Permit CITY OF TIGARD ELECTRICAL PERMIT
// 9naei, ,; , DEV ELOPMENT SERVICES PERMIT #: ELC97 -0794
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171 DATE ISSUED: i `/ 05 / 97
PARCEL: 2S110DC -02200
SITE ADDRESS...:15580 SW PACIFIC HWY #PREV
SUBDIVISION •WILLOW BROOK FARM ZONING:C -G
BLOCK LOT •011 JURISDICTION: TIG
Pro.j ect Description : Installation of one (1) branch circuit and one signal
circuit or limited energy panel.
- -- 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 • 1
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: 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
HOLLYWOOD VIDEO type amount by date recpt
15660 SW PACIFIC HWY PRMT $ 75.00 TJH 12/04/97 97- 301446
SUITE A -1 5PCT $ 3.75 TJH 12/04/97 97- 301446
KING CITY OR 97224
Phone #:
Contractor:
WILLAMETTE ELECTRIC INC $ 78.75 TOTAL
PO BOX 230547
REQUIRED INSPECTIONS
TIGARD OR 97281
Phone #: 624 -3631
Reg #..: 000750
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. Vtat Permittee Signature: ell Gl a jpi✓ gA l( Issued By: ,V
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. ELEEC' N: , en a i q ,r, -r-�� DATE: ha/3/9
LICENSE NO: /905i
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF :TIGARD Electrical Permit Application Plan Check # NIA
13125 SW HALL BLVD. Rec'd By T Sv1■•
TIGARD OR 97223 Date Rec'd i2 �} 9e7
Date to P.E. /...VA
Phone (503) 639 -4171, x304 Date to DST 1 ,244 7
Inspection (503) 639 -4175 Print or Type Permit # - E.LC,A7 - 0 ,94
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called txna;0ad ,
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development /44 /4, tu ao 4 Li o f /o Number of Inspections per permit allowed
Name (or name of business) `� Service included: Items Cost Sum
Address i S 44 0 S eu Pia r �r c t-r mot/ i/ S, i, i r 4• I 4a. Residential - per unit
City/State/Zip K ; . i ` C, rr y e -, I Each ad or less $110.00 4
p J Each addit tional 500 sq. ft. or
Commercial I. 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:
(Attach copy of all current licensee) C / ` 4b. Services or Feeders
Electrical Contractor /..1 , /10-0-1, t(e C (7 t I /�v C , Installation, alteration, or relocation
Address /'D 4, . 0 23 Ski 7 200 amps less $60.00 2
201 1 amps t to o 400 amps $80.00 2
City f i i4 0 State la& Zip 9 77c-- ( 401 amps to 600 amps $120.00 2
Phone Nos r, (14
-( - 36 7 / 601 amps to 1000 amps $180.00 2
Job No. !, '� 7 1- Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. V 4 - 2-Es T C Exp.Date ic1 - (- 9 r Reconnect only $50.00 2
OR State CCB Reg. No. 7 0 51 Exp.Date $ 4 -7 Qj 4c. Temporary Services or Feeders
COT Business Tax or Metro No. /5 4 Exp.D to Fe- ( -`I S' Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n / 401 amps to 600 amps $100.00 2
/� Over 600 amps to 1000 volts,
License No / S S Exp.Date /0 ( - / R see "b" above.
Phone No. /. ''-(- g6 7 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 State Zip without purchase of
Phone No. First / branch circuit fee. / $35.00 '' C 2
The installation is being made on property I own which is not Each additional branch circuit $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 1 7 / 6 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:
7
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $
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. ❑Trust Account # $ 7G p
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
h- t? /36 Do ra.c.Li
CITY OF TIGARD BUILDIN INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: ��,, '' Requested: / e/ -O! - 9 7 , 4. - . P.M. MST:
Location: is sea d�i�tJ �Q • / �h / BUP:
Tenant:' L 2J WOOD V I DE r / Suite: Bldg: MEC:
W
Contractor: (X n .C /J L Phone: 6,01-e- 3 3/ PLM:
Owner: ^ p �� Phone: ELC 9 / -7
"079
kV) ADD �S OP-- U -OcATI 0 J S PEct ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL EL SITE
Site Post/Beam Post/Beam Post/Beam Cover /S ervice Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved !Pd Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL AL #41 FINAL
' .5- 7( '=. C" ; e ( i . , 1 7ZC; . . /// ./Z . : . 7 (/ '--1''7.
4 2?ff er - 7 . ) s - - - g 2/- .
O Call for reinspection
.-e' Rwcir."
tion 11 Reinspection fee of / $ r morequired ^d' bee —Bore next inspection 0 Unable to inspect
Inspector: ' ' i Date: ? ` � Page k of