Permit CITY OFELEIRI.I' RD
, r �; .; ,, DEVELOPMENT !- ..: ,'' gt-C 9� - D' y7
�I� j
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171
PARCEL: 2S102P -00600
SITE ADDRESS...:11940 SW PACIFIC HWY *fl
SUBDIVISION •TI6ARD HISHHAY TRACTS ZONIN6:CBD
BLOCK • LOT •012 JURISDICTION: TI6
Project Description: Installing 2 permanent signs with outline lighting.
- -- 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..: 2
LIMITED ENERGY • 0 401 - - :- - _mp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 60 - -1000 volts.: MINOR LABEL (10)...: 0
----SERV ICE/FEEDER---- - 'RANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 - 200 amp • 0 ERVICE OR FEEDER: 0 PER INSPECTION • 0
201 - 400 amp • 0 1st W/0 SRVC OR FDR.: 0 PER HOUR • 0
401 - 600 amp • ►, EA ADD'L BRNCH CIRC: 0 IN PLANT : 0
601 - 1000 amp • 0 - - --I PLAN REVIEW SECTION
1000+ amp /volt ', > =4 RES TS • > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /F >= 25 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
RELAX THE BACK STO "E type amount by date recpt
11940 SW PACIFIC WY PRMT $ 80 00 BON 03/24/98 98- 304372
SUITE A PCT $ 4.00 BON 03/24/98 98- 304372
TIGARD OR 97223
Phone #:
Contractor: - -- ----'
-- - - - + -- -
E S & A INC 84.00 TOTAL
1210 OAK PATCH -111
REQUIRED INSPECTIONS
EUGENE OR 97042 Ceiling Cover Elect'l Service
Phone #: 541- 485 - Wall Cover Elect'1 Final
Reg #.. : 001112
This permit is issued subject to the • c -fined 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 9521 -0010 through OAR 952 -001 -1987. You may obtain a copy
of these rules or direct questions to DUNG by calling (503)246 -1987.
Permittee Signature: / "* 1 ' ► Issued By: 4
$4
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 : A DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Electrical Permit Application Plan Check #
.- 13125 SW HALL BLVD. Rec'd By s 0
Date Recd ' .
TIGARD OR 97223
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # PLC 9� /y7
Fax (503) 684 -7297 Called j /ZG/g,
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development I 2 �,, / Number of Inspections per permit allowed
Name (or name of business ,ACA RA Y 4 Re, .6C /t ��rvice included: Items Cost Sum
Address I I / 40 c S(A f .1f :JO NA. 4a. Residential - per unit
City/State/Zi � Q -7 1000 sq. ft. or less $110.00 4
ty (I I \ / / 2. Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial Residential ❑
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 ice ses) 4b. Services or Feeders
Electrical C. ractor _ �s1 '11 L'
Installation, alteration, or relocation
Address a . • r V a T�rsfi 200 amps or les $60.00 2
201 amps to 400 amps - $80.00 2
City I . tale a Zip ' 401 amps to 600 amps $120.00 2
Phone No. 1 -* / :9-' 7 4. 601 amps to 1000 amps - $180.00 2
Job No. Over 1000 amps or volts - $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No.
OR State CCB Reg. No. I 1 1 ?,� Exp.Date 7 - - '/
,,30 4c. Temporary Services or Feeders
COT Business Tax or Metro No2 Exp.Date 9R Installation, alteration, or relocation
200 amps or less $50.00 2 -
Signature of Supr. Elec'n /Li A IL /Me k ;(�j 201 amps to 400 amps $75.00 2
9 / 401 amps to 600 amps $100.00 2
J Over 600 amps to 1000 volts,
License No. S - 7 Exp.Date I 1 - � see "b" above.
Phone No.
il / / 9 - 7 -
4d. Branch Circuits
New, alteration or extension per panel
2b. 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 2
The installation is being made on property I own which is not Each additional branch circui
$5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $ 2
Each sign or outline lighting _ $40.00Q 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. S. Fees:
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 � 4 op
Lam)
TIME AFTER WORK IS COMMENCED. El Trust Account #
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96