Permit CITY OF TIGARD
himpthio DEVELOPMENT SERVICES ELECTRICAL PERMIT
.1 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT S : D C 1
DATE ISSUED: : 1 2 / 26 12/86// 96
PARCEL: 151260C- 01
SITE ADDRESS...: 09400 SW WASHINGTON SQUARE RD #MERV
SUBDIVISION....: ZONING :C -G
BLOCK LOT °
Project Description: ADD 1 BRANCH CIRCUIT
- -- 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: 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
MERVYN'S type amount by date recpt
22333 FOOTHILL BLVD PRMT $ 35.00 TAT 12/26/96 96- 288166
5PCT $ 1.75 TAT 12/26/96 96- 288166
HAYWARD CA 94541 - 8521
Phone #:
Contract or: --
OREGON ELECTRIC GROUP $ 36.75 TOTAL
1010 SE 11TH
REQUIRED I NSPECT I ONS
PORTLAND OR 97214 Ceiling Cover Underground Cove
Phone #: 503 -234 -9900 Wall Cover Elect' 1. Service
Reg #.. : 000002
This peroit is issued subject to the regulations contained in, the L
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permi e S i gnat ur )
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 Dore AAt.. . A _� A %/ A
than 180 days. Issued By /
OWNER INSTALLATION ONLY
The installation is being made on property l: 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 for inspection - 639 -4175
' Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
,� .,.: Permit # --.4- e-96 O . /
I _A11.1%711 1I Phone (503) 639 -4171 Date Issued /z-/21, e
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by
Inspection (503) 639 -4175
1. Job Address: JOB NO . 70238 4. Complete Fee Schedule Below:
Name of Development Mervyn' s Number of Inspections per permit allowed
Address 9400 SW Washington Square Rd. Service included: Items Cost(ea) Sum
City /State/Zip T i as rd , OR 4a. Residential - per unit 4
1000 sq. ft. or less $110.00
-
Name (or name of business) Mervyn ' s Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial El Residential ❑ Limited Energy $25.00
Each Manufd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
Oregon n Electric Group o u Installation, alteration, or relocation 2
Electric Contractor g P 200 amps or less $60.00
Address 1010 SE 1 1 th Ave . 201 amps to 400 amps $80.00 2
City Portland State OR Zip "2 14 401 amps to 600 amps $120.00 2 - `7 P 97 601 amps to l000 amps $180.00 2
Phone No. 234 -9900 Over 1000 amps or volts $340.00 2
-
Contractor's License No. 203 Reconned only $50.00
Contractor's Board Reg. Na.2695 , ' 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
, Signature of Supr. Elec'n - 200 amps or less $50.00 2
License No. 2345S Phone N . 234 -9900 201 amps 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.
Print 4d. Branch Circuits
rint Owner's Name
New, alteration or extension per panel
Address a) The fee 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. 1 2
First branch circuit $35.00 3 5. 0 0 2
not intended for sale, lease or rent. Each additional branch circuit $5.00
-
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 onorgy 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 described in N.E.C. Chapter 5 Per inspection $35.00
Per hour $55.00
In Plant $55.00
Submit 2 sets of plans with application where any of the above
I apply. Not required for temporary construction services. 5. Fees:
NOTICE 5a. Enter total of above fees $ 35.00
5% Surcharge (.05 X total fees) $ T.773
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 36.75
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.
L Trust Account # $
Pte" Balance Due $ % . 7S
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