Permit •
. CITY OF TIGARD PERMIT #
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 07/29/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 25110DC -00200
SITE ADDRESS...: 15660 SW PACIFIC HWY #4
SUBDIVISION WILLOW BROOK FARM ZONING:C -G
BLOCK • LOT •11
Project Description: Installing four branch circuits.
- -- 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/0 SRVC OR FDR.: 1 PER HOUR • 0
401 - 600 amp - 0 EA ADD'L BRNCH CIRC: 3 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
NOAH'S BAGEL type amount by date recpt
15660 SW PACIFIC HWY #A5 PRMT $ 50.00 CJS 07 /29/96 96- 282225
SPCT $ 2.50 CJS 07/29/96 96- 282225
TIGARD OR 97223
Phone #:
Contractor:
TUALATIN ELECTRIC 8 52.50 TOTAL
PO BOX 655
REQUIRED INSPECTIONS
WILSONVILLE OR 97070 Wall Cover Elect'1 Final
Phone #: 503-682-2955 Elect'1 Service
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 lore r ha r Ices 'J► m 1rJ7'
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 SUP R. ELEC' N: DATE : 9/ 'gr,
LICENSE NO: I
Call for inspection - 639 -4175
•
1
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # Q- a$aa as'
Permit # r2C9s- q 6
it :viii" Phone (503) 639 -4171 Date Issued a 9 -
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by �� r Pc S�11y,.,,a -
Inspection (503) 639 -4175 •
1. Job Address: 4. Complete Fee Schedule Below:
Name of DevelopmentTti aii ?Ito rhe_sjo €. Number of Inspections per permit allowed
Address 166960 F 4 St W • l TM•-s c- T'it-'■)' . Service included: Items Cost(ea) Sum
City /State/Zip T ° k A C)'K 9 / pcta, 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
Name (or name of business*, e�.4 ` i giA4� Each additional 500 sq. ft. or 1
portion thereof $25.00
Commercial Residential ❑ Limited Energy 2
$25.00 Each Maned Home or Modular
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contractor \c n Q \QC ∎C_. 200 amps or less $60.00 2
Address ?. 0 . 1bx, ( 55 201 amps to 400 amps $80.00 2
City ■.J; \51`rn∎l i\�. State OK Zip x '17070 401 amps to 600 amps $120.00 2
P 601 amps to 1000 amps $180.00 2
Phone No. Co B a - 2J 55 Over 1000 amps or volts $340.00 2
Contractor's License No. 3 -,X (45s C- Reconnect only $50.00
- Contractor's Board Reg. No. . _ -50 A( 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Suer. Elec'n / /L �� _ ��/
200 amps or less $50.00 2
License No. a - - hone No. . -. - 201 am ps to 400 amps $75.00 2
• 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
City State Zip purchase of service or feeder fee. 2
Each branch circuit $5.00
Phone No. b) The lee 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 i $5.00 _S 'S 2
Each additional branch circuit ,' $ $5.00 l . ,
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
-
I 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 d esc ri bed in N.E.C. Chapter 5 Per ins 535.00
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:
co
5a. Enter total of above fees $.
NOTICE 5% Surcharge (.05 X total fees) $ a P "
• PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ HZ hU
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. ❑ Trust Account # $
Balance Due $ c 2f
wwdVS.nyNN•pm .W
Page No. 1 CASE HISTORY FOR CASE NO.: ELC96 -0496
NOAH'S BAGEL.
15660 SW PACIFIC HWY Unit: 4
09/17/97
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent _ Done Done Date By
---- - -- -- -- -- -- - --
ELCC001 Application received / / / / 07/24/96 RECD CJS 07/29/96 CJS
ELCC003 Permit created / / / / 07/29/96 PEND CJS 07/29/96 CJS
ELCC500 (F)Issue permit ./ / / / 07/29/96 PASS CJS 07/29/96 CJS
ELCCB00 Case Finaled / / / / 10/24/96 PASS MJR 10/24/96 MJR
•