Permit A • CITY OF TIGARD
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DEVELOPMENT SERVICES PERMIRI #ALELC96I0770 -n- 13125 DATE ISSUED: 12/09/96
PARCEL: 1S136CA -01800
SITE ADDRESS...: 11643 SW PACIFIC HWY
SUBDIVISION • ZONING:C —G
BLOCK • LOT
Project Description: INSTALL 2 BRANCH CIRCUITS
- -- 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 /FAR..: 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/O SRVC OR FDR.: 1 PER HOUR ° 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 1 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
MILNE CONSTRUCTION type amount by date recpt
1312 SW 16TH AVE PRMT $ 40.00 TAT 12/09/96 96- 287385
SPCT $ 2.00 TAT 12/09/96 96- 287385
PORTLAND OR PLCK $ 10.00 TAT 12/09/96 96- 287385
Phone #
Cont ract or:
ALAN FITCH ELECTRIC $ 52.00 TOTAL
25973 S MOEHNKE
REQUIRED INSPECTIONS
BEAVERCREEK OR 97004 Ceiling Cover Underground Cove
Phone #: 503 -632 -4784 Wall Cover Elect'1 Service
Reg #. ° : 001068
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permit 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 a r/ ,
than 180 days. I s s' e d 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: DATE:
LICENSE NO:
Call for inspection — 639 -4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # ct 6 940- (1,
;r�l, Phone (503) 639 -4171 Date Issued fa. q ���
'` FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development ,, 11 Number of Inspections per permit allowed
Address l IIQ43 SW ?Pre t c, Ct 1 tA)F11 Service included: Items Cost(ea) Sum
City /State/Zip l►c'pet12N C I1 - 2Z3 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
-
Name (or name of business) ?eaiC 1no . - 1t, gip Each additional 500 sq. ft. or 1
portion thereof $25.00
-
Commercial 171 Residential ❑ Limited Energy $25.00
Each Manufd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor ALA-6) ,0c tt a 200 amps or less $60.00 2
-
Address 2.5'113 S • ?no t£4 a.►wE. CA"; 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 - City TAA tf=r- State Zip a1-noy 601 amps to 1000 amps $180.00 2
Phone No. 1,231.- '4 4t,4 Over 1000 amps or volts $340.00 2
Contractor's License No. -3f31-C_ Reconnect only $50.00 -
Contractor's Board Reg. No. o to tof31 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n a..,..- E--4-1A-_. 200 amps or less $50.00 2
License No. 31-21 S Phone No. (03'1 -41-A4 201 amps to 400 amps $75.00
401 amps to 600 amps $100.00
Over 600 amps to 1 000 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
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 se"v1Ce or feeder fee.
First branch circuit circuit l $35.00 .° ° 2 2
not intended for sale, lease or rent.
Each additional branch circuit I $5.00 ''j. - rT
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:
NOTICE 5a. Enter total of above fees $ 40 .°o
5% Surcharge (.05 X total fees) $ ,oa
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Sb. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $ 0 p °
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. ❑ Trust Account # $
Balance Due $ 52- , ° a
wordew, I4ec.rm.arp
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation 4[ri►
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk 40
Other: II 9 Date: I 1 a\ l l 1 A.M. .M. Entry:
Address: / l , L/ 3 ^ a--e-c�'.v_/ . ' 1
Tenant: le�� • �� Ste: v MST:
Con /Own: BUP: MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
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Inspector: /, r - 2 ■ •_ _ Date: /-2/
_APPROVED _ DISAPPROVED /CAL FOR REINS P. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation ec
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
1
Other: / 2 `�
Date: / 2k 9 2-0 L (0 A.M P.M. Entry:
Address: 6 t # r te `
.
Tenant: 1 . l sir , Ste: MST:
BUP:
Con /Own: r MEC:
PLM:
ELC: TTC
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
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1,(,1.x./' €& 6: ( —
nspector: i .4_r
Date/
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APPROVED DISAPPRO D /CALL FOR REINSP. CO