Permit CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
1J 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT #: ELC97 - 0105
DATE ISSUED: 02/21/97
PARCEL: 1S136DB -00501
SITE ADDRESS...: 11611 SW PACIIFIC HWY
SUBDIVISION • ZONING:C —G
BLOCK........... LOT •
Project Description: instl 1 branch circuit
- -- 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/O SRVC OR FDR.: 1 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
UNION GOSPEL MINISTRIES type amount by date recpt
3212 SE ANKENY PRMT $ 35.00 TAT 02/21/97 97- 290707
5PCT $ 1.75 TAT 02/21/97 97- 290707
PORTLAND OR 97214
Phone #: 235 -4483
Contractor:
TIGARD ELECTRIC INC $ 36.75 TOTAL
120 S ELLIOTT RD
REQUIRED INSPECTIONS
NEWBERG OR 97132 Ceiling Cover Underground Cove
Phone #: 538 -5000 Wall Cover Elect' 1 Service
Reg # 026064
This permit is issued subject to the regulations contained in the -- / /( a ed
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permitt Signature
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started ANd
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
_-..
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. ��vv �I //
• Tigard, OR 97223 Permit # �Lcq / -0/b.-
/i�,r (. Date Issued /a//97
ltl p`k. "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 ( ,t 1.):0 Csos)ii`L Number of Inspections per permit allowed
Address //6/I •4:c (..-4,-i- h )y SS Service included: Items Cost(ea) Sum
City /State /Zip s A.- 0 it 4a. Residential - per unit
1000 sq. ft. or less $110.00 4
Name (or name of business) l! ( " 5 %� a tL Each additional 500 sq. ft. or
portion thereof $25.00
Commercial X Residential ❑ Limited Energy $25.00 1
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
Electrical Contractor l =� 200 amps or less
. $60.00 2
Address (D- c) -5. , 4 r 1 „ 201 amps to 400 amps $80.00 2
L ) 401 amps to 600 amps $120.00 2
City______ State G Z Zip -7 f� i� 601 amps to 1000 amps $180.00 2
Phone No. _ 51A- sOc.c Over 1000 amps or volts $340.00 2
Job NO. S/ 4735 Reconnect only $50.00 2
contractor's license NO. .3 '� -' ^^ // 3 c 4c. Temporary Services or Feeders
Contractor's Board Reg. No pr sr -4 064-i Installation, alteration, or relocation
Signature of Supr. Elec'n x'171 200 amps or less 2
, U
License No. 3 83. . Phone N 'f"---t..9 `$Q'C) 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 2
City State Zip
purchase of service or feeder fee.
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 i $35.00 � �CX� 2
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 $ dC
NOTICE • 5% Surcharge (.05 X total fees) $ s
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. wardlrnm4aNeMo- ❑ Trust Account #
• Balance Due $ alLIC
( Q -
t D(
- 7/1Y/Y S. 79-9
„Lon/ g s - 7 2 N
>7 Q tyri /
?)/
11
pJ a ' ri
),
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 Reins.
Other: / C
Date: 3 /SI ` 7 A.M. P.M. Entry:
Address: //4 /1 P 71
Tenant: S e: MST:
BUP:
�� ^^ ''
Con /Own: _,l!/ .i� U • MEC:
`7 3O "
--.. ..04/44. PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
I (c- . 1 s , Yt p `
Inspector: / l _i -- -_ &�_� A6 DateCn3 ,651 '?
_APPROVED DISAPPROVED /CALL FOR REINSP. CF CO