Permit CITY O F TIGARD ELECTRICAL PERMIT
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DEVELOPMENT SERVICES DAT PERMIT O : EO/1500 00545
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 - 4171
PARCEL: 2S 101 AD -02400
SITE ADDRESS: 12753 SW 68TH AVE 100
ZONING: MUE
SUBDIVISION:
BLOCK: LOT : 032 JURISDICTION: TIG
Project Description: Extend 1 branch circuit.
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 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:
GEORGE FOX UNIVERSITY OWNER
414 N. MERIDIAN
NEWGERG, OR 97132
Phone: 503 - 554 -2080 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/15/02 $60.15
[TAX] 8% State Tax 10/15/02 $4.81 Rough -
Elect'I Final
Total $64.96
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1- 800 - 332 -2344.
By: : 6_,. Permit Si Issued Y nature: Permit 9
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: oLla X.t C -W DATE:
LICENSE NO: 3 S
Call 639 -4175 by 7:OOpm for an inspection the next business day
1U /11 /LUUL U21:4J rAd. OUJOatlJ OU t..ii ur '11t,Al(ll tgJuUL
-A • Electrical Permit Application
_Daze received: it) . 1c-0Z Permit no. sD O ---'
. ,l' A ii City of Tigard Project/appi. no.: Expire date:
City ofTigard Addt'egs: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639-4171 Dale issued: By V5 I Receipt no.:
Fax: (503) 598 -1960 , Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
O 1 & 2 family dwelling or accessory O Commercial/industrial O lti- family O Tenant improvement
O New construction O Addition/alteration/replacement Other �' fri[ tt ( ❑ Partial
JOB SITE INFORMATION
Job address: a7 Acv �� Bldg. no.: Suite no.: Tax map/tax lot/aceount no.:
Lot Block: Subdivision:
Project name: Description and location of work on premises: It «._!dl J
Estimated date of completion/Inspection: 0 Ird, •
f'ONTRACTOR APPLICATION FEE, SCIIEDL'LE
Job no: Fee 2Nat
Business name: M' , 0 a a i i 4 Descdption Qty. , (ea.) Total no. iosp •
Address: /-} ,A1. ale t t d I U CI T t Newres dentbd- eor awpi -fomJr per
dust, hnelndea attached garage.
City: i, a i,3 , , StateOQ ZIP: • /3 - Serrierindaded:
Phonc5(/ D.,0 7/ Fax 02 009 E -mail: 1000sq. ft. or less 4
CCs no.: n// A. Elcc. bus. lic. no: 3 ( 7 5 C- Each additional 500 sq. ft. or portion thereof
City / o ha n0 Limited energy. residential 2
�� Limited energy, non - residential 2
' / ..., /i/1/" �' /� �� Each manufactu home or modular dwelling
• Signature o supervising electrician (r ,•'''ed), bate / ) - n Service and/or feeder 2
Sup. elect name (print):Pcau I Co r be f f - P u License nn: i 3 Services or feeders -installation,
alteration or relocation:
• PROPERTY OWNER 2o0 amps orless 2
Name (print): 6'-e e - - . U ()ivy Si - q 201 amps to 400 amps 2
Mailing address: N 14 /v �'1 P f` 1 G I l k it 401 amps to trop amps 2
p
' t , J Oa- 7 601 amps to 1000 amps 2
City: c I State: ( ZIP: / 7 / 3 Over 1000 amps or volts 2
Phone: - . , 0 Fax:,Q`t/ app E- mail5Corb -H y Reconnect only
I
Owner installation: The installation is being made on pr"" :R ` , Tamporatysxtvicesorfeeders -
which is not intended for sale, lease, rent, or exchange according to cat q installation ,alteration,orrelecatbrc
ORS 447, 455, 479, 670, 701. • 200 amps or less 2
•
201 amps to 400 amps 2
du Owner's signal _ 4 , ' ,A Date: w - 0 • 401 to 600 amps 2
ENGINEER Branch circuits - new, attention,
Nome: or extension per panel:
A. Fee for branch circuits with purchase of •
•
Address: service or feeder fee, each branch circuit 2
City: f State: - 1 ZIP: B. Pee for branch circuits without purchase
Phone: Fax: E -mail: of service or feeder fee, frost branch circuit: 2
Each additional branch circuit:
I'LAN REVIEW (Please check all that apply) Misc. (Service or feeder not mdudee):
O Service over 225 oenpa- cotnmaeial ' 0 Moldy-1.uofieility Each pump uiigativncirzle
2
O Service over 320 amps - rating of 1 &2 O Hazardous location Each ego or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuits) or a limited energy panel,
O System over600 yobs nominal more rsida1iaI units in one smicturc altcation,orextension* 2
0 Building over three stories 0 Feeders. 400 amps or more ;Description:
O Occupant load over 99 persons 0 Manufactured structures or RV pork Each additional Inspection over the allowable in any of the above;
0 Egrets/lightingplan 0 Other . Per inspection 1 1 1 l
Submit _ sets of plans with any (tithe above. Investigation fee
The above are not applicable to temporary construction service. Other
Net an ihuisdtcdoas tempt credit cords, please call jtaisdction for more intmnc ton, Notice: This permit application Permit fee $
O visa O MasterCard expires if a permit is not obtained Plan review (at , %) $
Credit card tomb= / / within 180 days after it has been State surcharge (8%) .... $
Expires wrrrpted as complete. TOTAL $
Nome or cstdta
noer a m
s own on outfit cod •
$
ce dadaer signature Amount
440-4615 (6•tes=0144)