Permit 1 :::17 1 ( (DI TIGARD . '
ELECTRICAL PERMIT
PERMIT ft: ELC96 -0220
COMMUNITY DEVELOPMENT DEPARTMENT HATE ISSUED: 04r15/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL: 2811 c'DD- 1600
SITE ADDRESS...: 15755 SW SEQUOIA PKWY
SUBDIVISION....: ZONING :I -P
BLOCK LOT .............°
Project Description: Install one signal circuit or a limited energy panel.
- -- RESIDENTIAL UNIT - - -- .---TEMP SRVC/FEEDERS----.. MISCELLANEOUS
1000 SF OR LESS ° 0 0 - 200 amp ° 0 PUMP /IRRIGATION ° 0
EACH ADD' L 5120SF...: 0 201 - 400 amp. ......: 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY ° 0 401 - 600 amp • 0 SIGNAL /PANEL.......: 1
MANF. HM/ SVC /FUR..: 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 -- _._____ -. - --
PORTLAND ORTHOPEDIC type amount by date recpt
15755 SW .SEQUOIA PKWY PRMT $ 40.00 CJS 04/15/96 96- 278147
. 5PCT $ 2.00 CJS 04/15/96 96- 278147
TIGARD OR 97223 .
Phone #: •
Contractor: -- ------------------
MATRIX COMMUNICATIONS $ 42.00 TOTAL
1611 SE 7TH AVE • .
• ------ REQUIRED INSPECTIONS --- - - - - --
PORTLAND OR 97214 Wall Cover Elect' 1 Final .
Phone #: 503 -230 -7165 Elect' 1. Service
Reg #.. . 74332
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State rof 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 � -� ..6// ,A .., —__
- • 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 SUPR. ELEC'N: -- W'1'/'r-� 7 _ DATE: 4 /- /5-96
LICENSE NO :
Call for inspection - 639 -4175
•
•
Community Development ELECTRICAL PERMIT APPLICATION •
... A .
13125 SW Hall Blvd.
• Tigard, OR 97223 Planck/Rec. # 96- ;7814'7
, �� CIA �, Permit # ELC 9t -O.a D..v
�l Phone (503) 639 -4171 Date Issued .4 / 6`
/- - 96
.� FAX (503) 684 -7297 /
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by r`7Gr /Px S�Lini.clA
Inspection (503) 639 -4175 • .
I: 1. Job Address: . 4. Complete Fee Schedul Below:
6 .
Name of Development It0j (L L / / w 1, = / � • Number of Inspections per permit allowed
t
Address o " ,,� A _ ..r r r Service included: Items Cost(ea) Sum
City /State/Zip f �'t sWr '' 1 C I � 9 . q , 4a. Residential - per unit . 4
1000 sq. ft. or less $110.00
Name (or name of business) Each additional 500 sq. ft. o 1
portion thereof $25.00 -
Commercial 171 Residential ❑ Limited Energy $25.00
- Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 4b. Services or Feeders
Electrical ontractor • r Installation, alteration, or relocation 2 .
�p•��. w Atli •iii, .i�1J , r • $80.00 4 200 amps or less $60.00 2 - Addr - ss _, '
- � /�� r te , r 201 amps to 400 amps .
(� �` W��� '
City \��{�t�!•jt�1. Stat- Zi p 401 amps to 600 amps $120.00 2 -
601 amps to 1000 amps $180.00 2
Phone No. ‹,-- . Over 1000 amps or volts $340.00 . 2
Contractor's License No. 1C�iIL!L_- Reconnect only $50.00
Contractor's Board Reg.. No. Ipin _ 4c. Temporary Services or Feeders
` _ Installation, alteration, or relocation 2
, Signature of Sur. Elec'n / IAN A p 200 amps or less $50.00, 2
201 amps to 400 amps $75.00 2
"
License No. i, i 9 (2 0 Phone o. •
401 amps to 600 amps $100.00
Over 600 amps to 1000 volts
• ' 2b. For owner installations: see If above. ,
•
Print 4d. Branch Circuits
rint Owner's Name
New, alteration or extension per panel . • Address . - a) The tee for branch circuits with
purchase of service or feeder fee. 2
City State Zip 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
First branch circuit $35.00 2
not intended for sale, lease or rent. Each additional branch circuit $5.00
Owner's . • 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 I $40.00 il c) , -
4 or more residential units in one structure Minor Labels (10)' . $100.00
Service and feeder 225 amps or more
System over 600 volts n ominal 4f . Each additional inspection over .
•
Classified area or structure containing special occupancy the allowable in any of the above
as d escribed in N.E.C. Chapter 5 Per in $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: ,
NOTICE 5a. Enter total of above fees • . $
• -- .5% Surcharge (.05 X total fees) . $ t O
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ ,
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 $ - a ; n 0.
radIcaMesewlecpm.spp
0 ) CITY OF TIGARD BUILDIN NSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: / _ A.M. P.M. MST:
Location: / S .4 ' P BUP:
Tenant: G _ :ldg: MEC:
Contractor: lirat d' '"\ `e ' , Phone: ____ el PLM:
Owner: P.: - _ .� Li. ELC:
Owner: ? 6' --022
1 ,/ . TrMILW M 4 .:
IT:
BUILDING BLDG (con't) PLUMBING MECHANICAL CTRICAL . SITE
Site Post/Beam Post/Beam Post/Beam 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
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump .w • o
Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved • o • pproved Not Approved
FINAL FINAL FINAL FINAL FINAL •
// -.../M _ J
I / / Al ■ ii .: —0 4A / _ � �� . '
/016-9 ,i7 ii&/-111- — # _5°
•
O Call for reinspection Reinspection fee of $ required be re next inspection O Unable to inspect
6 Inspector: Date: 7�y'�/ Page of