Permit CITY OF T ELECTRICAL PERMIT
` �a, : ;,i DEVELOPMENT SERVICES PERMIT #: ELC97 -0666
1,L -11. I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10 / 14 / 97
PARCEL: 2S115BA -00101
SITE ADDRESS...:16200 SW PACIFIC HWY #X
SUBDIVISION ZONING:C —G
BLOCK LOT • JURISDICTION: TIG
Project Description : Installation of sign outlining.
- -- 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..: 2
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
CAPITAL /BIT HOLDINGS TWELVE IN type amount by date recpt
C/O FORUM PROPERTIES PRMT $ 80.00 DRA 10/10/97 97- 299965
8705 SW NIMBUS SPCT $ 4.00 DRA 10/10/97 97- 299965
BEAVERTON OR 97005
Phone #:
Contractor:
BLAZE SIGNS OF OREGON $ 84.00 TOTAL
PO BOX 23910
REQUIRED INSPECTIONS
PORTLAND OR 97281 -3910 Ceiling Cover Elect'1 Service
Phone #: 639 -3262 Wall Cover Elect'1 Final
Reg #..: 000643
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 for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952-91 -0010 through OAR 952-001 -1987. You lay obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: app ✓!/-�' Iss ued B • • k (74a„bak(L
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for
sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' N : „ d pp ✓yy1 DATE: /oI'd 47
LICENSE NO: 157 6 14)
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Electrical Permit Application Plan Ch
13125 SW HALL BLVD. Q Recd
'
TIGARD OR 97223 x l /011 Date Rec I d'ld'
' Date to P.E.
Phone (503) 639 -4171, x304
Print or Type Date to DST
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # F. �(.j.ci 7- 0060
Fax (503) 684 -7297 Called
1. Job Address: , 4. Complete Fee Schedule Below:
/►/�
Name of Development 1►1 C Number of inspections per permit allowed
Name (or name of business) Service included: Items Cost Sum
Address / h C') O 5 1 4 Pa-e . d 14-r.c)-1 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
City /State/Zip. '7' to -hc'f, i Each additional 500 sq. ft. or
Commercial 1 Residential El Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of al - rr =nt licens: - 4b. Services or Feeders
Electrical • tracto , � I alteration, or relocation
200 amps or less $60.00 2
Address 41. j 201 amps to 400 amps $80.00 2
City . r _.. l2 2 State _g_ Zip : 401 amps to 600 amps $120.00 2
Phone No. fos ? 3.D. C., _ 601 amps to 1000 amps $180.00 2
Job No. / - 1..<4 Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 4Ifi 2 Exp.Date :4-D 7 -- dU
OR State CCB Reg. No. i Z 7.3V D'L`Exp.Date .47- I - 1 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Jo / '3 Exp.Date / / q Y Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n 1 - , Y _.7-1,_ ae. �� 10,0 401 amps to 600 amps $75.00
100.00 2 2
Over 600 amps to 1000 volts,
License No. 1 :7'7 5 /� Exp.Date /0 -1 d l
Phone No. (3 9 1 "P- 6 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting 2 $40.00 C) 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. 5. Fees: d-
Not required for temporary construction services. 5a. Enter total of above fees $ Y
5% Surcharge (.05 X total fees) $ a 7
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 # C
$ O • at)
Total balance Due
I:\DSTS \ELC96.APP Rev 9/96
1
6/30/99 Activities for Case #: ELC97 -00666
4:42:27 PM -
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELCC001 Application received 10/10/97 DRA RECD DRA 10/10/97
ELCC003 Permit created 10/10/97 DRA PASS DRA 10/10/97
ELCC720 Wall Cover 11/18/97 MJR PASS MJR 11/18/97
ELCC799 Elects Final 11/18/97 MJR PASS MJR 11/18/97
ELCC400 (F)Ready to issue 10/10/97 DRA PASS DRA 10/10/97
ELCC500 (F)Issue permit 10/14/97 DRA PASS . DRA 10/14/97
ELCC800 Case Finaled 11/18/97 ' MJR PASS MJR 11/18/97
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