Permit . „ . ,
, , cfir OF .TIGARD .,. ELr�CTRIs..,fL F'F'sRMI•r , ,;
� „,. ��� €«i'
DEVELOPMENT _ 'SER . ' ',', • 'r R4IT �r'Ei.'7, , .3rf,a7, u :'
; , l .. DI'T ISSUED ,' _/ 4,' -4 "~ , -
13125 SW' Hall. Blvd.; Tigard, OR 97223 (503)639.4171 , ,� ' ,. '
rr yy''''�t ('�. SW tt PAC T T ••��,, 'r f -YRC. EL. , 2S 1 151-3A `004 '�. , L .. '
I :.�_'i1=„4tn- DDi- . }y3. 1bST_ +ILO' SW PACIFIC 1- 114Y,,• %X , ,
:.2,uDDI V I c :r la6'tia n a , , , . 'zO; : 'a:C'_ ,
a a a TUR LSD I CT I ON1:,-,:' T I�G' -' '
' I: r ^cc. ect D snr' i pi.; i'on'; . tJn ,three ( new b rar;:,`� c and one 'll ner' s
circuit/ - . - - 1, -
..
B t r FEEDERS"- _ . - C t r I r € S :
irtC��DC(T €:AL U€'w�"�- €Ire° C.1:tiCi E DC..s� - (� €?S�ELLr�1•.�� i,s_.
1000 Sr OR LESS. ,a _?r ' Zs'' E00• ama'. a . a'.. s n 0 • • , PUril'= /IRRI GAT ION. o a n a r%I .
E aCF: DD' L: '50.2. ! ' = a -n , g 2 201 - 40: ainipa n . r. a o . a I Z + • S I WN /OUT LINE LTG; e '.0 . •
L MI E.D' ENERGY = 40,1 -' GOO' 'amp. n . g ..iii . 'SIGNAL /PANEL.., _, - -I.
i`•lrh+;:° 1 -111/ PVC /FD . -0 ' Ci ?r °I-am 7s'•1;LI 'y$ ',i-olts. o 0 , 'iiNGR LABEL''':lcod,; n - v..1
. ._.__ /r==EDER - ---- , - • - -• - 'BRANCH ^ -CIRO T.TS-- - - -•-- - - -- rD'D9 L_ INEC
ID LZn. amp. ; a a ... 0 ,,,.W CR FEEDER ;' 4?•' ' PER ''- IDied .....'t 0 201 -•. 40'0, z- in p. . , . rig "l st W /0' SA Ye. OR FDR., :. - ', PER. HOUR. . . o . e r� ' ,
:,401,7 GOO amp,—;.,....t.'0 - .,'Elr 'PDW.:L ,BRNCH C7i' Co: 2 - IN PLAFF . . ..a o 0. •
, .G0 1 -- '1+o ainp. , 'g '0 '_ - PL.Ahi RL.VIEW SEC71.10;d:- • -•-
i.,000 : am,1o 1t' a ., a a''g 0 ' _ ' > -4 'RES JNITS. a a ; C2II2+ VOLT €\JQMINAL, _„ -
F;ee r crn 1 u . a a `{+ SV /FDR } - 225 • Ati,IPS . ' CLASS r tRC JS C 200
• MA k31-:ALL' S, , - , ' ' ' Ly.F..e ainnt.mt ' b date, -2', - ' r‘eca•L '
• 1 c •y , 1%hi7r 'SL In "_.utr ._ _-. - - - -- -_ -- _,'-- _..40.1 Iv! T . �, —• 5.1 .7leh, - -T il- S_'. -1'4 i�yr �_I_C7 : - .7 s7l94 —
i ' -F 1, ARD 97.E2C ,.� ' • ' 'F5PC $, � - .,E5. I TJH � ,11_.>.f,4v / - ��,1 � 9 t .',0s 94-'3 s .,
.74 -ate '' n.s
C 0ri l :, r'aCt 0l'„ - - - -, . - - - -;�'- - - - -- . -, - 7:..,„7 -.- -- •' - --- - --• •- - -_ — - -'- --- -- , i L ,
BROADWAY, ELECT f�IC:` ". It IN k ','�::.,';'. fl1_
' PCIJ BOX 33524., %-,... , " '
' -- REE:G6U I RED , =I NSPECTI.'3Ct1S. . _ -_ •
. SE_ iTTLE WA.' ,9`8.1Z-3:7,--.0,7•i24 . ', , Cei 1. inn Cover,.. ..Ei ct�
..' 1, S rerV �' .c , , .. .
