Permit E CG ��� -�s33
CITY OF TIGARD ELECTRIC HERMIT
A DEVELOPMENT SERVICES PERMIT : ELC9 7 _,, 53 -
DATE ISSUED: 08/06/37
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
• PARCEL: 1S136DB --0 600
SITE (DDRESS...:112t11 SW 72ND AVE
SL'FDI'VISION....: ZONING :C• -•G
BLOC14..........: JURISDICTION: TIC
Project Description: temporary service or feeder: 201 asps to 400 amps
- - -RES I DENT I AL UN I T - -- -- - -- TEMP SRVC/FEEDERS--- --------M I SCELLANEOUS-----•---
1000 SF OR LESS • 0 0 -- 200 amp - 1 PUMP /IRRIGATION 0
EACH ADD' L 500SF...: 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 (1.0)...: 0
-- - -- -SERVICE /FEEDER -- - -- - - -- BRANCH CIRCUITS - - - - -- -- -ADD' L INSPECTIONS--- -
0 — 200 amp......: 0 W /rE ^VICE 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' I_ 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: - --------
MCDONALDS CORPORATION type amount by date recpt
5000 SW MEADOWS ROAD, SUITE 230 PRMT $ 50.00 GEO 08/06/97 97- 29800E
LAKE OSWEGO OR 07035 5PCT $ 2.50 GEO 08/06/97 97- 29800E
Phone #:
•
Contractor: - - --- --
ST JOHNS ELECTRIC INC $ 52.50 TOTAL
4415 NE MINNEHAHA
REQUIRED INSPECTIONS - - - -•—
VANCOUVER WA 98661 Ceiling Cover Underground Cove
Phone #: 360 - 693 -5100 Wall Cover Elect'1 Service
Reg #..: 000431
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 -001 -0010 through OAR 952 001 - 1987. You may obtain a copy
of these rules or direct questions t• C 'y cal k (503)246 -1987. /j
Permittee Signature: A' I _ Issued By: /OA .�,;`/ -
_ - - -------- •-------- - - - - -- -OWNER INSTALLATION ONLY - - - - -- -------------------- - - - - --
The installation is being made on property I on which is not intended for
sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
- - - - -- - CONTRACTOR INSTALLATION ONLY -_.
SIGNATURE OF SUPR. ELEC'N: 2 : , DATE: � _ 7
/ - C cr
LICENSE NO: X04 ✓
+ + + + + + + + + + + + + ++ + + + + + ++ + + ++-F ++++++- r-+++++++++++ + + + + + ++++++ + + ++ +++ ++ ++ ++ + +++ +-i + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
++++++-+-++- h+++++++++++++++++++++++++++++++++++++++ + + + +++ + + ++ ++ ++ +++ +-i•-S--I-+ +++ +++ ++
I �
_ • Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. G a te ✓ ?
Tigard, OR 97223 Permit # ` T -
6111,i�l��,;,� A Date Issued
A I Phone (503) 639 -4171
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below: .
Name of Development ' Number of Inspections per permit allowed
1 SW e ZA A . ii ✓t,
Addres cidl n Service included: Items Cost(ea) Sum
City /State /Zip // 9a rd O/2_ �i'7e 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) 4'\c. nn IA iris Each additional 500 sq. ft. or
portion thereof $25.00
-
Commercial X 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
n/� I / Si. Yn n S f � T Installation, alteration, or relocation
Electrical Contractor
h ir. r�,`L � C 200 amps or less $60.00 2
Address yy /5 AM mbnn e kie, If4 > 201 amps to 400 amps $80.00 2
City \. v ►e.e a�,.i�S
- 1 State 1 Zip 9 4 / 401 amps to 600 amps $120.00 2
ty 601 amps to 1000 amps $180.00 2
Phone No. 360 H 9.3-5700 Over 1000 amps or volts $340.00 2
Job NO. Reconnect only $50.00 2
contractor's license NO. 37- 350C', 4c. Temporary Services or Feeders
Contractor's Board Reg. No. . �� Installation, alteration, or relocation
Signature of Supr. Elec'n ,,41.1.r..411,146; 4 6; 200 amps or less 2
201 amps to 400 amps 7 $50.00 c0 O n 2
License No. �30�`/ $ Phone No .f, 6 93-,5/07) 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
purchase of service or feeder fee.
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
not intended for sale, lease or rent. First branch circuit $35.00
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 $ So 0 0
NOTICE 5% Surcharge (.05 X total fees) $ .2 • 50
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ ,S,2. SO
5b. Enter of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review ew if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. wmmcomdeNeko ❑ Trust Account #
$
Prm.V0
Balance Due $ 52.50
1