Permit ' f
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• :21400 D EVELO PMENT SERVICES' "Em1 T T # t E L_C 3 b- 'k1i. =4.i , '
1 , 13125 SW Hall Blvd.; Tigard; OR 97223 (503)'639 -4171 r C ` 0 ` ` -
.i DATE I ittEl? lAr�� E1
: F' :iRC;EL 3 1 S 1;s` DB- 38� '
SITE E ADDRESS. a : a 11.420 SW '3; ND AV,L'
sl_!Dr)I V I GI ON, , , . g DOGWOOD RIDOE . `' 7OI;.i NEl R -'i n 5' ' " ' '
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, LC1T, ��c'11 �' � LF �.a SC:'i "1:ClI� l .� ,. F'1`,`o ec1' pt Installation of 1 branch circuit; • .
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L. 1 �� OR LE3e . " 1 Vl•• ' - 0iZ0 ampia , ,.. rl'.' :, PUrY1F`�'. , I�R'R'I,L(,= H ,i'ON�l. ' _ :!t't:, ,
EACH (DD l�iliSt=:',,'. C! L.1D1 ' 4 17i ± +, anlr1. '.' , . „ z Lr� . �i , S%bei'OUT L INCA.,'LTG.. 111
ENERGY. . . . _ -F -/_ L' �. K.�_ ct � _ R.. �J.:.Oi�;AL._v P���.}i...,... 0;
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-- •' - - -sER I) I CE /FEE E R ---,7 , ; .- •----- B 'RI -I INCH CT Rai t T S - -- -=•- '-- - -ADD' L I NSPECT I ONS
ID ' _• 2.00 a in p,.... .. n c At W/SERV ICE OR FEEDER g,, 0 . _ . PER INSPECT .COIN.. a a y
..;2x'11, - 400 , 1n p ,,,_.a. t 0 1 s Wry SRVC OR =DR.. 1 FCF' HOUR...o.G, F. :_.� .
-401., -- 671 a r? p.. 01 E; 1 ADD' L_ B 'NCH' C•I t�C t , IZ : TN-PLANT . a... e . . _i 1 , '
e - 01 1 i 00 a ' c, . „ ! _ - - - - -- -------------- •---- F'_ AN REV1.EI,J SECT ION- -'--•-----z-•-•----- --- ---
'1.CI IZs-+- ''an? n , „ . 01 - )' =4 RE.E UN:L ._' .., > i z' 'VOLT NOM NAL.,, .
' 'roc un „ne'c't an1,1r;, , .. t 's - �: >VU`. /FDR 5 -4�i' PS,. „ t , ” CLASS '(R'Cf" /BPE:C 0CC.
KEVIN. V,.IPENE - T t type , � ar,?n, +.Mt ' h� -d �t,p •• � i , - : •Era ~L,t , ;
11420. SW 922RD AVENUE '1R1v1T "'S ' , s:;,',, DELI .06/ 2 4 /98. -: 41C=,80' '''
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r `il Ili T1e 'i° 503.-:61-0- 669
C o.rltr - act: 6r, = '-- •' - - - - -- - -.. . -'-_- - _ -, -- --•
'r',EVIN VI>;FN . .. 36. 75 TOTAL
114'20 SW 92ND FIVE - - -, •
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'TIGARD. OR 9?'t'ir.t �C 7.f�c,k; "', 1� Be r'�: °ice
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This pea•,oit is iss!ied to the o the'egula't ions c onta i ned in th'e "Tiga= ttunic•ipal Cods, 'State of Oregon, Specialty Codes and 'a11 'other
applicable kits. " i1 r icariii, 4111 be cone in acto1`dahte With approved plans. This Nernit'wi1.1 expire if wor!{ 1'5 . not started':•Jithin.,1,83 ' •
days of issuance, or if ;fork, is suspended fa; acre than 18 days, W IT:O tlNl , Oregon la:a 1_equir is you to .fo;ilow the •r'ties''adupted by' ,
t' - • f• i t r _ it t n ] -_ G. .1 i a
she Oregan L +t?.it'; l�ctr�ara�_ian�Cerl�er. �t?;,se�,'u =.' �a•L ;.� ser4h in,0,:k.95� �_- v314:'tihrauorh OAR 9r.,0 -��1'- 1'38. You Oav Gb;3i'r, a cop'
of these ',i'y]es'or direct =question, to DUE by ca1iing 1,503`rd45-1•557, -- - -
s'e.r' 'ii•D fi at ?1'+ ^e I 1 _ ' .
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OWNER' s s :Gylf1 T OF E ;. _ kC� -t W V/�GQ? N:Q� _ _ DAT E- , ' ' C y .' ._ 4-_``1_'_ ,tS_�__.:
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CITY OF TIGARD Electrical Permit Application Plan Ch-. '
13125 SW HALL BLVD. Rec'd By 5f
c
TIGARD OR 97223 47 -o0/v Date
Date to ReP.d E. �0
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # LLC.QP-- mii j
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
0 Job Address: II 4. Complete Fee Schedule Below:
Name of Development Dog w 06 d \ , Number of Inspections per permit allowed
Name (or name of business) 44vI 3 5+e' V t QtrJ .. Service included: Items Cost Sum
Address I let 20 5v.) i Znrd I A v c- 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City/State /Zip I [G.A Lb OR ' 7223 Each additional 500 sq. ft. or
l portion thereof $25.00 1
Commercial ❑ Residentia
// `` 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 I 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
201 amps to 400 amps $75.00 2
Signature of Supr. Elec 'n 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
C:1) New, alteration or extension per panel
For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name t fn) 4 t S1r2. PµANIE V tAgnie feeder fee.
Address I I '12_0 S W c i2,4 4 Ave- Each branch circuit $5.00 2
Tt CAM's State b K Zip q 72 2.3 b) The fee for branch
as circuits
City P without purchase of
Phone No. 503 - 6 70- 0 4•61 service or feeder fee. , - - 0 0
i
First branch circuit $35.00 3 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
,...----- / (Service or feeder not included)
Owner's Signature �Y✓� f1abui ?J aO&.i2. Each pump or irrigation circle $40.00 2
Each sign or outline lighting - $40.00 2
3. Plan 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. S. Fees: 55 . a
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ I . 7 C
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 ❑Trust Account # 3/ ,
TIME AFTER WORK IS COMMENCED.
Total balance Due $
I \DSTS \ELC96.APP Rev 9/96
L g....i.i4e____
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: ( /a.5 Iqr A.M. SO K MST:
Location: I I 1-Fiti () _h Ci(pe BUP:
Tenant: Suite: Bldg: MEC:
Contractor: 3tiphiuntib Phone: (2 70 - L. ( / PLM:
Owner:
C ? — 3 (// /
OA, ��� Phone:
yvrtpu1.0wn.0 _ yH.PAI , t p-h ELR: J i /J' 6,
BUILDING BLDG (con't) PLUMBING MECHANICAL E S SITE 1
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In ei mg, 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 Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved ' o roved Not Approved
FINAL FINAL FINAL <111" ar.i. FINAL
l ��.L Al . If CL e- 9� eve y - .200a f- 6o Cu L/Z/Q as'
It) 3--. AA-4 ,....4.-Z, .- 46-,'7
"ei-Ai, f 'GL 96 - Do 6 .e L= ' .De- rc -+ /'MfJ.'
rc., +2 o d cam. -- / : L
a. f. a - r . 'I P 1 : e et ,o0/-4 CZ) 1,0:7 /ee-y%e%d?
O Call for reinspection O Reinspection fee of $ // required before next inspection O Unable to inspect
Inspector: ,0 Date: h' " 2f' 9P Page of