Permit CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
��U ltil( PERMIT #: ELC96 -0802
1�► 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/19/96
PARCEL: 2S 10EAD- -02200
SITE ADDRESS. 08900 SW. - BURNHAM RD #F -20 •
SUBDI V I SCION . :'. BURNHAM TRACTS ZONING:CBD
BLOCK.. ... -. ° °.° LOT ° ° ° ° ° ° ° °..... :6
Project Description: installing 3 branch circuits
'.--= RESIDENT'IAL UNIT - - -- - -- -TEMP SRVC /FEEDERS - - -- - - - - -- MISCELLANEOUS
1000 SF OR LESS° ° ° ° : 0 0 - 600 amp...... ° : 0 PUMP/IRRIGATION....: 0
EACH ADD.' L 500SF ,: 0 A „, : 21?+,1,. -. 400 . amp,.:,.. e...,. :, !. ; SIGN /OUT LINE LTG. ° : 0
LIMITED ENERGY.....: 0 401 - 600 amp.......: 0 SIGNAL/PANEL.......: 0
MANF.. HM/ SVCJ,FDRe s,r : 0 60; 14+a .. MINOR 'LABEL (10)...: 0
-- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 - 20+0 amp ... ° ° . ° :. 0 -_,.W/SERVICE DC?,,. FEEDER; :.,, , 0. PER INSPECTION.....: 0
201 -- 400 amp......: 0 1st W/O SRVC OR FDR° : 1 PER HOUR.... ° ° . ° ° . ° : 0
401 - 6021 BRNCH CTRL '. . ° �: IN PLAN e ° ° ..° ° ° .: 0
,,� ,, . T°
60201 - 10000 amp.....: 0 -- - -- - PLAN REVIEW SECTION _-- - - -._-
1000 + amp /vo l t;„ . ° . ! > =4,.. RES..,UNi, f..S. ° ,° ° ) 600. VOLT NOhII.NAL ° :
Reconnect only.....: 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.. :
Owner° - • 7 " - FEES,
DARRELL WAKEFIELD type amount by date recpt
' '8912I0,y.,SW LURNH IM. RD PRINT, , , .. 45°.0I .,TAT 12/19/96.96r-287972
STE F -20 SPCT $ 2.25 TAT 12/19/96 96- 287972
TIGARD OR 97223
Phone #:
Contractor: --
PHOENIX ELECTRIC CO $ 47 °25 TOTAL
7379 SW TECH CENTER. DR
. REQUIRED INSPECTIONS
TIGARD OR 97223 Ceiling Cover Underground Cove
Phone # :, 503 -684 -3600 , Wall Cover . •El.ect',:1.. Service
Reg #° ° : 2647
This permit is issued subject to the regulations contained. in the. -4 7 1 VAhli-)
Tigard Municipal Code,, State of. Ore. Specialty, Codes and. all. other Permittee ignat.ure
applicable laws. All work will be done in accordance with
approved plans. This permit- will expire.,if work 'is• not started ,
within 18O days. of issuance, or if work is suspended for more .. .. . /, . -
than 1130-days.. . - , - • up!
OWNER I NSTALLAT I Ohl ONLY
The,; installation is.. bei, ng;., made,,.. .o,n ► wh: ich i
sale, lease, or rent..
OWNER'S . SIGNATURE: , • • . . D�1TE:
CONTRACTOR INSTALLATION ONLY -- ------ -- - - --
SIGNATURE OF SUPR.. ELEC' N :., DATE' _
LICENSE NO:
• Call for inspect i.on. - 639-4175, .
Community Development ELECTRICAL PERMIT APPLICATION
i to 13125 SW Hall Blvd. /I (�/ h G
Tigard, OR 97223 Permit # gLc -7(p- b 5
ti��,� Date Issued /Z 7/y'
Vl � II Phone (503) 639 -4171
CITY OF TIGARD FAX (503) 684 -7297
TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: (n� 4. Complete Fee Schedule Below:
Name of Developmentl,CO3\C.e:�i�e \ X'\ \CNf`e \\ Number of Inspections per permit allowed
Address t, ` 0 0 -k.-!-- oJ hrr v , -�5- V I4i Service included: Items Cost(ea) Sum
City/State/Zip nY ,
3 - C il r* 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 X Residential Tj(r 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
Installation, alteration, or relocation
Electrical Contractor P `� -1 . -lc F k Q O` , 200 amps or less $60.00 2
Address " v ,.Gh \ 4J P.�t ttt i� 201 amps to 400 amps $80.00 2
' 4 amps to 600 amps $120.00
2
City \ f \ �\ State C� '� Zip ` l 601 amps to 1000 amps $180.00 2
Phone h y a w. \\ \ s la,\( f - \ A. •- Over 1000 amps or volts $340.00
•
2
Job NO. % Y Q i L� j 1 -�1�� Re connect onl y $50.00
contractor's license NO. ' 14- 1r-L- 4c. Temporary Services or Feeders
Contractor's Board Reg. No. a Installation, alteration, or relocation 2
Signature of Supr. Elec'n _. 200 amps or less 2
License No.� / hone No. 1 n t- - l_(� n(� 201 amps to 400 amps $50.00 2
401 amps to 600 amps $75.00
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
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. y 2
not intended for sale, lease or rent. First branch circuit $
Each additional branch circuit $ $ 5.00 Ci11
5.00 t (' ci'.)
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 $ ~. "0
NOTICE 5% Surcharge (.05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ �'1 .`a
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. wordkomdev\eiee- ❑ Trust Account #
$
prm.app _
Balance Due $ L`1, a,3
• 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 ect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date: 3 C 9 A.M. P.M. Entry:
Address: 8 / O L„ fr loldofy(
Tenant: U-) U Ste:F MST:
BUP:
Con /Own: MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Cy/
/.� _5 : /`
r ( I
7/1/ � 1
Inspector: � � � �� ��� Date:
✓\ APPROVED DISAPPROVED /CALL FOR REINSP. AO CO