Permit '
ELECTRICAL PERMIT
PERMIT #: ELC96-0306
(201= TIGARD DATE ISSUED: 05/14/96
COMMUNITY DEVELOPMENT DEPARTMENT
1o1omSw Hall Blvd. Tigard, 81e9 (503) 839-4171 ��^ �� �u �� PARCEL: 2S112DC
SITE ADDRESS...: +@6t�-SW 72ND AVE " ~ ^= --- '^~
SUBDIVISION • SP TIGARD INDUSTRIAL PARK ZONING:I-L
BLOCK : LOT ^2
Project Description: One signal circuit or limited energy panel.
---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 •
MANF. HM/ SVC/FDR..: 0 601+amps-16900 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/O SRVC OR FDR.: 0 PER HOUR : 0
401 - 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 - 10690 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
NIKE - TETRA type amount by date recpt
ONE BOWERMAN DRIVE PRMT $ 40.00 CJS 05/14/96 96-279377
5PCT $ 2.00 CJS 05/14/96 96-279377
BEAVERTON OR
Phone #: 503-671-2017
Contractor:
CAPITOL ELECTRIC CO INC $ 42.00 TOTAL
12810 NE AIRPORT WAY #1
REQUIRED INSPECTIONS
PORTLAND OR 97230 Ceiling Cover Elect'l Final
Phone #: 503-255-9488 Elect'l Service
Reg #..: 48748
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signature
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 '-L-,
than 18N day,. Issued By
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: (711 [C��/�}
� /r. �r, ��
� DATE: - //f- '..
/y��
LICENSE NO:
Call for inspection - 639-4175
•
|-�
" Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # /r96 -r') s
,� i , , Date Issued 5 -i'- 96
Phone (503) 639 -4171
"''` FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: / 4. Complete Fee Schedule Below:
Name of Deyelo me9t NI iii/ 711. A /1/ 7�LS Number of Inspections per permit allowed
/5 0,
Address � ,S 6) '7 7 h1 �( Service included: Items Cost(ea) Sum
-
City /State /Zip / (7ti ,f,✓ D 1 4 2- 2 '9 4a. Residential - per unit
7 /� 1000 sq. ft. or less $110.00 4
Name (or name of business) T4. //f / � S Each additional 500 sq. ft. or
portion thereof $25.00
Commercial ❑ Residential El Limited Energy $25.00 1
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
7 / i f / Installation, alteration, or relocation
Electrical Contractor a i k/� 200 amps or less $60.00 2
Address / 1$/49 NC a/iic Dk W/r)( 201 amps to 400 amps $80.00 2
City Jiff /HPJJ al State D /2 Zip/972. 30 401 amps to 600 amps $120.00 2
601 amps to 1000 amps $180.00 2
Phone No. So-3 - 26 Over 1000 amps or volts $340.00 2
Job NO. g' to - 7 S Reconnect only $50.00 2
contractor's license NO. 4c. Temporary Services or Feeders
Contractor's Board Reg. No. Installation, alteration, or relocation
Signature of Supr. Elec'n 200 amps or less 2
License No. Phone o. 201 am to 400 amps 550.00 2
401 amps to 600 amps $
Over 600 amps to 1000 volts $100.00
. 2b. For owner installations: See "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit $35.00
Each additional branch circuit 55.00
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 7 °�
/
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 535.00
Per hour 555.00
In Plant 555.00
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 $
yd
NOTICE 5% Surcharge (.05 X total fees) $ 7 --1---
Subtotal $ c, Z ��
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 $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. worecomdev c- ❑ Trust Account #
$
prm.app a
Balance Due $ `,/Z