Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #: ELC96- 0599
DATE ISSUED: 09/17/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 2S 1 10DC- 00200
SITE ADDRESS...: 15660 SW PACIFIC HWY #3 •
SUBDIVISION • WILLOW BROOK FARM ZONING:C -G
BLOCK • LOT :11
1 Project Description: Installing 8 branch circuits.
- -- 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 • 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.: 1 PER HOUR • 0
401 - 600 amp • 0 EA ADD'L BRNCH CIRC: 7 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 --
RELAX THE BACK type amount by date recpt
15660 SW PACIFIC HWY PRMT $ 70.00 CJS 09/17/96 96- 284035
SPOT $ 3.50 CJS 09/17/96 96- 284035
TIGARD OR 97223
Phone #:
Contractor: - .-- - - - - --
WILLAMETTE ELECTRIC INC $ 73.50 TOTAL
PO BOX 230547
REQUIRED INSPECTIONS -- - - - - --
TIGARD OR 97281 Wall Cover Elect'l Service
Phone #: 503-624-3631 Underground Cove Elect'l Final
Reg #..: 75059
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm i tt ee Signature
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started j
within 180 days of issuance, or if work is suspended for more
than 180 days. I s s u e d 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: 9.- t 7 -`tG
LICENSE NO: ._
Call for inspection - 639 -4175
•
• Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # ELC9r - OS99
/4,010,,,,A , Date Issued q- 17- ct6
Phone (503) 639 -4171
_44;1;11i' FAX (503) 684 -7297
CITY OF TIGARD TDD No. (503) 684 -2772
Inspection (503) 639 -4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development I , 5 iNa t7 Pot t Pa.ok-Q Number of Inspections per permit allowed
Address / 346 04-) Pam% riC /)<w y /1 Service included: Items Cost(ea) Sum
City /State /Zip 1 I C' �fl 4a. Residential - per unit
�J pp__ y-� 1000 sq. ft. or less $110.00 4
Name (or name of business) FP I a k X r e rJ Q .tG (( Each additional 500 sq. ft. or
portion thereof $25.00 1
Commercial ,J Residential ❑ Limited Energy $25.00
Each Manurd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
4b. Services or Feeders
p Installation, alteration, or relocation
&
Electrical Contractor r th'a /Id >° e '1 )71r! � s c 200 amps or less $60.00 2
Address PD gem zs6 S l 7- ,,tt 201 amps to 400 amps $80.00 2 2
City sr i m e) t7 State&._ Zip 99- 2 - / 401 amps to 600 amps $180.00 2
`� 601 amps to 1000 amps
Phone N6. u z N - 36"c ) Over 1000 amps or volts $340.00 2
Job NO. qq + Reconnect only
$50.00 2
contractor's license NO. 3 - 2$3 L 4c. Temporary Services or Feeders
Contractor's Board Reg. No. -7,310 `1 . Installation, alteration, or relocation 2
Signature of Supr. Elec'n 200 amps or less 2
License No. /iG S-'c Phon Z Y - r 3 I 201 amps to 400 amps $50.00 2
401 amps to 600 amps $75.00
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
purchase of service or feeder fee. 2
City State Zip Each branch circuit $5.00
Phone No. b) The fee for branch circuits withou 2
The installation is being made on property I own which is purchase of service or feeder fee. 2
First branch circuit / $35.00 3 S
not intended for sale, lease or rent. Each additional branch circuit $5.00 `3 s - j "
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
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: � c 2
5a. Enter total of above fees $
NOTICE 5% 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 Revi ew if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. xordtumdeNeIea ❑ Trust Account #
prm.epp $
Balance Due $ � / 3
t%
Page No. 1 CASE HISTORY FOR CASE NO.: ELC96 -0599
RELAX THE BACK
15660 SW PACIFIC HWY Unit: 3
09/02/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
-- -- --- - -- - - - -- - --
ELCC001 Application received / / / / 09/15/96 RECD DEB 09/17/96 CJS
ELCC003 Permit created / / / / 09/17/96 PEND CJS 09/17/96 CJS
ELCC500 (F)Issue permit / / / / 09/17/96 PASS CJS 09/17/96 CJS
ELCC720 Wall Cover 09/17/96 / / 10/29/96 PASS MJR 10/31/96 MJR
ELCC725 Underground Cover 09/17/96 / / 10/29/96 PASS MJR 10/31/96 MJR
ELCC800 Case Finaled / / / / 11/12/96 PASS MJR 11/12/96 MJR