Permit CITY OF TIGARD r :1..I:.:(:i'Tli :I :(:::(41... F:'I:::f h1:I:'
III DEVELOPMENT SERVICES PERMIT # #:: E:a._C'.':)6I- ••(-)r�i,r�,
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE L .7.7Uf.::I) :: 05/20/ 98
►°'flRCEt.. :: 2910:1.r•1C:•- •014O€)
SITE nDr ESS......: tr77 :1.2 5 SW HAMPTON ST
SUBDIVISION .., ..., nFEVEL(ThII) NO.. 2 Z N:I :NGnNUE
BLOCK....... ...n LOT..... ........n020 J'tJ1;:TsDTC'TToN: T :I :G
Project I)ce sc•ri ptr :i.can: Tenant Improvement to add first branch circuit and one
additional branch circuit.
---RESIDENTIAL UNIT---- ...._.._•TI:: :MP SRVC /FE.E :I)EFica.._.._....- .-..•-.. ......_..I"ITSCE1_.L.fNE(3LJ::i ° _._..._.
i.000 SF OR I...ESS3........ n 0 0 ' -' 200 amp .............. n ( {) I:'UIriP /:F.RRIGAT:I ON......., :: 0
EACH (I)I)' I_. 500SF......: () 201 -- 400 amp.......: (!l SIGN/OUT 1_.II'IE.': LTG..: f.)
t..:I:iiiTE :I) I:: :Nr :RG'Y..........: 0 401 -- 6('3t?j atmp .............. n O SIGh►flI_. /F'(•1NEL..... e ........ n ('3
I1AI .. HM/ SVC /F DR...:: U £01+amps"_ 10( *) volts..:: (0) MINOR I...ABL :L (10)...: ('3
_..- ..°......SE: :RV :I :CE /FEE :I)E:.R• --• -'-- --BRANCH. CIRCUITS. -_ -- ....__.- 'flI)D"L :I :NS3i4°C'TIOI,IS —
0 ••- 200 amp............: 0 W /Sir :RV :i :CE OR FEEDER FEEDERn 1 PER INSPECTION.....: 0
201 -- 40('3 am p...... - .... n ('3 1st W/O SRC OR FTJR.: :I. PER HOUR...........: 0
401 "- 6€ (0 amp...........: 0 EA i DI)" I._ BRNCH C::I :RC 0 IN I'L.ANT ...................... :: (
Ei(%) :t. -. 103@ amp........, n 0 ----------- ---- __ -- -PLAN REVIEW SECT :I:ON -___.. .._.._._....._.._..._....__....__--
1(%)C0(%I+ amp /vo:l.t.'.......... :: (t) >: =4 Rr :S UNITS.. .............. n > 6('3(0 VOLT NOMINAL..:
Reconnect cat•t:l.y.. ,..... ,. n 0 SVC /FI)fi ›.-.: 225 AMPS..: CLASS AREA/SPEC C)CC..:.
Ownern _.._._............ -..... ___..._.......-._....... .._ .........................._. _.._. I ::•EE.:S
EQUITY GR(:)lJI :' type amount by c :►ate reclo•t
7 :125 SW HAIYII ::'TON STREET F :'IwIYIT s 40.00 DI...► -► 05 /20/913 98-305917
;`.x`:7:1.•7
T:I :(:)GlI OR 97223 5f:'CT $ ly 2.00 Di..1 -1 05/20/98 98-305917
f
Phone On
Contractor:: __..____..___._.__.---.._..._..-._. ..._._._._..._.._..__......_.__
_...._.._..........- ........ $ 42.00 TOTAL.
._......_.._.- .._.._ REQUIRED INSPECT I OHS -----
Ceiling Cover Elect" 1 Service
Phone ##: Wal :I. Cover Elect" 1. f':i.nal
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 - -0810 through OAR 952-001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Al
Permitt ee Signature: .. ..-_ issued l(ec:I By n __ . •
--------------------------- OWNER INSTALLATION O N L Y . ........_....._......._.
