Permit ' ' : C IT Y O F T IGA RD , ., •
,; k ,,, DEVELOPMENT SERVICES • • ELECTRICAL PERM :. ' ;
°' . . ( 13125�SW Ha11.Blvd, Tliatd OR'97223 �(50 ' PERMIT'. - 0 . Et__C9C- �Qt'i.'Z6''
"� DATE I SSLJEI n 04/01/,7 ,
. ; PARCEL: 2S102C.T.•s -tzi�� ''0'2 • , '
SITE ADDRES• . , :138115 SW PACIFIC HWY ' - .
wa!'JBBIVI ON., . "NOR r' H' ''i'I,C3f71r{`.l VI>_! E '+?IJG I T {t lm zpm.1.0` 1.C-G , • , .
' .i 1._OCK...".. L_.0.7 , ........ ;'33 JUR':.EL�IC,T�ILDil: TIG ,„ •
F'ro,jcc Des:cr7.'pt,i.crn:e INSTt�LL'tl�1f,�ri?I�:H CIAWiT, ' „ "
.- .- _-RESIDENTIAL UNIT - - -_. _ -TEMP a'R /F,EEi)E:;I E --•• -- , „ ' .MiSCE_LL ANEO! fS- • - - - -" •
1000 SF 'OR' Lr €= SS....,.: "0 - 200 a.nip; . •. ,..... • i •TION: , v Ir1" '
EACH' ADD' L 5005E. ,.: '► 201 - 401+ .r: A: . , . o .: i'° SIGN/OUT LINE LTG... : 0 , • '
'L_,IMITED" EN'ERGY.'.. .. 0 „ , ' 401 - • 600 amp..' . .. 0 IGNfiLJ.F'A iEL-:.. w : ' 0.
MAW. HM/ siC /'FpR.. _ 0. S:01.}ampsi 1:'0I@ volts. a 0 MINOR "LABEL'. t1.0) . 0 '
- - - -_ -SE•RV ICE /FEET EP__ -._- -- -BRANCH-4 CIRCUITS-_ -__ -. , ---,--ADD.' L INSPECTIONS---::- -
- 0 - 200 'amp'. ..... . - 0- W /SERV'ICL. OR FCEDER :•• 0 PER ' IN5PECTI'ON. ; ..: 0 ,
201. - ',4i�ii� am r.). . , , . _ 0 1st W /O' S,,RVC „OR FDR.. '1 • -ER •HOUR. , . . :,'.•. ,'. , � i
• 401 - 600 amp : . O EA' ADD' L ' BpNCH' C•I RC „- 0 ' • ' , IN PLAN? _ ... • . 0
' Gp.i - 12100' amp..... ... = 0 , - ',- .___._.w___-- ___- _- _ -PL.AN REVIEW SECTICNr1- '
10004 a,m•p'/ v n l t ... ,... 0' • ) =4 RES UNITS.... . ' . , '. : . , . ) 606 ' VOLT NOF'i I NAL. .
Reconnect ' only....... .... 0 ,S'JD /Fti ) = 225 A.h1PS'..,.. CLASS A.REA/PPEC OCC. :
❑wne.- -•- ••-- -- - - -- ---- . -• - . - - - -' FEES --7---
H & R BLOCK - • ' , . , type amount by . daitt3 - ,' „ „
,13285 SW PACIFIC -• • a,. ' -- - _ --- - -- - F =RM T 1 ---, - 35.. 00„•C.TB 02•- /20,,l E 36-276081 - - --
BLDG_ D ' -, •SpCT., i • . 1 C.3 S, 0244'0/961, 96-276281
Phone 'W . :, ,
' C1.3ntr'Lr_t Or,, - - -- - --- -- - -- -_-_ - -- -- ,
ATLAS ELECTRICAL CONTRACTORS., . ' :i - ?a,6. 75 TOTAL. • . • • '
"_
_ ; .
REQtJI REl ,:',;INS,PECT'I'ONS .L,-"--- -
MILWAUd'.IF_. OR 97.267 • ' ,, ' Wa C over• , Elect"' I. Fi:ria,i. ,'•, . • ,
- Phone #i•. 2t3 -S' n__, 214 • ' • , , , El'ec:t' 1' Service; a „
. „
This pera t is issued subject to, •e.. regulations contained LP..Mahe , • _ _
Tigard Municipal Cede, State of Ore. .Specialty Codes and all other Perm,it't'ee Signature, .
