Permit ELECTRICAL PERMIT
I1'f OF TIGARD DATE 09 /
C1_
09/96
-'COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PARCEL: 2S 1 10DC -001 '210
SITE ADDRESS...: 15570 SW PACIFIC HWY
SUBDIVISION WILLOW BROOK FARM ZONING:C -G
BLOCK • LOT •11
Project Description: Install single circuit for pay telephones. Bring all
telephone wiring to code.
- -- 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 /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: QI
- - -- 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.: 0 PER HOUR • 0
401 - 600 amp : 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 101
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
11570 SW PACIFIC HWY PRMT $ 76.00 CJS 09/09/96 96- 283727
SPCT $ 3.50 CJS 09/09/96 96- 283727
TIGARD OR 97223
Phone #:
Contractor: -------
TUALATIN ELECTRIC $ 79.50 TOTAL
PO BOX 655
REQUIRED INSPECTIONS
WILSONVILLE OR 97070 Wall Cover
Phone #: 503 -682 -2955 Elect' 1 Final T
Reg #.. : 65650
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 issuance, or if work is suspended for sore ,� /
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: fY)c.,le _ DATE: q- c(-
LICENSE NO: _ ___,
Call for inspection - 639 -4175
' Community Development ELECTRICAL PERMIT APPLICATION
. A
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # ELC 9 49 - d ? i
A„,, „,� , �,., / Date Issued q c(- '(S
� 1 I Phone (503) 639 =4171
°J'` FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development i i 1 i ""t Numb of Inspections per permit allowed •
Address - �- ---0- L. .:, Service included: Items Cost(ea) Sum
1
City /State /Zip Ig / t1O , Oip _ (3 toa`!7 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) ,1, Each additional 500 sq. ft. or
portion thereof $25.00
Commercial/ Residential Limited Energy $25.00 1
Each Manutd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
/ Installation, alteration, or relocation 2
Electrical Contractor 11 �-1C•71 200 amps or less $60.00
Address -- Pa 1L (o55 T� /? 201 amps to 400 amps $80.00 2
City W i (G9 r' 1.11 I (-e State V IZ Zip �/ 7670 401 amps to 600 amps $120.00 2
601 amps to 1000 amps $180.00 2
Phone No. -a.. - _ai Over 1000 amps or volts $340.00 2
Job NO. I Reconnect only $50.00 2
contractor's license NO. _ • , C. . Y 4c. Temporary Services or Feeders
Contractor's Board Reg. No. • • ^.... # Installation, alteration, or relocation
Signature of Supr. Elec'n /SP/WIMP 200 amps or less 2
License No.
31-6 2 , s Phone N o 201 amps to 400 amps $50.00
/ 401 amps to 600 amps $75.00
2
Over 600 amps to 1000 volts $100.00
. 2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
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 without
The installation is being made on property I own which is purchase of service or feeder fee. 3 2
First additional circuit br I $$5.00
not intended for sale, lease or rent. J
Each atlditional branch circuit $5.00
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:
5a. Enter total of above fees . $ .6.
NOTICE 5% Surcharge (.05 X total fees) $ (. -75
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 3(0. 75
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. w°rdlwmde ele. ❑ Trust Account #
$
prm.epp
Balance Due 74. t -
• 'I .∎. .i II C
�7s . - - -, - ,_
rn1 ZuDU £Jec4- i,-l041 Iv\spec)cw-
1/21/00 Activities for Case #: ELC96 -00215
4:24:36 PM
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Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 APPlication received 9/9/96 CJS RECD CJS 9/9/96
ELCC003 Permit created 9/9/96 CJS PEND CJS 9/9/96
ELCC500 (F)Issue permit 9/9/96 CJS PASS CJS 9/9/96
ELCC510 (F)Reprint permit 9/9/96 CJS 9/9/96
ELCC800 Case Finaled 9/11/96 MJR PASS MJR 9/11/96 plug holes
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