The installation is being made on property I own which is not :intended for
sale, lease, or ren't..
OWNER'S S :I:GNflTURr ::: DATE_ n
_.._......_.._ . ........................._._.._ ...... ...._...... INSTALLATION ( 3NL ._...- .._....._ ....._.._.._. ..__ -.....
SIGNATURE OF SUPR. EL.EC" Nn -',1/°'9*-- _. _ DATE:: _ cg / � _ ..
LICENSE NO:
11 - . - 4-1..4..4..4 ..4.4.4..x...4..4- •4•i•-4•-4-fi• •4•- a•-F••4• -4• 4-•4 •4•-4.+ +++•4- +.4 + + . 4 ..p..p.. 4 .. 4 .. 4 .. 4 . + + • 4 •• 4 -• 4 • + + + • 4 •-4•. ¢+ . 4 . 4 .• 4 •• 4 .. 4 .. 4 .. x .. 4 4 • 4 - 4 - 4 .. 4 .. 4 .
C. 1.1. 639•'••4175 by 7n@0 p..m.. for an Inspection needed the next business day
.4.4..4. +.4..4..4..4..4..4..4..4.4. 4 -4.4. 4- 4.+.4.. -4. 4..4.4- 4..4.. 4..4..4..4 4- 4. +.4..4. +.4..4..¢. +.4..4..4..4. +.4..-0...4..4 4- 4-•4•-4-.4..4 444..4..4. +.1...4..4.+ +.4..4..4..4..4.
-
CITY OF TIGARD REcEl\trectrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By .2 z--/
1998 Date Rec'd - 5,20/9
TIGARD OR 97223 1,A`( 2. Date to P.E.
Phone (503) 639 -4171, x304
pEVEtOPPA
Print or T e Date to DST
Inspection (503) 639 -4175 COM+�►U��� yp Permit # b. 96P - 04:26 4
Fax (503) 684 7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
-
Name (or name of business) f'i v, j k 64 a ✓ i f) Service included: Items Cost Sum
Address •l 2 C Ski lick,,,,., 0 (A.:- . 4a. Residential - per unit
1000 sq. ft. City /State /Zip I I S IA 4.A 0 "- Each additional or less $110.00 4
2 Z �� Each additional 500 sq. ft. or
Commercial Residential ❑ portion thereof $25.00 1
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 i" ): I i ito, z t{t El c is ` Installation, alteration, or relocation
Address d /3 Zoo Ty 200 amps or less $60.00 2
�'� 201 amps to 400 amps $80.00 2
City Ti ` 0.-n_ v o State Cry Zip '1'} Z 6 - 1 401 amps to 600 amps $120.00 2
Phone No. • (0 2 4 • 3 f. 3 I 601 amps to 1000 amps $180.00 2
Job No. LA-0'Z Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 3 4 2 el C Exp.Date id I • 2 Reconnect only $50.00 2
OR State CCB Reg. No. a 50 S ', Exp.Date - 4 " Y ' 4c. Temporary Services or Feeders
COT Business Tax or Metro No. ice/ G Exp.Date •- r- 7 ' In stallation, alteration, or relocation
!/�� 200 amps or less $50.00 2
2
Signature of Supr. Elec'n Y� 201 amps to 400 amps
$75.00
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No lG.IS- S' Exp.Date /d r • 96' see "b" above.
Phone Nr C 2 y - zcr 1
4d. Branch Circuits
New, alteration or extension per panel
213. 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.
First branch circuit / $35.00 - S 2
The installation is being made on property I own which is not Each additional branch circuit i $5.00 5" ` 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
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: ` , o
Not required for temporary construction services. 5a. Enter total of above fees $ ��
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 or
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
$ `( 2,_- __ .
Total balance Due
I: \DSTS \ELC96.APP Rev 9 /96 q,i i X05 9 --(10.1.-71/