Permit A CITY OF TIGARD
\ DEVELOPMENT SERVICES ELECTRICAL PERMIT
PERMIT #: ELC96 -0666
— • 13125 SW HaII Blvd., Tigard, OR 97223 (503) 6394171 DATE ISSUED: 10/18/96
PARCEL: 2511ODB -00700
SITE ADDRESS...: 15520 SW PACIFIC HWY #D
SUBDIVISION • WILLOW BROOK /TIGARD PROMENADE ZONING:C –G
BLOCK LOT -10
Project Description: TEMPORARY SERVICE FOR PAD D, TIGARD PROMENADE
SOUTH OF WASH. FED., NORTH OF HOLLYWOOD VIDEO. 1
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 – 200 amp • 1 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.: 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
CARL KARCHER ENTERPRISES type amount by date recpt
800 MELLON AVENUE PRMT $ 50.00 JMH 10/18/96 96- 285389
SPCT $ 2.50 JMH 10/18/96 96- 285389
MANTECA CA 95337
Phone #: 823 -9251
Contractor:
ST JOHNS ELECTRIC INC $ 52.50 TOTAL
3202 NE 65TH ST
REQUIRED INSPECTIONS
VANCOUVER WA 98663 Underground Cove Elect' 1 Final
Phone #: 360- 693 -5100 Elect' 1 Service
Reg #..: 43135
This permit is issued subject to the regulations contained in the 4/i LE lD
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 more � i1 1i • 1
than 180 days. I r' ued By
- OWNER INSTALLATIOi 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 for inspection – 639 -4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. EL�9�_ 06.6 Tigard, OR 97223 Permit #
wref lipli , �. Date Issued C ow to -/ ?-S
431- ; �� 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 (( n,r I c ,tR Number of Inspections per permit allowed
Address 1 552.0 5 LO Po, c : fir. 1.1 ray t' Service included: Items Cost(ea) Sum
City /State /Zip T9 n r d , n R q7.224 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) l , a r I c ,Tit Each additional 500 sq. ft. or
portion thereof $25.00
Commercial g Residential El Limited Energy $25.00 1
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation
Electrical Contractor ,SI 94.... ihti r r. Tine 200 amps or less $60.00 2
Address y'l 1 cl ii) 6. i'YI ..:-..-1 e 1no ha. SA-- 201 amps to 400 amps $80.00 2
City Vet 1n P.nr.w - - State (AM- Zip n 641 401 amps to 600 amps $120.00 2
601 amps to 1000 amps $180.00 2
Phone No. 3 4o 6 9.3- slot) Over 1000 amps or volts $340.00 2
Job NO. Reconnect only $50.00 2
contractor's license NO. 3 7-3.50C... 4c. Temporary Services or Feeders
Contractor's Board Reg. No. ,/6 0. Installation, alteration, or relocation
Signature of Supr. Elec'n /_ -� //�!j' 200 amps or less _L_ 50 .o<9 2
201 amps to 400 amps $50.00 2
License No. 3 Da '/S Phone No.3 h 9.3 -5 /O0 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
City State Zip purchase of service or feeder fee. 2
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. 2
not intended for sale, lease or rent. First branch circuit $35.00
Each additional 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 $ 50.00
NOTICE 5% Surcharge (.05 X total fees) $ .1 . 5 p
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 5 ? 5 0
5b. Enter 25% of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
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. wordlcomdeVdeo- ❑ Trust Account # $
prm. 0 / 1 1 d _a Balance Due $ <52,50
/ - /I r 4 ---- Ige-d4 ....
Page No. 1 CASE HISTORY FOR CASE NO.: ELC96 -0666
CARL KARCHER ENTERPRISES
15520 SW PACIFIC HWY Unit: D
09/16/97
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Dane Date By
ELCC001 Application received / / / / 10/18/96 MAIL JMH 10/18/96 J*H
ELCC500 (F)Issue permit / / / / 10/18/96 'PAID JMH 10/18/96 J *H
ELCC725 Underground Cover 10/18/96 / / 10/18/96 10/18/96 J*H
ELCC800 Case Finaled • / / / / 10/21/96 close openings PASS MJR 10/23/96 MJR
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