Permit CITY OF TIGARD ELECTRICAL PERMIT
,:.414,, „n , � DEVELOPMENT SERVICES PERMIT #: ELC97 -0792
.4.:
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 12/09/97
PARCEL: 16136DB -02600
SITE ADDRESS...:11201 SW 72ND AVE
SUBDIVISION • ZONING:C —G
BLOCK • LOT • JURISDICTION: TIG
Pro.j ect Description : Installation of one branch circuit for street lights.
- -- 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 • 0 W /SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 — 400 amp • 0 1st W/0 SRVC OR FDR.: 1 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
MCDONALDS CORPORATION type amount by date recpt
5000 SW MEADOWS ROAD, SUITE 230 PRMT $ 35.00 TJH 12/04/97 97- 301441
LAKE OSWEGO OR 07035 5PCT $ 1.75 TJH 12/04/97 97- 301441
Phone #:
Contractor:
LINNCO ELECTRIC CO $ 36.75 TOTAL
PO BOX 925
REQUIRED INSPECTIONS
ALBANY OR 97321 Underground Cove
Phone #: 541 - 926 -4266
Reg #..: 000497
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 than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -801 -0010 through OAR 952 - 001 - 1987. You may obtain a copy
of these rules or direct questions to OINC by calling (583)246 -1987.
Permittee Signature: M '/1zim Aye/ haifIssued By: lid' 407 -
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: Oh Gt pttca t '--� DATE: /245/0 r 7
LICENSE NO: -3Z 57- S ' r
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
- 6Z vi il - d /
r
Community Development ELECTRICAL PERMIT APPLICATION .
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # NIA
Permit # ELM r 7 - O YL
, y'lII" Phone (503) 639 -4171 Date Issued ix/419i
-` " ' --� FAX (503) 684 -7297 Issued by -F-
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
McDonalds N umber of Inspections per permit allowed
Name of Development �p
Address 99@ and 72nd 11 ZO I 51A) 721,2) P "-"-"_ - Service included: Items Cost(ea) Sum
City/State/Zip Ti gard , OR 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
-
Each additional 500 sq. ft. or
Name (or name of business) portion thereof $25.00 1
-
Limited Energy $25.00
Commercial ® Residential ❑ Each Manuf•d Home or Modular 2
Dwelfmg Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor EC /Linnco Electric 200 amps or less $60.00 2
-
Address PO Box 925 201 amps to 400 amps $80.00 2
• 401 amp; to 600 amps $120.00 2
City Albany State OR Zip 9737.1 601 amps to 1000 amps $180.00 2 -
Phone No. 541- 926 -4266 Over 1000 amps or volts $840.00 2
Contractor's License No. 2,7-15C Reconnect only $50.00 - Contractor's Board Reg. No. 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Su r. Elec'n
2 201 amp; to 400 amps
00 amps or less $50.00 2 - License No. 2575 Phone No. 541 - 926 -4266 401 amps to soo amps $75.00
$100.00 2
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 bein made on roe I own which is pur`ha of service or feeder fee 2
Fa
9 P P rtY First branch circuit fee $35.00 35.00 2
not intended for sale, lease or rent. Each additional branch circuit $5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
Each pump or irrigation circle $ 2
3. Plan Review section (if required): 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) S100.00
- Service and feeder 225 amps or more 4f. Each additional inspection over
System over 600 volts nominal the allowable in any of the above
Classified area or structure containing special occupancy Per inspection $35.00
as described in N.E.C. Chapter 5 Per hour $55.00
-
I Pmt $55.00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $ 35.00
NOTICE 5% Surcharge (.05 X total fees) $ --4-4;
_7.5
Subtotal $ �
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 25% of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Plan Review if required (Sec.3) $
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $ •
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. ❑ Trust Account # $ -0-
Balance Due $ 36.75