Permit (153) 40,0 CITY OF TIGARD
^ ^ i � 1 �,� ; , � l h � � DEVELOPMENT SERVICES RESTRICTED ENERGY
PERMIT #: ELR97 -0338
DATE ISSUED: 11/20/97
PARCEL: 25115BA -00101
SITE ADDRESS...:162O0 SW PACIFIC HWY #X
SUBDIVISION • ZONING:C —G
BLOCK • LOT • JURISDICTN: TIG
Project Description: Installation of one signal circuit or limited energy panel.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO...: AUDIO & STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM BOILER • LANDSCAPE /IRRIGAT..:
GARAGE OPENER CLOCK • MEDICAL •
HVAC DATA /TELE COMM..: NURSE CALLS •
VACUUM SYSTEM FIRE ALARM • OUTDOOR LANDSC LITE:
OTHER: .. HVAC • PROTECTIVE SIGNAL..:X
INSTRUMENTATION.: OTHER..: ..
TOTAL # OF SYSTEMS: 1
Owner: FEES
MARSHALLS type amount by date recpt
16200 SW PACIFIC HWY #X PRMT $ 40.00 TJH 11/20/97 97- 301102
TIGARD OR 97223 SPCT $ 2.00 TJH 11/20/97 97- 301102
Phone #:
Contractor:
STONER ELECTRIC $ 42.00 TOTAL
2701 SE 14TH
REQUIRED INSPECTIONS
PORTLAND OR 97202 Ceiling Cover Low Voltage Insp
Phone #: 233 -3631 Wall Cover Elect'l Final
Reg #..: 000448
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty 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 rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -010 through OAR 952- 801 -0080. You may obtain copies of
these rules or direct questions to I at (503)246 -1987. /
Issued by , h � �,,�_ Permittee Signature sQ a�
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: 472 Q L'Q O DATE: /I/zD /79
LICENSE NO: /72.95
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + ++
rd
CITY OF TIGARD Electrical Permit Application Rec'd Check #T i �sov�
13125 SW HALL BLVD. Le? FST�
TIGARD OR 97223 Q C� Date Rec'd II X2.0)97
Date to P.E. I' )lA
Phone (503) 639 -4171, x304 Print or Type Date to DST 11 )2ole7
Inspection (503) 639 -4175 Permit# E LC 9 t 1 - 0 "10 jEtikY1 -0
Incomplete or illegible will not be accepted
Fax (503) 684 -7297 Called tulDu,QDr�
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) ,' /'s / /.L ( 5 Service included: Items Cost Sum
I
Address /� ZOO �� / C / /C yW V � 4a. Residential - per unit
Ci /State2i /�/ � �/Z Each sq. h. or less $110.00 4
ty p Each additional 500 sq. ft. or
El Limited thereof $25.00 1
Commercial El 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 licenses) 4b. Services or Feeders
Electrical Contractor ✓ TOME'/? j /4.Ec -7 Installation, alteration, or relocation
Address Z 7c= 570" /fi g 200 amps or less $60.00 2 -
201 amps to 400 amps $80.00 2 -
City P c , ' r . N/9 State OA Zip 9 7 Z. o Z 401 amps to 600 amps $120.00 2
Phone No. 'ZS 3 - 3 C 3 J 601 amps to 1000 amps $180.00 2
Job No. ‘.5 4/4' , Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. ZG - / 7 C Exp.Date /0 /- 98
OR State CCB Reg. No. 4'9 S I 3 Exp:Date ; - 2 -0 -q r 4c. Temporary Services or Feeders
COT Business Tax or Metro No. '/-i// G Exp.Date �- / -5 r Installation, alteration, or relocation
200 amps or less $50.00 2
$75.00 -
��- /t
Signature of Supr. Elec'�rl/V % 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. / 7 2 q1 - 5 Exp.Date /C2-/- 9g see "b" above.
Phone No. Z 3 -.7 -TG 7 /
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee. / $35.00 � � 4 2
First branch circuit
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 y�
�. 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 $ ' 7 .5 -
5% Surcharge (.05 X total fees) $
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 El Account # 7 '
TIME AFTER WORK IS COMMENCED. $ 7
Total balance Due
1: \DSTS \ELC96.APP Rev 9/96 •
6/30/99 Activities for Case #: ELR97 -00338
4:43:30 PM
•
• Assigned - Hold Updated •
Activity Description Date 1 Date 2 Date 3 To • Done By Disp. Level . By Updated Notes •
ELRC001 Application Received 11/20/97 TJH RECD TJH 11/20/97
ELRC003 Permit Created 11/20/97 TJH PASS TJH 11/20/97
•
ELRC700 Ceiling Cover - 11/21/97 MJR PASS MJR 12/3/97
ELRC725 Low Voltage Inspection 11/21/97 MJR PASS MJR 12/3/97
ELRC799 Elect'1 Final 12/3/97 MJR PASS MJR 12/3/97
ELRC500 (F) Issue permit 11/20/97 TJH PASS TJH 11/20/97
ELRC800 Case finaled 12/3/97 MJR PASS J *H 12/4/97
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