Permit CITY OF TIGARD ELECTRICAL PERMIT
I N' r DEVELOPMENT SERVICES PERMIT #: ELC98 -0028
�'
DATE ISSUED: 01/20/98
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� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
PARCEL: 291O2BD -01503
SITE ADDRESS...:1275O SW PACIFIC HWY
SUBDIVISION •FREWINGS ORCHARD TRACTS ZONING:C —G
BLOCK • LOT -001 JURISDICTION: TIG
Project Description : Village Square - job *7385
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 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: 2 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
ROSE GOSPODINOVIC type amount by date recpt
12770 SW PACIFIC HWY PRMT $ 45.00 JSD 01 /20/98 98- 302576
TIGARD OR 97223 5PCT $ 2.25 JSD 01/20/98 98- 302576
Phone #:
Contractor:
ELECTRICAL DIMENSIONS INC $ 47.25 TOTAL
PO BOX 12146
3961 SW WILLAMS AVE REQUIRED INSPECTIONS
PORTLAND OR 97212 Ceiling Cover Elect' 1 Service
Phone #: 282 -7255 Wall Cover Elect'1 Final
Reg #..: 000440
This per.it is issued subject to the regulations contained •n 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 per.it will expire if work is not started within 180
days of issuance, or if work is suspended for more than 1: days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rule are . t fo n OAR 952-001-0010 through OAR 952-991-Pe ou may obtain a copy
44 401
of these rules or direct questions to OUNC by calli g (�. )246 ' :7.
0401111112 -
Permittee Signatire: AAA/ 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 : DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY Or TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By L) ^ I
TIGARD OR 97223 Date Rec'd 0 / 0 5 g r
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Permit# Esc `-� '4t- 4vz
Incomplete or illegible will not be accepted '
Fax (503) 684 -7297 Called /l �-, / pe
1. Job Address: , V l , e 4. Complete Fee Schedule Below:
Name of Development t tL 9 < J 9; (� r ✓ . Number of Inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum
I
Address ) 2_.7 So S w cxcc e(3 ikiy 4a. Residential - per unit
Ci City/State/Zip T t 7 cifce Q.. Each additional it or less $11 0.00 4
ty p Each additional 500 sq. ft. or
Commercial tau Residential 1=1 Limited 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
Installation, alteration, or relocation
Electrical CorAactor Q ec Iv, gas r^L 200 amps or less $60.00 2
Addr S ro 41:7‘ Ili ui Sc. 201 amps to 400 amps $80.00 2
City reiaw•cl State C.,v Zip CI 7 7_1 L 401 amps to 600 amps $120.00 2
Phone No. 212.72.5-r 601 amps to 1000 amps $180.00 2
Job No. 73 RS Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 2--‘, - 4 3 7 C Exp.Date /t -/ -9R Reconnect only $50.00 2
OR State CCB Reg. No. 94'60 Fl Exp.Date 1 - - 9' 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date 7- /i -98 Installation, alteration, or relocation
�� 200 amps or less $50.00 2
Signature of Supr. Elec'n A I /! �/�
� .. : 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. A9 Lc/ -5 Exp.Date /0 -/- . see "b" above.
Phone No. L$ X- 7 2 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. o0
First branch circuit / $35.00 35 2
The installation is being made on property I own which is not Each additional branch circuit Z. $5.00 io °O 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: s oo
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ Z Z T
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
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # 9 72.57
Total balance Due $
I: \DSTS \ELC96.APP Rev 9/96
13
CITY OF TIGARD BUILDING INSPECTION DIVISION .
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: ! » 7 A.M. P.M. MST:
Location: 11P /
� � ,.■._,i _mil /� BUP:
Tenant: _ _ _ ' .� _ I __. uite: Bldg: MEC:
Contractor JZ.& 1, ��/ L / 4 • hone: ,742- 7 p G 5 PLM: p
Owner: /_ I _ _: _ / _/ I/ _/ r_- i " /L (U Phone: 3?-07 / 7 ELC: q(J --�
ELR:
4 � - SIT:
BUILD G BLDG (con't) PL I: ING MECHANICAL ELECTRICAL) SITE
Site Post/Beam Post/Beam Post/Beam over Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In / UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnec / /• Vault
Bsmt Damp Drywall Storm Furnace Temp Service i MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approv -a Approved
Appr /Sdwlk Not Approved Not Approved Not Approved a„ -_..,. . • -� Not Approved
FINAL FINAL FINAL FINAL FINAL
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17.3 FLA 9q 1 %4A
2,7 MINI /9/4P. 4 1-a A Fvs,s oil. ci2
0 A -0 S . s i L L ,I 0
O Call for reinspection einspection fee of $ required before next inspection O Unable to inspect
Inspector. Date: / A, or (� Q�
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