Permit CITY OFTIGARD
,,, .,; DEVELOPMENT SERVICES ELECTRICAL PERMIT
- ,„ 1 " 1 1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT #: E LC96 —�D730
DATE ISSUED: 11/13/96
PARCEL: 2S110DB -00703
SITE ADDRESS...: 15348 SW PACIFIC HWY
SUBDIVISION • ZONING:
BLOCK • LOT •
Project Description: Les Schwab Temporary Service
200 or less at job site
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 1 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.: 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
LES SCHWAB TIRE CENTERS INC type amount by date recpt
PO BOX 667 PRMT $ 50.00 JMH 11/13/96 HNDWRITTEN
5PCT $ 2.50 JMH 11/13/96 HNDWRITTEN
PRINEVILLE OR 97754
Phone #: 541 - 447 -9162
Contractor:
TUALATIN ELECTRIC $ 52.50 TOTAL
PO BOX 655
REQ IRED INSPECTIONS
WILSONVILLE OR 97070 Under. •un. ..ve Elect' 1 Final
Phone #: 503- 682 -2955 Elec' S . e
Reg #..: 65650
( (
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other ' ermi t.le Signa _ire
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. sued By
OWNER INSTALLATI N 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
(,vii i!- I -To r'
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. �, D 3o
Tigard, OR 97223 Permit # (�i i c_ot -
�. Date Issued
// 7th �+
. ,.�
� I Phone (503) 639 -4171
FAX (503) 684 -7297 /�
CITY OF TIGARD TDD No. (503) 684 -2772 6 1 ft i_g c, ;25 c o 7 d:
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Sc.. k (,.-u (1 Number of Inspections per permit allowed
Address )S3 L iq S. 1 4- , - 1 6',1P--3 t. ,g_w-, Service included: Items Cost(ea) Sum
City /State /Zip ' 4 .-A o - ' 71.1 e2 y 4a. Residential - per unit
/ / 1000 sq. ft. or less $110.00 4
Name (or name of business) L -e--5 � vi,..,., 6 Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial 1Fr Residential El Limited Energy $25.00
Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
-
2a. Contractor installation only:
4b. Services or Feeders
,� r Installation, alteration, or relocation
Electrical Contractor V atati � �,.• v. 200 amps or less 4 $60.00 2
Address Po. 4,... aF- 4 SS 201 amps to 400 amps $80.00 2
City (.: /sue ;Jk State 0A- Zip 91-,/o 401 amps to 600 amps $120 2 2
- St q 601 amps to 1000 amps
Phone No. "2 -s29ss Over 1000 amps or volts $340.00 2
Job NO. S N L Reconnect only 00 2
contractor's license NO. 6 1, G 4c. Tern, • Services oo� Csere . ♦�
�^
Contractor's Board Reg. No. - SC - lnst , •n, alteration, or reloeatid
Signature of Supr. Elec'n lA us amps or less --1- 4 -- 2
License No. 3 ( t 9 • 01 amps l0 400 amps $50.00
,i SS 3 S ' hone N. 6s.2 " j .1 amps to 600 amps $75.00
Over - . . . t o .. : 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 feede fee. 2
City State Zip
Each branch circuit $5.00 Ai • g•
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
not intended for sale, lease or rent. Eddch e b $35.00
Each addkion 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 circult(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 O ' j (1 - 1 $ •
NOTICE 5% Surcharge (.05 X total fees) '� J ' Z • .$ -
�lI
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal _- .--:' $ -1h r
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) $ 07 10
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal (t $ I I ti'i
COMMENCED. va ❑ T Account # :'� JC $
Wm.aPP r ' .
Balance Due //_; 1 , _ ' $ �y y y
f ,
eAttnakc BO F6 -a-53 ._ , .
Page No. 1 CASE HISTORY FOR CASE NO.: ELC96 -0730 -
LES SCHWAB TIRE CENTERS INC
15348 SW PACIFIC HWY
09/17/97
Action Description Reg/ Schd/ End/ Action Notes Disp By Update . Upd
Code Sent Done Done Date By
ELCC003 Permit created / / / / 11/13/96 PAID JMH 11/13/96 J *H
ELCC500 (F)Issue permit / / / / 11/13/96 PAID JMH 11/13/96 J *H
ELCC725 Underground Cover 11/13/96 / / 11/13/96 11/13/96 J *H
ELCC730 Elect'1 Service 11/13/96 / / 11/15/96 grounding electrode conductor to DIS MJR 11/18/96 MJR
terminate at neutral bar
ELCC800 Case Finaled / / / / 11/20/96 PASS MJR 11/20/96 MJR
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