Permit CITY OF TIGARD ELECTRICAL PERMIT
«y , DEVELOPMENT SERVICES PERMIT #: ELC97 -0389
'IL. SW HaII Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 06 / 19 / 97
PARCEL: 2511ODC -02200
SITE ADDRESS...:1557O SW PACIFIC HWY
SUBDIVISION •WILLOW BROOK FARM ZONING:C —G
BLOCK • LOT :11 JURISDICTION: TIG
Project Description : In -store bank / /instl 1 service feeder & 25 branch circuits
// job g 578T
- -- 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 1 W /SERVICE OR FEEDER: 25 PER INSPECTION 0
201 — 400 amp : 0 1st W/0 SRVC OR FDR.: 0 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 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 STORE type amount by date recpt
15570 SW PACIFIC HWY PRMT $ 185.00 TAT 06/19/97 97- 296197
TIGARD OR 97223 5PCT $ 9.25 TAT 06/19/97 97- 296197
Phone #:
Contractor:
TUALATIN ELECTRIC $ 194.25 TOTAL
PO BOX 655
REQUIRED INSPECTIONS
WILSONVILLE OR 97070 Ceiling Cover Underground Cove
Phone #: 682 -2955 Wall Cover Elect'l Service
Reg #..: 000656
This permit is issued subject to the regulations contained 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 952- 001 -0010 through OAR 952 -001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling 503)246 -1987. /
Permittee • Signature: Issued B A 9 y
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 : t - � 0 DATE: 6
LICENSE NO: 3 q 3 S
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
1 _
CITY OFTIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
I TIGARD OR 97223 Date Recd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST �
Inspection (503) 639 -4175 Print or Type u
Permit # , d raiNtif
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: IS a..n- k 0,0,;-....5 ,- - - e •c;s,H;,, S 4. Complete Fee Schedule Below:
Name of Development .c a- --N-- -7 Sd-Q' -- Number of Inspections per permit allowed
1
Name (or name of business) ��ILS r at. -,g o Service included: Items Cost Sum
Address I IJ s `D ..S• . 1;�, P # z „,..-,-4,- •t4,...• . 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State /Zip y r IL Each additional 500 sq. ft. or
l Commercial Residential El portion thereof $25.00 1
i Limited Energy $25.00
Each Manuf'd Home or Modular
r Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
t (Attach copy of all current licenses) 4b. Services or Feeders
i Electrical C9ptractor f t la L _ - - 4 _- Installation, alteration, or relocation
Address /. o - 4 - 6 l 200 amps or less $60.00 r%0 2
201 amps to 400 amps $80.00 2
City L (So •L: l k. - State 6,2 Zip 9'70'? 0 401 amps to 600 amps $120.00 2
Phone No. (. $ .2 - ,2 9 516" 601 amps to 1000 amps $180.00 2
Job No. .Si T Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 3-46 $G Exp.Date
OR State CCB Reg. No. 6, S C, S(= Exp , -' a 4c. Temporary Services or Feeders
COT Business Tax or Metro No. . /,' a .Date Installation, alteration, or relocation
Mk' 200 amps or less $50.00 2
201 amps to 400 amps -
- $75.00 Signature of Supr. Elec'n /�f �v / � 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 3 ' 3 S /Exp.Date see "b" above.
Phone No.
4d. Branch Circuits
New, alteration or extension per panel
213. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit s $5.00 1 ° 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 $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: l .
Not required for temporary construction services. 5a. Enter total of above fees $ -, f
5% Surcharge (.05 X total fees) $ °I
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. El Trust Account # $ '�Y
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
1/21/00 Activities for Case #: ELC97 -00389
4:25:58 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 6/19/97 6/19/97 TAT 6/19/97
ELCC003 Permit created 6/19/97 • 6/19/97 TAT 6/19/97
ELCC725 Underground Cover 6/19/97 TAT 6/19/97
ELCC730 Elect'I Service 6/19/97 TAT 6/19/97
ELCC799 Elect'I Final 6/19/97 8/15/97 MJR PASS MJR 8/20/97
ELCA500 (F) Issue permit 6/19/97 TAT PASS TAT 6/19/97
ELCC720 Wall Cover 7/24/97 MJR PASS J *H 7/31/97 Electrical wall cover approved,
• low -volt permits required. •
ELCC700 Ceiling Cover 8/15/97 MJR PASS MJR 8/20/97
ELCC800 Case Finaled 8/21/97 JT 8/21/97
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