIRCe 0 IN PLANT,..........: 0
601 - 1000 'amp.....: 0 PLAN REVIEW SECTION- --
1000+ a'mp /volt., . L .. : 0 >=4 RES UNITS......... ' ) 600 VOLT NOMINAL..:
Reconnect only.....: 0 SVC /FDR >= '225 AMPS..: CLASS AREA /SPEC OCC.
Owner: -• .- -- - - - --- - FEES -- - --
ISAAC BARUCH , type amount by date recpt
' 1333 3RD AVE7 PRMT $ 40.07 „ID r 10/04/96 96- 284799
5PCT $ • 2.001 FDA 10/04/96 96- 284799
SEATTLE OR 98101
Phone #o '
Contractor: -- - , - -- _- .--- - - -- -- - ---
BLAZE SIGNS- OF OREGON $ 42.00 TOTAL
PO BOX 23910 ,
. REQUIRED INSPECTIONS
PORTLAND „OR 97281-3910 Elect' 1 Service .
Phone *k: 503.639 -3262 Elect' 1 Final ...
.
Reg i *... 64325 .
1111 .
. . ,
This permit issued subject t to
teofOre. SpecialtyT' contained in
all other Si gnat ure
applicable laws. All work will be done in accordance with •
approved plans.' This. pernit will expire if work is not started I r
. (4,141A/6
`within 18Q1 days of issuance, or if work is suspended for nore _�_
than 180 days. Issued iy '
_ -® - - -- - -- OWNER INSTALLATION ONL
The installation is being made on property I on which is not intended for
_sale, lease, 'or rent.'
'OWNER'S SIGNATURE:' - . . ' . ' . __ DATE o __ .
- - -- CONTRACTOR INSTALLATION ONLY •- - - - ----
SIGNATURE OF SUPR. ELEC'Na ' DATE:
•
LICENSE NOo. .
Call for inspection - 639- -4175
CITY OF TIGARD Electrical Permit Application Plan Check#
13125 SW HALL BLVD. Recd By
TIGARD OR 97223 Date Reed
Phone (503) 639 -4171, x304 Date to P.E.
Print or Type Date to DST
YP
Inspection (503) 639 -4175 Permit # .Ccl (p..Q .30
Fax (503) 684 - 7297 Incomplete or illegible will not be accepte Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or `-f name / / of business) +X A (--C) Service included: Items Cost Sum
Address / / COs PAC -I F/ C / y 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State/Zip 1 1 jO. ?Y(. J 04-- •
Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial Residential ❑ Limited Energy $25.00
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Co tractor 3 N Z_ S / 4105 65A+ - '464 - -1.nic Installation, alteration, or relocation
200 amps or less
- 580.00
Address D Y 67 201 amps to 400 amps - $80.00 2
City W --- State Orr- Zip ci 72 6 / 401 amps to 600 amps - $120.00 2
Phone No. G 3' - 3 2(02. 601 amps to 1000 amps - $180.00 2
Job No. 30 S. / (ex/ / Over 1000 amps or volts - $340.00 2
Elec. Cont. Lice. No 8 0 C LS Exp.Date Reconnect only - $50.00 2
OR State CCB Reg. No. , ( / 32.i - Exp.Date2 /27/0c 4c. Temporary Services or Feeders
I COT Business Tax or Metro No.Woo2oi 3 Exp.Date i - l - 97 Installation, alteration, or relocation
200 amps or less - 550.00 2
201 amps to 400 amps - $75.00 2
Signature of Supr. Elec'n � i+-H -- 401 amps to 600 amps - $100.00 2
Over 600 amps to 1000 volts,
License No. 3/ 3 SL Exp.Date see "b" above.
Phone No. G 39 - '3z �L 4d. Branch Circuits
New. alteration or extension per panel
2b. For owner installations: a) The tee for branch circuits with
purchase of service or
feeder fee.
Print Owner's Name Each branch dreult
- 55.00
Address b) The fee for branch circuits .
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit - 535.00 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 iri ation circle - $40.00
2
Each sign o utiine lightin / $40.00 y �'
Signal panel. (s) or a limited energy
3. Plan Review section (if required):* 2
panel, alteration or extension S4o.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 300 volts nominal Per inspection - $35.00
I Classified area or structure containing special occupancy Per hour - $55.00
as described in N.E.C. Chapter 5 In Plant - $55.00
5. Fees:
* Submit 2 sets of plans with application where any of the above apply. r r
N
ilOsg
ot required for temporary construction services. 5a. Enter total of above fees
5% Surcharge (.05 X total fees) 5 -�;
NOT1CR 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
0 Trust Account #
TIME AFTER WORK IS COMMENCED.
Total balance Due $
1 'DSTS'EL =96 APO Rev 9/96
4/10/00 Activities for Case #: ELC96 -00630
4:13:03 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 APPlication received 10/4/96 JDA RECD JDA 10/4/96
ELCC003 Permit created 10/4/96 JDA PASS JDA 10/4/96
ELCC730 Elect'l Service 10/4/96 JDA 10/4/96
ELCC799 Elect'I Final 10/4/96 JDA 10/4/96
ELCC500 (F)Issue permit 10/4/96 JDA PASS JDA 10/4/96
ELCC590 Expired by limitation 4/6/00 HAP DONE No Hold AKJ 4/6/00
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