Permit ELECTRICAL PERMIT
PERMIT #: ELC96 -0282
.GIN OF TIGIARD
DATE ISSUED: 05/03/96
COMMUNITY DEVELOPMENT DEPRTMENT 1 PARCEL: 2S101-09001
SIT 3 himft d. T ie , 'd. 1 0r � 7 fJ' 8 6� T ( p1 )3 1:1 3 0 4 L -4171 12555 5 ""
SUBDIVISION • WEST PORTLAND HEIGHTS es TM A ZONING:C —P
BLOCK • LOT •29 -
Project Description: TEMPORARY SERVICE < 200 AMP FOR TENANT: PRECISION IMAGESETT
ING
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 1 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 0 201 — 400 amp 0 SIGN /OUT LINE LTG..: 0
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/O 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
PRECISION IMAGESETTING type amount by date recpt
12585 SW 68TH AVENUE PRMT $ 50.00 JMH 05/03/96 96- 278582
5PCT $ 2.50 JMH 05/03/96 96- 278582
TIGARD OR 97223
Phone #:
Contractor:
DON RIFE RIFE ELECTRICAL CONTRACTORS $ 52.50 TOTAL
256 NW 23RD AVENUE
REQUIRED INSPECTIONS
PORTLAND OR 97210 Elect'1 Service
Phone #: Elect'1 Final
Reg #..: 072343
e
This permit is issued subject to the regulations contained in the O�`-'�� y` , TO . /94
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm i tt ee Signature
applicable laws. All work will be done in accordance with
^ 1
approved plans. This permit will expire if work is not started . / / , / j / ` ,,�,
within 180 days of issuance, or if work is suspended for more ,.. c r may., _a . 4 4 L i
than 180 days. By
By
OWNER INSTALLATIN ONLY --
The installation is be g made on property I on which is not intended for
sale, lease, or rent.
____C042!g______
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SURR. ELEC' N : 0R.„,...0 0R.„,...0 pi Ze;A DATE: r//
LICENSE NO:
Call for inspection — 639 -4175
•
i.
Community Development ELECTRICAL PERMIT APPLICATION
1 T
Tigard, OR a 97223 Permit # I(U t/c_ 1 D
���rp I Date Issued �1 # 5a')�'f�
��� _Li P hone (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:
Name of Developmen C S7 d ..
/'� rr a // Number of Inspections per permit allowed
Address / 5 X iU (D O 4,4_, Service included: Items Cost(ea) Sum
- 1
City /State /Zip / ii 4a. Residential - per unit
v 1000 sq. ft. or less $110.00 4
Name (or name of business) Each additional 500 sq. ft. or
portion thereof $25.00
Commercial Residential ❑ Limited Energy $ 25 . 00 1
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
' J Installation, alteration, or relocation
Electrical Contractor / G � �� �/ 200 amps or less $60.00 2
Address d5'- 4, A/ &+.d' a 3 Ad6 , Ity,e ? 201 amps to 400 amps $80.00 2
City 1 - L P State_6A_ Zip ,7.;?/ 4 401 amps to 600 amps $120.00 2
601 amps to 1000 amps $180.00 2
Phone No. 4 g 3 P �9 " Over 1000 amps or volts $340.00 2
Job NO. Reconnect only $50 .00 2
contractor's license NO. oa fo " ' 7 G 4c. Temporary Services or Feeders
Contractor's Board Reg. No. _ Installation, alteration, or relocation /
Signature of Supr. Elec'n 200 amps or less 2
License No.., .?7/ /` 201 amps to 400 amps $50.00 T Phone No. :7-,-57,2:11 401 amps to 600 amps $75.00 2
Over 600 amps to 1000 volts $100.00
. 2b. For owner installations: see "b" above.
G � 1 l 4d. Branch Circuits
Print Owner's Name New, alteration or extension per pane
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. 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 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.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:
5a. Enter total of above fees $
NOTICE 5% Surcharge (.05 X total fees) $
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. worthcomdev1ebo- ❑ Trust Account #
$
prm.app
Balance Due $
1
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover / 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 Reins.
Other:
Date: 5 (!o (5 A.M. P.�M.�^ Entry:
Address: C a 4 k. A-C1`e
Tenant: 13-5 Ste: .Aa9g ? .0..-S Z
BUP:
Con /Own: F-A- C� X13 -Pa�3 MEC:
ttt)11 A PL
THE FOLLOWING CORRECTIONS ARE REQUIRED: . •
/4/Cp,
4/ al
Inspector: - / r ,.- . • / ., Date C:n
A_ APPROVED _DISAPPROVED/CALL FOR REINSP. CO