Permit ,r
CITY OF TIGARD
�� A\ DEVELOPMENT SERVICES ELECTRICAL PERMIT
���' I�i'I PERMIT #: ELC97 -0087
13125 SW HaII Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 02/14/97
PARCEL: 25110AB -00200
SITE ADDRESS.—: 14.385 SW PACIFIC HWY
SUBDIVISION : CANTERBUURY PLACE ZONING:C —G
BLOCK • LOT • 1 -3
Project Description: INSTL 1 SIGN /OUTLINE LIGHTING
- -- 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..: 1
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.: 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
BEDMART type amount by date recpt
14385 SW PACIFIC HWY PRMT $ 40.00 TAT 02/14/97 97- 290419
SPOT $ 2.00 TAT 02/14/97 97- 290419
TIGARD OR 97223
Phone #:
Contractor:
WEBBER ELECTRIC $ 42.00 TOTAL
4550 NE ALBERTA ST
FVOlffl"IMar' REQUIRED INSPECTIONS
PORTLAND OR 97218 " " Ceiling Cover Underground Cove
Phone #: 281 -9246 ������ Wall Cover Elect'l Service
Reg #..: 000357
This peroit is issued subject to the regulations contained in the -� / /l 0
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm t e S i g n a
applicable laws. All work will be done in accordance with
approved plans. This peruit will expire if work is not started
within 180 days of issuance, or if work is suspended for tore _ AI , ■ Of L_ _ .
than 180 days. Issued By /
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 : DATE:
LICENSE NO:
Call for inspection — 639 -4175
I
€ITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit # Offs � 1
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business)/ 0" A in Service included: Items Cost Sum
Address 1 .5" SW Rte 14 i G 5 / 4a. Residential - per unit
p /
7/ CAR Cl , n 1000 sq. ft. or less $110.00 4
City/State/Zip C99 /� Each additional 500 sq. ft. or
Commercial r i l Residential ❑ portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of :, I c rrent icense 4b. Services or Feeders
Electrical Co tract. • ' •
II� i , L , _ I Installation, alteration, or relocation
Add - s ' S� _Ti L - !7A∎ ` ! a 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City t .' ' Zip ,_ 401 amps to 600 amps $120.00 2
Phone No. 7 g /
In �. l 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. ,a10.6 C.. Exp.Date /o 5
OR State CCB Reg. No._ " I� Exp.Date �7" ? 97 4c. Temporary Services or Feeders
COT Business Tax or Metro c / d9 Exp.Date 7-/- 47 Installation, alteration, or relocation
200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec n� 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. 6S Exp.Datel 0 - /- 7.13
see "b" above.
Phone No. p_' I.9 zi. b 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installationsex a) The fee for branch circuits with
�� D purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee. ,
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting - 7 - $40.00 Ain ory 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 • In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. S. Fees: / h o
Not required for temporary construction services. 5a. Enter total of above fees $ `7
5% Surcharge (.05 X total fees) $ A pP
NOTICE • Subtotal $ Sl a`
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # �[
Total balance Due $ 'j
I: \DSTS \ELC96.APP Rev 9/96