Permit ELECTRICAL PERMIT •
PERMIT C
DATE ISSUED:
COMMUNITY DEVELOPMENT DEPARTMENT • PARCEL: 1S1 �6DD - ��8��
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
SITE ADDRESS ° 11b65 SW 671H AVE
SUBDIVISION WEST PORTLAND HEIGHTS ZONING :C -P
BLOCK . LOT..... o ...
Project Description: Install one service or ,feeder and ten branch circuits. . •
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS ° 0 0 - 200 amp 0 PUMP /IRRIGATION : 0
EACH ADD'L S OSF :.0 201.- 400 amp 0 SIGN /OUT LINE LTG..: 0 •
LIMITED ENERGY.....: 0 401 - 600 am 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 - 2 amp ° 1 W /SERVICE OR FEEDER: .10 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 - - --
MERCER OFFICE BUILDING type amount by date recpt
• 11565 St.) 67TH AVE . PRMT $ 110.00 CJS 04/18/96 96- 278357
• SPCT $ 5'.50 CJS 04/18/96 96- 278357
TIGARD OR 97223 • •
Phone #:
Contractor: • -•
GENIE ELECTRIC CONSTRUCTION $ 115.50 TOT
20395 SW AVERY CT
PO BOX 575 • REQUIRED INSPECTIONS -- - - -• --
SHERWOOD OR 97140 Ceiling Cover Elect' 1 Service
Phone #: 503 -631 -8403 • Wall Cover Elect'1 Final
Reg #..: 056639
•
This permit is issued subject to the regulations contained in the _
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm itt ee Signature
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 / 4 / j Sc./1m d/ -
than 180 days. Issued By •
•
• 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: Or) fP/ DATE: �/- /S 96
LICENSE NO /
•
Call for. inspection -•639- -4175
•
•
•
•
V
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # ELC96 - O a39
� � i . Date Issued y- 18 - 96
R ��i Phone (503) 639 -4171
CITY OF TIGARD FAX (503) 684 -7297
TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
f I
Name of Development /2et- Get- 99 8uf`14)
OS Number of Inspections per permit allowed
Address 1/ \S S t Ce 7 7 4 Aye Service included: Items Cost(ea) Sum
City /State /Zip / s & d Off` S / L. ? 3 4a. Residential - per unit
p ' 1000 sq. ft. or less $110.00 4
Name (or name of business) In?c i.- l ce(. -- Each additional 500 sq. ft. or
portion thereof $25.00
Commercial g .. Residential ❑ Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
, / 4b. Services or Feeders
' � / Installation, alteration, or relocation d /
Electrical ContractorGe fie t✓Tre CA C c3'/�S �1if 200 amps or less / $60.00 ‘77 , 2
Address Ro a ox 75 201 amps to 400 amps $80.00 2
CI SAck-w®oc/ State �� - ZI c g7 /ft 401 amps to 600 amps $120.00 2
City p 601 amps to 1000 amps
Phone No. / - -50.1 - 68/- 9 i( 3 Over 1000 amps or volts $340.00 2
Job NO ;? 6',qa- Reconnect only $50.00 2
contractor's license NO. 3a C q -c 4c. Temporary Services or Feeders
Contractor's Board Reg. No. .6. - Installation, alteration, or relocation
Signature of Supr. Elec'n !!i/�arar! «=_ 200 amps or less 2
201 amps to 400 amps $50.00 2
License No. / 5SY - S Phone No. ,ti, 8 �D 401 amps to 600 amps $75.00 2
Over 600 amps to 1000 volts $100.00
2b. For owner installations: see "b" above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
Address a) The fee for branch circuits with 2
City State Zip purchase of service or feeder fe e. d>0.....• y Each branch circuit $5.00 SO
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
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 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
4 or more residential units in one structure Minor Labels (10) $100.00
Service and f eeder 225 amps o r 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 $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: of
5a. Enter total of above fees $ ! a • _
NOTICE 5% Surcharge (.05 X total fees) $ •� 0
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ / 1 S. SO
5b. Enter of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Review
OR WORK IS SUSPENDED OR ABANDONED FOR Plan Reeview if required (Sec.3) $
SO
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ / /.5 -,
COMMENCED. wordkcomdelAeIeo- ❑ Trust Account #
$
prm.app
Balance Due $ 11 5 -
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 - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Rrsi
Other:
Date: _ //5 / A.M. P.M. Entry:
Address: / C? - 7
Tenant: Ste: MST:
• GG / BUP:
Con /Own: F(//43 MEC:
PLM:
ELC: C -iv
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
< Sir / -off
p Air
/ . 5 - --
h / � _ lO�> ' -- pez, f*_._
/44. -p
(` 4 cQ C r T c? J
Inspector Date: f"
APPROVED _ DISAPPROVED /CALL FOR REINSP. CF CO
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 /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: _ cam?
Date: 5 [3 °� // `r A.M. P.M. Entry:
4
Address: / 110 � 2
Tenant: 8 6 Ste: MST:
�+ BUP:
Con /Own: C6 e. ✓ - MEC:
PLM: ,,,
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
frkf. 7`•• /JJ � 4/
r
a ^ tccvj 5 .e g c�
r
I6r An it r!
1 2-P ciz,C C-er eC 1 ' c
Inspector: /f C r -e
_ Date:
APPROVED / DISAPPROVED /CALL FOR REINSP. CF CO
■Pr
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain over /Se ' FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: S f 1 ke A.M. P.M. Entry:
Address: / ! 5
Tenant: Ste: MST:
BUP:
Con /Own: 6Q. c j f -- F U
PLM:
ELC: j (a -D a i�
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
51-1 elfP r e e � f ( f
c /Ls
Gt [l�c E?P e
•
Inspector: " �^y .-t < / r1,( f el Date: S �J?
_APPROVED y DISAPPROVED /CALL FOR REINSP. CF CO
P c
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 /FIr /Slab Plbg. Top Out Insulation 411/2,
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: O q
Date: D d 1 a- ) ! coo A.M. P.M. *Entry:
Entry:
Address: / 1 tJ CP S g 7 ` try..
Tenant: �J1.G (sec/ a Ste: MST:
BUP:
Con /Own: G 9/ -3 4 0 3 MEC:
. ELM: c
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Z ' ("e C- -7 / C ei r .E., .
c
r JP
A Ins .i e. b. _ 4 Date .2 -p/
DISAPPROVED/CALL FOR REINSP. CF CO