Permit {
CITY OF TIGARD
ELECTRICAL PERMIT
PERMIT #: CAL ELC2000-00525
DEVELOPMENT SERVICES DATE ISSUED: 9/1/00
I I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S110DC -02200
SITE ADDRESS: 15570 SW PACIFIC HWY
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Installation of lighting for one sign.
- RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD CENTER LP GALLAGHER ELECTRIC
9777 WILSHIRE BLVD #609 2895 NE DIVISION
BEVERLY HILL, CA 90212 PO BOX 70
GRESHAM, OR 97030
Phone: Phone: 666 -8816
Reg #: LIC 13536
SUP 634S
ELE 26 -533C
FEES Required Inspections
Type By Date Amount Receipt
Elect'l Service
PRMT CTR 9/1/00 $42.75 2720000000( Elect'I Final
5PCT CTR 9/1/00 $3.42 2720000000(
Total $46.17
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE u��� ISSUED =
.JCL i
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. ELE 'N: o DATE:
LICENSE NO: 6
Call 639 -4175 by 7:00pm for an inspection the next business day
•
Community Development® ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. 4) Q�
Tigard, OR 97223 445 Q `L Q � # Ece- t �J��
,��,,�l,,�l� I ,� � �9 ate Issued 9 -�'
��I l i Phone (503) 639 -4171 J� 9c.
FAX (503) 684 -7297 Q` C"
CITY OF TIGARD TDD No. (503) 684 -2772 Ar
Inspection (503) 639 -4175 is r
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development c , - l A ' / Number of Inspections per permit allowed
Address ( 5 S - w f I t !1 . �
tC_ m y Service included: Items Cost(ea) Sum
C ity /State /Zip �1 (4i V
) 2_. 6 112-73 4a. Residential - per unit
busi
( r) ``! _ _ _ . 1� Y l Each sq. fn. additional 5 sq. ft. or
less $110.00 4
Name r name f ne s �{ w F/ Each l 50
p , ] \ portion thereof $25.00
mmercial Residential 111 Limited Energy $25.00 1
n ' Each Maned Home or Modular
t I OA a CAkt ; Dwelling Service or Feeder $68.00 2
Contractor installation only:
4b. Services or Feeders
to . � , Installation, alteration, or relocation
Electrical ntract&w nea-- y 200 amps or less $60.00 2
Address fj hex 1,b 201 amps to 400 amps $80.00 2
Cit A 2 34fhl State 0 Y` Zi '7Q '; 401 amps to 600 amps $120.00 2
y (�,�j p 601 amps to 1000 amps $180.00 2
Phone No. (.00 Co -k ( Over 1000 amps or volts $340.00 2
E Reconnect only $50.00 2
Job NO. �{
contractor's license NO. e2(t) S 3 3 1. 4c. Temporary Services or Feeders
Contractor's Board Reg. No. a. S - Installation, alteration, or relocation
g p '�� 200 amps or less 2
Signature of Su r. Elec'n 201 amps to 400 amps License No. (04 Phone o. �rLagji 401 amps to 600 amps $75.0 2
2
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
City State Zip purchase of service or feeder fee. • 2
Each branch circuit $5.00
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
not intended for sale, lease or rent. Eat ddcha blt $$5.00
Each a additionnal 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 $491R7
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: $ /� - 1 . 5
5a. Enter total of above fees /
NOTICE a eJ, Surcharge (.05 X total fees)
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. wordlwrndeNeleo ❑ Trust Account #
prm.epp
Balance Due $ `t '(P