Permit •
ELECTRICAL PERMIT
4'`—CITY OF T I GARD DATE PERMIT ISSUED: C 11 /22/95
COMMUNITY DEVELOPMENT DEPARTMENT PARCEL: 1 S 136AD -06100
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
SITE ADDRESS...: 11419 SW PACIFIC HWY
SUBDIVISION • ZONING:C —G
BLOCK • LOT •
Project Description: Tenant improvement
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 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 (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/0 SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 7 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
BUSTERS SMOKEHOUSE type amount by date recpt
11419 SW PACIFIC HWY PRMT $ 70.00 B 11/22/95 95- 273147
5PCT $ 3.50 B 11/22/95 95- 273147
TIGARD OR 97223
Phone #:
Contractor:
BLOCK & SON ELECTRIC $ 73.50 TOTAL
PO BOX 1062
REQUIRED INSPECTIONS
WELCHES OR 97067 Ceiling Cover Elect'1 Service
Phone #: Wall Cover Elect'1 Final
Reg #..: 079104
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other ' rm it t e e S ' • n at u e
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. 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: DATE:
LICENSE NO:
Call for inspection — 639 -4175
_ 111111111111.1.11111M
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # t �O51
,„„ �.ell�,� , � Date Issued 1\ 724S
Ai- r .� 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 84 T4 /s 5,„0 le e. Number of Inspections per permit allowed
Address //6// s A, 7i c �u'y Service included: Items Cost(ea) Sum
City /State /Zip 7 e at✓ "n 9 7 Z >? 3 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of b siness) "if/7;24? Each additional 500 sq. ft. or
portion thereof $25.00
Commercial Residential ❑ Limited Energy $25.00 1
Each Manurd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
Electrical c...gntc3 / 6. 44 - C Installation, alteration, or relocation
r0 l_ v ���111 $60.00 2
Address 200 amps or less
Addre c /04:7a- / 201 amps to 400 amps $80.00 2
City W OkCtilaS State p ^ Zip 7 /o/p 2 401 amps to 600 amps $120.00 2
2
Phone No. 4 f1' - 9800 Over t a
000ampso volts $340.00 2
Job NO. Reconnect only
$50.00 2
contractor's license NO. .3 - 3 • / C/ 4c. Temporary Services or Feeders
Contractor's Board Reg. No. V" '9 I nstallation, alteration, or relocation
Signature of Supr. Elec'n 1 1� ` ���%�- 200 amps or less 2 2
License No. ,3� .2 .. 'hone No. 60(08- 9,00 201 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 withou
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 -&-
Each additional branch circuit 7 $5.00 ? 5 Q+
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 $ 70- °W
NOTICE 5% Surcharge (.05 X total fees) $ j, 5
PERMITS BECOME VOID IF WORK OR CONSTRUCTION . Subtotal $ 1.3- g`U
5b. Enter 25% of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
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. wurdicnmdMeko- ❑ Trust Account #
$
prm.apv
Balance Due $ 7 3,5-0
02/22/2000 Activities for Case #: ELC95 -00572
2:17:11 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done Disp. Level By Updated Notes
ELCC001 Application received 11/22/1995 B PEND B 11/22/1995
ELCC500 (F)Issue permit 11/22/1995 B PASS B 11/22/1995
ELCC720 Wall Cover 11/30/1995 MJR PASS MJR 11/30/1995
ELCC799 Elect'I Final 12/26/1995 MJR PASS MJR 12/26/1995
ELCC800 Case Fineled 12/26/1995 MJR YES MJR 12/26/1995
•
•
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec -O- Phone): 639 -4175 Business Phone: 639 -4171
1
Inspection: J!--- -
Footing Susp. Ceiling Sprink. Rough -in Appr /Sdwlk
Foundation Plbg. Underslab Mech. Rough -in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough -in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing - Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. __
Date Requested: ))_ /2_ ,./ 9 c j Time: AM PM
Address: !/ 1 4 I q p H
Builder: cis-6)--8,3g41 B C..4-4- SIN Permit #: ( ,- 057 L
THE FOLLOWING CORRECTIONS ARE REQUIRED:
CF
Inspector: /� r dP • i _i Date: 0 ^ �d - 1 ' fr .
✓ APPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE
_Call For Reinsp. n 4_,