Permit CITY OF TIGARD ELECTRICAL PERMIT
�, DEVELOPMENT SERVICES PERMIT #: ELC98 -0496
/ f��'I DATE ISSUED: 08/20/98
E _ - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134BC -00600
SITE ADDRESS...: 12390 SW SCHOLLS FERRY RD
SUBDIVISION °PP1993 -057 ZONING:C —G
BLOCK LOT °002 JURISDICTION: TIG
Project Description : Installation of sign lighting for 1 sign.
- -- 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..: 1
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
DENNIS THOMPSON type amount by date recpt
12475 SW MAIN ST PRMT $ 40.00 DEB 08/20/98 98308463
TIGARD OR 97223 SPCT $ 2.00 DEB 08/20/98 98308463
Phone #:
Contractor:
DENNIS THOMPSON $ 42.00 TOTAL
12475 SW MAIN ST
REQUIRED INSPECTIONS
TIGARD OR 97223 Elect'l Service
Phone #: 620 -2184 Elect'l Final
Reg #..:
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 fo• more than 180 days. ATTENTION: Ore... es you to follow the rules adopted by
the Oregon Utility Notification Center. T . , rules are set forth in OAR 952 -901 m10 through i " 952-m1-1987. You may obtain a copy
of these rules or direct questions to ' h %y calling i •.)246 -1987. Permittee Signature: ,/ et„__ , ,7w1 /, iL— Issued : !� /
—OWNER INSTALLATION ONLY
The installation is be • made on property I own which is not intended for
sale, lease, or rent. G �----q
OWNER'S SIGNATURE: , . , ,-t, /i 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
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CI14 OF TIGARD Electrical Permit Application Plan Che
13125 SW HALL BLVD. Rec'd
TIGARD OR 97223 Date Reed 8 Bo 8
Date to P.E. --
Phone (503) 639 -4171, x304
Print or Type Date to DST
Inspection (503) 639 -4175 Permit # tu%9( 'I0 4 ./q o
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development 1 I4 C ( g V V (A I Q C 1 Number of Inspections per permit allowed
Name (or name of business) Sao included: Items Cost Sum
Address / > 00 S IA/ Sao ((5 ( -(vv 4a. Residential -per unit
- Z � 1000 sq. ft. or less $110.00 4 -
City /State /Zip ` O. /I 1 f7, Each additional 500 sq. ft. or
Commercial la Residential ❑ Li portion 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 licenses) 4b. Services or Feeders
Electrical Contractor Installation, alteration, or relocation
200 amps or less $60.00 2
Address 201 amps to 400 amps $80.00 2
City State Zip 401 amps to 600 amps $120.00 2
Phone No. 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. Exp.Date
OR State CCB Reg. No. Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Si nature of Su r. Elec'n 201 amps to 400 am $75.00 2
9 p 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No.
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
r purchase of service or
Print Owner's Name ■ Y l W1 I S feeder fee.
Address /24 7 , . -Gt/ 4( , Each branch circuit $5.00 2
City State 07 Zip q 72-2-3 b) The fee for branch circuits
tY P without purchase of
Phone No. (, 7.t? - 7.-f S( service or feeder fee.
First branch circuit $35.00 2
The installation is being de on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease r r nt. 4e. Miscellaneous
filA n - ----- (Service or feeder not included)
Owner s Signature �.(.(�c.�_ (/1/1�� Each pump or irrigation circle $40.00 ,, 2
Each sign or outline lighting $40.00 i lt , . 2
3. Flan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 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: , / d a
Not required for temporary construction services. 5a. Enter total of above fees $ �f
5% Surcharge (.05 X total fees) $ • O
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 # OU $
Total balance Due
1 \ MIS \ELC96 APP Rev 9/96