Permit CITY OF T'IGARD ELECTRICAL PERMIT
��, yl , l ; � x DEVELOPMENT SERVICES DATE ISSUED: 8
0, 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
PARCEL: 2S101DA -00104
SITE ADDRESS...: 13333 SW 68TH PKWY
SUBDIVISION •GTE ZONING:MUE
BLOCK . • LOT • JURISDICTION: TIG
Project De s cr i pt ion : Add RAMP service and one branch circuit to a PSE power
pole. (Pole 8875
- -- 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..: 0
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 • 1 W /SERVICE OR FEEDER: 1 PER INSPECTION • 0
201 - 400 amp • 0 1st W/O 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
FARMERS INSURANCE type amount by date recpt
4600 WILSHIRE BOULEVARD PRMT $ 65.00 GEO 06/02/98 98- 306217
(WESTLAKE CONSULTANTS - ENGIN) 5PCT $ 3.25 GEO 06/02/98 98- 306217
LOS ANGELES CA 90010
Phone #:
Contractor:
ANDERSONS INTEGRITY ELECTRIC $ 68.25 TOTAL
18435 SW PACIFIC HWY
STE D REQUIRED INSPECTIONS
TUALATIN OR 97062 Elect' 1 Service
Phone #: 524 -4681 Elect'1 Final
Reg #..: 000914
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 an 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notificatio .nter. Those r •; e set forth in OAR 952-001 -0010 through OAR 952- 001 -1':'. You : -y obtain a copy
of these rules or direct quest i.I . !! by a (5031246 -1987. /
i�
r" Perm ittee Signatur - i_., __ ,, - sued By : ,/ / r , ../..., /�
OWNER INSTALLATION ONLY
The installation is �,• m-de on property I own which is not intended for
sale, lease, or r - n
OWNER'S SIGNATURE ` ! DATE:
CONT TOR I " • i AT I ON ONLY
S IGNATURE OF SUP R. ELEC' N •!4 • i� .._ ...1__ DATE: (/ �.. .- Z .- "G: 5-----
LICENSE NO: 3 -7. O - 5
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
SSE To
y _ Community Development ELECTRICAL PERMIT APPLICATION
A 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
• Permit # _ -d,Cd
ELI' �i , Date Issued
Diu M Phone (503) 639 -4171
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by
Inspection (503) 639 -4175
1. Job Address: Qt,) ?cam- Pow- �` errs 4. Complete Fee Schedule Below:
Name of Dew ent ,per Number of Inspections per permit allowed
Address _ , 15 SW (o i•S _r �- Service included: Items Cost(ea) Sum
City/State I/L p � i4 cL 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
-
Name (or name of business) Each ion additional er sq. n. or
portion thereof $25.00 1 -
Commercial,) Residential ❑ Limited Energy $25.00
- Each Manufd Home or Modular 2
Dwelling Service or Feeder $6800
2a. Contractor i tallation only:
' 4b. Services or Feeders
Installation, alteration, or relocation 0 2
Electrical Contractor ' :! ,._., _. ___ . 200 amps or less 1 $60.00 ( o 6 2
Address IS Gt�l. ig0 _-.. ( 201 amps to 400 amps $80.00 2 -
Citya'( - State Oft- Zip 7 7D GZ 401 amps to 600 amps
601 amps to loco amps $120.00 2
$180.00 2 - Phone No. (o9/ / fl Over 1000 amps or volts $340.00 2
Contractor's License No. q/ (RV Reconnect only $50.00
Contractor's Board Reg. No. C.., 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec' 200 amps or less $50.00 2
License No. 'VI/ o 5 Phone No. Szxt - 4.6%1 201 amps to 400 amps $75.00 2 - 401 amps to 600 amps $10o.0o
Over 600 amps to 1000 volts
2b. For owner installations: see If above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The tee 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 or viCe or feeder fee. 2
not intended for sale, lease or rent. Esc additional circuit blt $$5.00
r Each adddional branch circuit $5.00
Owner's 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 $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 inspection $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: / 'r
5a. Enter total of above fees $
NOTICE & 5
5% Surcharge (.05 X total fees) $ 3- Z 6
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b.
Enter line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Reevivi of
if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. ❑ Trust Account # $
Balance Due $ Aj Zs
,ortrox11 d.V.I.crf111.acip
v
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: (Q ?) (9 X A.M. P.M. MST:
Location: -. 3 - ._ BUP:
Tenant: / Suite: Bldg: MEC:
Contractor. 1) �`-e_/ / Phone: ___,5::_g 46 g( PLM:
OwIIer ` Phone: ELC: 7,K a 3 Q
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam ' Cover /Service r Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump • .
Approved Approved Approved k pprovek Approved
Appr /Sdwlk Not Approved Not Approved Not Approved ' . WIC • oved Not Approved
FINAL FINAL FINAL Cri. ir- FINAL
(7 a a ILIddi -44 'CI li 1 0 .... -_ ... .. _ _ ___e O. aas , . / /
AMA i - '.....11-e.IIIV 1 1 giA.,-, cv4teit
1
N.
l'�—e - - A4.dt_.
l/
r.<- JO...a
C—C__
0 Call for reinspec • n 0 Reinspection fee of $ required before next inspection 0 Unable to inspect
Inspector: Date: 6 - - Fp Page of