Permit ELECTRICAL PERMIT
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CITY OF T DATE I ISSUED: C O3 /25/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639-4171 PARCEL ° 2S 1 10DC 00100
SITE ADDRESS...: 15b70 SW PACIFIC HWY
SUBDIVISION WILLOW BROOK FARM ZONING:C -•G
BLOCK LOT •11
Project Description: Install ten branch circuits and one signal circuit or a
limited energy panel.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC/FEEDERS----
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 ° 1
MANF. HM/ SVC/FDR..: 0 601+amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS -• - -•
- 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: 9 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 - - --
SAFEWAY type amount by date recpt
15570 SW PACIFIC HWY PRMT $ 120.00 CJS 03/25/96 96- 277393
5PCT $ 6.00 CJS 03/25/96 96- 277393
TIGARD OR 97223
Phone #:
Contractor:
STONER ELECTRIC $ 126.00 TOTAL
2701 SE 14TH AVE
REQUIRED INSPECTIONS
PORTLAND OR 97202 Ceilir. :.ver Elect'1 Service
Phone #: 503- 233 -3631 Wall Cover Elect' 1 Final
Reg #. . : 44823
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 iesuie . _v if work is suspended for more / ,4 f/ r 3 ft1.
than 180 days. 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: Q/1 afpJ c flan. DATE: 3- a5- 96
LICENSE NO:
Call for inspection - 639 -4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 96 - 01773 9 3
Permit # ,(LL96 -O/77
'bar. l'�� Phone (503) 639 -4171 Date Issued 3 - A5 - 96
Ar FAX FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by � / S�ti m . cl�
Inspection (503) 639 -4175
1. Job Address: 1 4. Complete Fee Schedule Below:
Name of Development � o. -(e_ ),Noy .o-1 C., Number of Inspections per permit allowed
Address /5570 \,J lac.: ; c �.,.),./ Service included: Items Cost(ea) Sum
City/State/Zip \ ,\ c o... (P) ce &N ° ' 3 4a. Residential - per unit 4
1000 sq. tt. or less $110.00
Name (or name of business) � cq-�-e Lam/ Each additional n r Soo sq. n. or
portion thereof $25.00 1
-
Commercial ® Residential ❑ Limited Energy $25.00 - Each Manurd Home or Modular 2
-. 5C\ib fir a , (oQli C Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor ^ `j' -r i s E\ e c_l.crt 200 amps or less $60.00 2
Address ;27o / S F /L/ 71- Aug- 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 2 -
City @n,-*\04,g.._ State OR Zip °k1 Oa 601 amps to 1000 amps $180.00 2
-
Phone No. a33- 36,31 Over 1000 amps or volts $340.00 2
Contractor's License No. t96 - /a R Reconnect only $50.00 -
Contractor's Board Reg. No. i/Y S / / a /// 3 J_ 4c. Temporary Services or Feeders
g p / ?, st'J/ �it.&y
Installation, alteration. or relocation 2
Signature of Su r. Elec'n 200 amps or less $50.00 2
License No. 39 S Phone No. , 3� - 34.3 ( 201 amps to 400 amps $75.00 - 401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
2b. For owner installations: see •b• above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The lee for branch circuits with
Cif State Zi purchase of service or feeder fee' 2
�7 p Each branch circuit $5.00
Phone No. b) The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. o0 2
not intended for sale, lease or rent. First branch circuit $ 3� 2
Each additional branch an $ 5.00 circuit t_ E5.00 L{ S O
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 pp 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension I $40.00 4 O .
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 ins $35.00
Per hour $55.00
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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 $ i oCO•
5% Surcharge (.05 X total fees) $ (, °"
Subtotal $ ./___(v,"'
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Sb. 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 Subtotal $ Itit)67 co
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. ❑ Trust Account # $
Balance Due $ /26., °o
waA'comdel aMrpmApp
1/21/00 Activities for Case #: ELC96 -00177
4:22:37 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 APPlication received 3/25/96 CJS RECD TMP 3/25/96 •
ELCC003 Permit created 3/25/96 CJS PEND .TMP 3/25/96
ELCC500 (F)Issue permit 3/25/96 CJS PASS TMP 3/25/96
ELCC800 Case Finaled 4/2/96 MJR YES MJR 4/3/96
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