Permit ELECT�I
art � ��� TIGARD
�^��'�-' ^ �~- ~ DATE ISc`u�»� m��/��/'96
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COMMUNITY DEVELOPMENT DEPARTMENT
1x1osmw Hell Blvd. Tigard. Oregon 9722 308199 (503) 639-4171 PARCEL 25110DC-00109
5ITE ADDR:=)S. . . : 15570 SW PACIFIC |'>WY .
SUBDIVISION....: WILLOW BROOK FARM ZO%ING:C-G
LOT. . . . . . . . . . . . . : 11
Project Description: SIGN CIRCUITS CHECK TO SEE IF PROPER
C:.RCUIT3/BRANCHES/OUTLETS PERMITTED.
--RESIDENTIAL UNIT-L--- ---TEMP 5RVC/FEEDERS----
1000 SF OR LESS--; . : Q 0 - 200 amp. ... ... : 0 PUMP/ �RRIGATION.
EACH ADEOL 500SF...: 0 201 - 400 amp.......: 0 SIGN/OUT LINE LTG..: 3
LIMI ENERGY....:: 0 401 '- GOO amp. . . . . . . : 0 SIGNAL/PANEL.... 0
MANF. HM/ SVC/FDR..: 0 601+amps-1000 volts.: 0 MINOR LABEL (10)...7 0
'--'GERVICE/FEZDER--'- ----DRANCH CIRCUITS----- ---ADD"L INSPECTIONS--
0 - 200 amp. .. . . . : 0 W/SERoICE OR FEEDER` 0 PER INSPECTION,.... : 0
201 400 amp. . . . . . : 0 1st WIC GRYC, OR FDR. 0 PER |<]UR. . . . . . . . . . . . 0
401 - 600 amp. . . . . . : N EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
6e1 1200 amp. . . . . : l0 -----------------PLAN REVIEW SECTIC%----- ---� ' - ^ —
1000+ amp/volt.... . : 0 >=4 RES UNITS. ...... . : > 600 VOLT NOMINAL. . :
F4econnec 0 3VC/FDR ) = 22'5 AMP3. . : CLASS AREA/SPEC OCC. 7,
Owner: -------------�---�----------------------- ---- FEE3 -------�
ES & A SIGNS type amuunt �e �
1210 OAK��ATCH ROAD � PA $ 12�. 00 Jk|' � 0.2,/i20/96 95-2.7284
5PCT $ G.00 JMH 03/20/96 96-277284
EUGENE OR r.:7402' •
Phone �: 800-285-3847
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Contra�to': ---------�-------------------------------------------
FRANK BRAYTQN $ 12E.00 TOTAL
4490 SW MUELLER DR #L-302
. -----� REQUIRED INSPECTIONS ------
AL.LHA OR 97@07 WalI Cover Wall [over
Phone �:� Wall Cover El 1 Service
1 1e #..: 111236
• .
This peroit is issued subject to the regulations contained inith»
Tigard EdmicOal.[ode, State of Ore. Specialty Ccides end all 'other 'Perini Signature'
apTlicable ia/s, wsr ;All be doos in azorduoce with .
approved plans. 7his pera/t w� e�� x�rstarted /* i� �i� not started
uitkin I L I days of is 0 1 ' work is suspended for oore LJz
than days. I ,ueo By
^-- • INSTALLATION ONLY '--'---''--------' --- '-----''
The installation is being made on property I own which is not-intended for
sale, ]ease, or rent.
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OWNER'S SIGNATURE: _ • DATE: •
INSTALLATION ONLY-- ---- ----------'-- --
SIGNATURE OF SUPR. ELEC'N: DATEc
- LICENCE NQ: ' ^ ___-
Call for inspection — 639
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Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # . L(. -O 170
,; ii i' " - �� I I Phone (503) 639 - 4171 Date Issued A21104. c h.Q.CQS.R tr\i)
CITY OF TIGARD FAX (503) 684 Issued by
TDD No. (503) 684 -2772
Inspection (503) 639 -4175 (,z ii0 ( s.j'k.. a rn, L? ( 5)
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development 6A F E MY Number of Inspections per permit allowed
Address 155t70 ,Sim PACIFIC Hal Service included: Items Cost(ea) Sum
City/State/Zip TI6Al2.t>, OP. C112Z3 4a. Residential - per unit 4
1000 sq ft or less $110.00
Name (or name of business) SA FE h1A Li Each additional 500 sq ft or
portion thereof $25 00 1
—
Commercial Residential ❑ Limited Energy $2500
— Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68 00
2a. Contractor installation only: 4b. Services or Feeders
1 Installation, alteration, or relocation 2
Electrical Contractor GSM, INC, 200 amps or less $60 00 2
Address i21O OAKP! c + � 12D 201 amps to 400 amps $8000 2
401 amps to 600 amps $120 00 2 —
City E V 6fc NG State 0r— Zip 91402 601 amps to 1000 amps $180 00 2 — Phone No. 5 ye,S- t-R, Over 1000 amps or volts $34000 2 —
Contractor's License No. 20--255 C-LS Reconnect only $5000
— Contractor's Board Reg. No. ii 12-810 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n 200 amps or less $50 00 2
License No. :/ Phone No. cl13S -Sst/4 201 amps to 400 amp $75 00 —
401 amps to 600 amps $100 00
4-45516- Over 600 amps to 1 000 volts
2b. For owner installations: see 'b' above
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip purchase of service or feeder fee. 2
'1 p 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 Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation arde $40 00 2
Each sign or outline lighting — 5 — $40 00 124, co
Signal arcu"t(s) or a hauled energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or extension $40 00
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 $3500
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:
5a. Enter total of above fees $ 120 -
NOTICE 5% Surcharge (.05 X total fees) $ t o . c ' '
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ j2L, 9v
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 $ 12b °v
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