1 -liotl 17"1 '234 6564 .. ' a1I l_.GVer di:;'''-' E ei',Fi ial '
R'e $4, 000 „ .1
'
• his . oergit,'is issued s -ta the regulations c
.T, contained in the Tigard tMunicipal Code, State of'Grajon Sp'eciaity' Codes and a1i er .
applicable lays., , Fr l• iGV,it i411 to done in accordance , ;it�i aoo -'owed plans. ' 'This .emit will, er;oirne, if -.wofk i5 not started Witt a r'1,180
days of i5suanc~e Or if v:drk 'is ,suspended for pore than i8Z days, '',_TTE !Oregon law requires .you,t - o,' fallow,, the rules ado; ted by
the Oregon, Ali ity ftotif ;Cation Center. Th05e miles arc; set - forth in i3rZR'3552 i1- Zl10, through OAR E- Z —i987u , You ay Obtain =a coo, ,
L 1 t 1. t 4 3 - I �,
.of these rules d ,direct ques�ian3' �o Wet by calling 1,5Z3)2467,4387.
Pei mi t ,ee S.r
',. ionatL .A. rr' d C J soap' , By n ' •
..:. -._ - _--- _- - - -- - -. -.- . = -- - - OWNER INs ,ONLY- _.- _--- _.._ -- - - - — , -•--- -- -- 7
T il c' , ,, , ii ' c i , is bin ,io.Ide c n tJi a 4ttrn ''t41 - ri.ch i'S not - irli ,eTI•C1ed 'F'ci7, , - ' - . ,
' ;a 7o. _ .1,E,a5” or_ _rerii; o . . : ° - " =
OWNER.,' C ,CTCNA T 11F:r a � '? _ ' DATE :, : . •
ONLY,----- `f _ _
�..� ._ ":74,1.”' . _ ..____ � .,, -CC�!� nRCTsTR .I1 -•1S f1L.L' �i' ION, „_ -....
S ION TURE ;' O 6UPR. EL
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_, T' 'DATE g ; _� �. . _ ,.
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L.,I -C NSE 'ril '�' c '�'I�V' ' ,
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•444 = `r'•{- ,'.�r.4:•i •ter-- t--F..1- .-.,.;;,;.-4,: {',-.Ac-i-:;,:.•,± +1:, f..}.'.L'..:F'.4. .y 71` ±+ 1^ fr E7• r ti<;- 1-- 4-; d- ti••r1-÷- I-,^ri 4,: -1.7, - ÷ i- -1- 'i "'^'I ",,i ,,
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ELe?7- .20752
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
,' , : Permit # 91 943
. i I Phone (503) 639 -4171 Date Issued Il /14 /3
°� ' L f " " FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by TGRr;i �ANSo1�
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development ent f 1 Number of Inspections per permit allowed
Address 10–.0 SO RI�T1 C � y Service included: Items Cost(ea) Sum
City/State/Zip —Ti C Residential - per unit 4a. Residenti 4
J M AX h al is 1000 $ „000
Name (or name o busine Each ad 50 ft or
additlonal 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
� � e(t f � In 200 atlon, alteration, or relocation 2
Electrical contractor C����f �t �l 200 amps or less $60.00
C re (Q 7A.Arl 60 20, amps ►o 0 amps $60.00 2
sot amps to 600 amps $120 00 2 — ( ,`l yt( State Zip 1_i 601 amps to 1000 amps $180 00 2
Phone No. Over 1000 amps or volts $340 00 2
—
Contractor's License No. 3`7 C-0 Reconned only $50.00
Contractor's Board Reg. No. .� ,. 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Sur. Elec'n � v.-.-. 200 amps or less $5000 2
License No. 3) vi_s Phone No. 2=34. (oSoy 201 amps to 400 amps
y- $7500 2
401 amps to 600 amps $100 00
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
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 a 2
First branch circuit $35 00 3S 2
not intended for sale, lease or rent. Each additional branch circuit $500 la
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or imgation circle $40 00 2 — Each sign or outline lighting $40 00
Signal circuit(s) or a limited energy 40 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.0 Chapter 5 Per inspectio $35 o0
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 $ 8
�
5% Surcharge (.05 X total fees) $ 4r,5
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ A y, 1-5
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 $ iq.0
rpd)comd„Mlaaprm app
j /95i- 53 ;s
•
RE CEIVED
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COMMUNITY DEVELOPPSFNT