Permit l
CAN OF TIGARD DATEiISSUED�:'C09 /09/896
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PARCEL: 2S 103DD -01 000
SITE ADDRESS • 13935 SW PACIFIC HWY
SUBDIVISION ZONING:C —G
BLOCK • LOT •
Project Description: Installing one signal 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 • 1
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.: 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
BOSTON MARKET type amount by date recpt
12700 SW NORTH DAKOTA EXPIRED PRMT 40.00 CJS 09/09/96 96- 283712
,PCT 2.00 CJS 09/09/96 96- 283712
TIGARD OR 97223
Phone #:
Contractor:
SUNSET ELECTRIC $ 42.00 TOTAL
1635 SE ENTERPRISE CIRCLE
REQUIRED INSPECTIONS
HILLSBORO OR 97123 Elect'l Service _ _
Phone #: 503- 648 -0735 Elect'l Final
Reg #..: 203
This persit is issued subject to the regulations contained in the i , `�—
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittfe S
applicable laws. All work will be done in accordance with
approved plans. This pereit 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
Community Development ELECTRICAL PERMIT APPLICATION
..- A 13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 2837/ a
A l F . � \ Permit # TLC46 -05R S
.�II I Phone (503) 639 -4171 Date Issued 9- 9- Q
FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772 Issued by r�c. -lP- .‘4,,,.,/,-/-/
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development /3054/t ///(44eL Number of Inspections per permit allowed
Address /, q9 , 3 5-1*) q Jam/ Service included: Items Cost(ea) Sum
City/State2i • (% i
0 . ,_ - 4a. Residential - per unit 4
/ 1000 sq. ft. or less $110.00
-
Name (or name of business) ,s�D/L *t .l:4.(/ Each additional 500 sq. ft or 1
portion thereof $25.00
Commercial Er Residential ❑ Limited Energy $25.00
Each Manut'd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only:
4b. Services or Feeders
Installation, alteration, or relocation 2
Electrical Contract• LLtt,Q.l fie.- 64 i
200 amps or less $60.00 2
Address • _ S 201 amps to 400 amp $80.00 2
_� �" `� 401 amps to 600 amps $120.00 2 -
City /. • S ate d2 Zip 97/9 3 601 amps to 1000 amps $180.00 2
Phone No. ' -O A.. _ r Over 1000 amps or eons $340.00 2
Contractor's License No. 3 /9c Reconnect only $50.00
- Contractor's Board Reg. No. - 6 _ 4c. Temporary Services or Feeders
Installation, alteration, or relocation 2
Signature of Supr. Elec'n J - 200 amps or less $50.00 2
License No. ZOG 95 Phone No 6,19 r 201 amps to 400 amps $75.00 2
F E® Over amps to 600 amps $100.00
Over sot amps to 1000 volts
2b. For owner installations: see 'b' above.
4d. Branch Circuits
Print Owner's Name New, alteration or extension per panel
Address a) The fee for branch circuits with
City State Zip Each bre of a�� or feeder fee. $5.00 2
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
First branch circuit $35.00 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 drare)
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 ins $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:
NOTICE 5a. Enter total of above fees $ 4 . (s
5% Surcharge (.05 X total fees) $ .' (A)
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. ❑ Trust Account # $
Balance Due $ 1,9- ij
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