Permit CITYOFTIGARD ,
Aet. DEVELOPMENT SERVICES ELECTRICAL PERMIT
1 PERMIT #: ELC98 -0516
.�'! ''� I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/28/98
PARCEL: 25110DB -00702
SITE ADDRESS...: 15410 SW PACIFIC HWY
SUBDIVISION °WILLOW BROOK FARM ZONING:C —G PD
BLOCK LOT • JURISDICTION: TIG
Project Description : Electrical service for installation of a permanent 4'7° x
5'2" wall sign.
' - -- RESIDENTIAL UNIT - - --
1000 SF OR LESS -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
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/O 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
VALVOLINE type amount by date recpt
15410 SW PACIFI C HWY EXPIRED 5PCT $ 42.00 T I GARD 0R 97223 DLH 08/27/98 98- 308660
Phone #:
Contract or:
CMR SIGN SYSTEMS $ 42.00 TOTAL
1820 E BURNSIDE
REQUIRED INSPECTIONS
PORTLAND OR 97214 Ceiling Cover Elect'1 Service
Phone #: 285 -7918 Wall Cover Elect'1 Final
Reg #..: 001042
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
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. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 -001 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling ((503)246 -1987.
Permittee Signature: / ng
-� Issued By: --i-2_
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for
sale, lease, or rent.
OWNER'S SIGNATURE: A/� DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUP R. EL EC" N: /5 ( DATE: 0. :F 7
°
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
......1,4 �+++ +++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
r
.CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Fr`77f1FFD Recd By -'.-H
TIGARD OR 97223 Date Rec'd t/Z 4 1 4 71 °
/ILK; ; - 10 Date to P.E. --- 6TN
Phone (503) 639 -4171, x304 S 9f 'Q / � 4 rint or T ' `'s Date to DST
Inspection (503) 639 -4175 � �� - 5
Incomplete or illegible Wi e no t.beva'ccepted Per CZ 9�-a i6
Fax (503) 684 -7297 Called
1. Job Address: jai, 4. Complete Fee Schedule Below:
Name of Development V d �/ - ?
vL - Number of Inspections per permit allowed
Name (or name of business) AO <) . ervice included: Items Cost Sum
Address 4a. Residential - per unit
City/State/Zip / yr " loco sq. ft. or less $110.00 4
ty P Each additional 500 sq. ft. or
Commercia Residential ❑ po thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation o y:
(Attach copy of all cure 1' n 4b. Services or Feeders
Electrical Con for / ii `� , Installation, alteration, or relocation
Address - • ���-. a■L! 200 amps or less $60.00 2 201 amps to 400 amps $80.00 2
City r State Zip ° MEW 401 amps to 600 amps $120.00 2
Phone No. -7 - ( 3 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
I Reconnect only $50.00 2
Elec. Cont. Lice. No. ate AI
OR State CCB Reg. No. Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n 201 amps to 400 amps $75.00 2 v . 401 amps to 600 amps $100.00 2
License No ,29 a ( Over 600 amps to 1000 volts,
Exp a 1' ' see "b" above.
Phone Nc /� /
- 7 7 l /' 4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address Each branch circui $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 circuit $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
Each sign or outline lighting - 7 $40.00 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. 5. Fees:
4 0 ,ve.. _
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $
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 bpi
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
Total balance Due
$
I: \DSTS \ELC96.APP Rev 9/96
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