Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC98 -0451
DATE ISSUED: 08/04/98
::_.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171
PARCEL: 2511ODC -02200
SITE ADDRESS...:1566O SW PACIFIC HWY #2
SUBDIVISION •WILLOW BROOK FARM ZONING:C —G
BLOCK • LOT •011 JURISDICTION: TIG
Project Description : Add a first branch circuit.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 5O0SF...: 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/O SRVC OR FDR.: 1 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
HOGI YOGI type amount by date recpt
15660 SW PACIFIC HWY PRMT $ 35.00 GEO 08/04/98 98- 307978
TIGARD OR 97224 SPCT $ 1.75 GEO 08/04/98 98- 307978
Phone #:
Contractor:
$ 36.75 TOTAL
REQUIRED INSPECTIONS
Elect' 1 Service
Phone #: Elect'1 Final
Reg #.. :
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 ( s 246 -1987. ,
�Permittee Signature: / Issued B -1 /
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 �� c
SIGNATURE OF SUPR. ELEC' N : c 7 J DATE: �
LICENSE NO: 4 R6qq S
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + ++
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. RECEIVED Rec'd By
TIGARD OR 97223 Date Recd
Date to P.E.
Phone (503) 639 -4171, x304 AUG - 4 199 Date to DST
Inspection (503) 639 -4175 Print or Type Permit # GC°9.f�-CJ�
Fax (503) 684 -7297 Incomplete or illegiblquinjotpylaccepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
``''
Name (or name of business) H Y2 y A. Service included: Items Cost Sum
Address 456 fee ) 5.%-v. f LCD ikw y
4a. Residential - per unit
Ci City/State/Zip `7T r4 . per. Each additional it or less $110.00 4
tY p � � Each additional 500 sq. ft. or
Commercial Residential 1=1 Limited 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 all current licensesp / . ' � / ( � ,� . 4b. Services or Feeders
Electrical Contractor ; �/>E�c ' w Installation, alteration, or relocation
Address 1927 - 2/ s Ala -e- 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City i+ .rrsr er,dG State �•2-- Zip 97 / /Cv 401 amps to 600 amps $120.00 2
Phone No. 3S7 -4o/3 601 amps to 1000 amps $180.00 2
Job No. I V009 Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 34-520- Exp.Date /Of r
Reconnect only $50.00 2
OR State CCB Reg. No. 2/59 4 Exp.Date /e/g e 4c. Temporary Services or Feeders
COT Business Tax or Metro N cer Exp.D a 4/99 Installation, alteration, or relocation
200 amps or less $50.00 2
-
Signature of Supr. Elec'n 201 amps to 400 am $75.00 2
401 amps to 600 amps $100.00 2
-
Over 600 amps to 1000 volts,
License No 4 21e f 'S Exp.Date /0- I- see "b" above.
Phone No .357 - 4013
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 circ $5.00 2
City State Zip b) The fee for branch circuits
tY p without purchase of
Phone No. service or feeder fee.
First branch circuit / $35.00 33 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 2
Each sign or outline lighting $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:
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ -�
. NOTICE • Subtotal $ 3 � O '
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 $
1: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: L -1.-1-i )1 A.M. P.M. MST:
11
Location: 1, claco P ✓ - BUP:
Tenant: 00, . Suite: " d- Bldg: MEC:
Contractor: ' - / / l Phone: , 5-7 T ula PLM: j /
Owner: Phone: ELC: 7K 8 4
d
fry i ' -4'. -A...a;` 2 ELR:
STT:
BUILDING BLDG (can't) PLUMBING MECHANICAL LECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Servi Sewer /Storm
Footing Roof UndFl/Slab Rough -In ei Ong Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved ∎ iroved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved ► . ' •0) •ved Not Approved
FINAL FINAL FINAL 'SAL FINAL
dE -41,-..- e
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0 Call for rein n Q Reins lion fee of $ required before next inspection 0 Unable to inspect
Inspector: / Reins
Date: ? — 6 - 9," Page of
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