Permit CITY OF T ELECTRICAL PERMIT
/41. ., ;1 �� DEVELOPMENT SERVI PERMIT
ISSUEDL /1
PARCEL: 2S110DC -02200
SITE ADDRESS...:15660 SW PACIFIC HWY #5
SUBDIVISION -WILLOW BROOK FARM ZONING:C —G
BLOCK • LOT •011 JURISDICTION: TIG
Project Description: Pizza Rush TI
- -- 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)...: 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/O SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 1 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 DCC.:
Owner: FEES
TIGARD PROMENADE PARTNERS type amount by date recpt
3752 HOLIDAY CT #225 PRMT $ 40.00 JSD 07/14/98 98- 307327
LA JOLLA CA 92037 5PCT $ 2.00 JSD 07/14/98 98- 307327
Phone #:
Contractor:
CUSTOM ELECTRICAL SERVICES $ 42.00 TOTAL
625 SW 10TH AVE #283C
REQUIRED INSPECTIONS
PORTLAND OR 97204 -0000 Ceiling Cover Elect'1 Service
Phone #: 282 -8815 Wall Cover Elect'1 Final
Reg #.. : 124261
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 80 days. ATTENTION: Oregon law requires you to follow the r les adopted by
the Oregon Utility Notification Center. Those rules re et fo d in OAR 958 -1-010 through OAR 952- 001-1987. Yo may obtain a copy
of these rules or direct questions to OINC by hind ( 146 P :7.
Permittee Signature Issued By: it
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 - OF TIGARD Electrical Permit App it Plan Chec _ ���/ �
13125 SW HALL BLVD. _
TIGARD OR 97223 JUL 1 �' 1998 Date Rec'd r C
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Ty� �,�MUNITY DEVELOPMENT permit #
Fax (503) 684 - 7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) p Z Z, , R. V S I-, Service included: Items Cost Sum
J
1
Address , 0 4 0 S L J t,
2 , l l/ 4a. Residential - per unit
1000 sq. h.orless $110.00 4
City /State/Zip Each additional 500 sq. ft. or
Commercial 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: 4b. Services or Feeders
.'
(Attach copy of all current licenses) //
Electrical Contractor * L.* SroYVt )/� ,rtco� ( S x."LPS Installation, alteration, or relocation
200 amps or less $60.00 2
Address 7- 7 Sw ) L. Tit . 2 S C 201 amps to 400 amps $80.00 2
City nt.. - r` State 77 ✓ Zip 401 amps to 600 amps $120.00 2
Phone No. 7 z- S - $ ' / 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 2. G - 71y -- =xp.Date //, -/ - Reconnect only $50.00 2
OR State CCB Reg. No. / 2 5F 7. Z / Exp.Date 7 '- z3-9ar 4c. Temporary Services or Feeders
COT Business Tax or Metro No. 6 Exp.Date 7V - rr Installation, alteration, or relocation
200 amps or less $50.00 2 -
Signature of Supr. Elec'n /a� /i t s
201 amps to 400 am $ 100.0 2 -
401 amps to 600 amps $100.00 2
-
Over 600 amps to 1000 volts,
License No l -Z'�� Exp.Date /1 / - 9 see "b" above.
Phone No. 7 Yom. - g9 ■S
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 S Zip without purchase of
Phone No. service or feeder fee.
First branch circuit ( $35.00 __2.F
2
The installation ' eing made on property I own which is not Each additional branch circuit �- $5.00 2
intended for sa e, 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
- _ _. _.._ -It.* Signal circuit(s) or a limited energy
minor Lapels t fu •- '.. • iO 2
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:
Z-
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ /..-
NOTICE Subtotal $ Lt Z
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 # ! R
Total balance Due $ z
r(--d3).‘
I:\DSTS \ELC96.APP Rev 9/96