I' applicable, laws'. A11 r:ork will be one • in accordance with ' " '; ' •, „ '
approved. plans;" , This peroix''•will expire if work• is mgt started ' ,
' within 'i' 0 days or i suance: •cr ^ii work is s ►_spe:rd°d• f .core ,-- .. - _ _ �._�
'than .let days. ' - • . " Issued By!., . - _ . . • ,• -__- -- __-- _ ..___ -: -J7 _
'' - __ -- _ ._OWNER , ? 'TNST'(-�LLFITx'o�i' ONLY • - - --
The installa't °1.o -n' 3. _ __ ca'ei.ng., made o,ii property 'T'rps"an which is not iint 'nd'ed• 'ror' ' , '
. sale, leas,e o•r�'•„r en .- :, . ' , , . . ., ,,.
' OWNER' S S 1GNATUR €= . ' _ _ . �_ . - _ _ _ - ' ' • ' __ 'DA
TE p
_�___ - CONTRh1i .l't7 l Ns TAL,1_r' T I ON i7NJJ\ „- _�__ ..._._ -__ ___ - M _._ _
I
SIGNATURE. o 'FAJP'
S ;- EL€:: - C' N' ',DATTE ,
'1 0ENSE Ni : _ _ • , , „ ' 7 ,. ,. - ;,_ ' ,
' • ;
:. " ''' .. 1 '� Cali t, O'r ].,i1 i�J,rl. . �J�I - �I:l ?rJ • ' I _. _ ' n -• ; ' fi n
J ' . ... - - • • -- -
Community Development ELECTRICAL PERMIT APPLICATION
A 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 9G -, 7/7, 42/
Permit # ELC96 D /oA
A Phone (503) 639 -4171 Date Issued 3! - 2 o -q,
FAX (503) 684 -7297 Issued by C Li i ri.-r _s-,..4,„,.,-1,,,i CITY OF TIGARD TDD No. (503) 684 -2772 y
Inspection (503) 639 -4175
I .. 1. Job Address: 4. Complete Fee Schedule Below:
Name of De elopment H & R Block • Number of Inspections per permit allowed
Add r;s 0' Pa c i f i c Hwy - Bldg. D Service included: Items Cost(ea) Sum
City /State/Zip Beaverton OR 97005 4a. Residential - per unit 4
1000 sq ft or less $11000
Name (or name of business) H & R Block Each additional 500 sq ft or 1
portion thereof $25 00
Cornmercia)( la 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
Electrical Contractor Atlas Electrical
Installation, 20 mp alteration,
or less ,or relocation 2
200 amps or less $60 00 2
—
Address 4403 SE Roethe Road 201 amps to 400 amps $8000 2
City 1i l wa u ki a StatOR Zip 97267 401 amps to 600 amps $120 00 2
-
`7 601 amps to 1000 amps $180 00 2
Phone No. 659 -2212 Over 1000 amps or volts $34000 2
Contractor's License No. 3-2C Reconnect only $5000
Contractor's Board Reg. No. 1532 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n 200 amps or less $5000 2
License No. 2581S Phone No. - .-L. 201 ampsto400amps $7500 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
City State Zip purchase of service or feeder fee. 2
Each branch circuit $5 00
Phone No. b) The fee for branch circuits withou
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit 1 $3500 35.00 2
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 energy 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
j 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
apply. Not required for temporary construction services. 5. Fees:
NOTICE 5a. Enter total of above fees $ 35.00
5% Surcharge (.05 X total fees) $ 1. / 5
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 $ 36.75
won:AmmiaNalscprm app
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: hh
Date: o�f� 1 C 7 A.M Q P.M. Entry:. go-5— go-5— ,
r 7Address:
/ ,� � �/ ��
Tenant: �^ S e: MST:
� Cam' ' ' 5 7 -z L ME
C:
f MEC:
PLM:
ELC: '7 0
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR•
uJ J `-ter
/ a<s
/ /
/Vc1e r
r
Ef t J - _ �. - " i -
Inspector: / /' / cZ en . ( / ?'ZGLJ Dater ?7
APPROVED DISAPPROVED /CALL FOR REINSP. 4 60 CO