Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC1999 -00250
411A DEVELOPMENT SERVICES DATE ISSUED: 4/26/99
I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 103 D D -00 500
SITE ADDRESS: SW PACIFIC HWY I 566 0
SUBDIVISION: MELROSE f — ( ZONING: C -G
BLOCK: L OT : JURISDICTION: TIG
Project Description: Add a first branch circuit.
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:
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: 1 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 RETAIL CENTER PROPERTES NEW TECH ELECTRIC
15800 SW BOONES FERRY RD 1400 NE 48TH AVE
LAKE OSWEGO, OR 97035 HILLSBORO, OR 97124
Phone: Phone: 503 - 648 -1900
Reg #: LIC 41868
SUP 2113s
ELE 26 -418C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT GEO 4/26/99 $35.00 99- 314844
5PCT GEO 4/26/99 $1.75 99- 314844
Total $36.75
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 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.
Permit Signature: Issued By: 4
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: c9 1/ co ' DATE: 1'24 '" 2f
LICENSE NO: / 3 S (/
Call 639 -4175 by 7:00pm for an inspection the next business day
RECEIVED
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVDoR 2 6 1999 Rec'd By
TIGARD OR 97223 Date Recd
Phone (503) 639 -4171, IIUNITY DEVELOPMENT Date to P.E.
Print or Type Date to DST
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit #F" iff fv
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business /
� " (l�(;�'.G' /I � ,P� Service included: Items Cost Sum
Address 6(i2 4 C t� c / c y 4a. Residential - per unit
❑ Li
City/State/Zip % S(O v - r `J 1000 sq. ft. or less
Each additional 500 sq. ft. or $110.00 4
Commercial 4d Residential portion 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 allfurren ic se 4b. Services or Feeders
Electrical Contractor, / / ,e eC a Installation, alteration, or relocation
Address / • 0 • E . - 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City ..: :'./. 0 State 7. / Zip c /� 401 amps to 600 amps $120.00 2
Phone No. 6 / 4' /COO 601 amps to 1000 amps $180.00 2
Job No.. 3SF6 / Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 4 f /z9C Exp.Date
OR State CCB Reg. /rci6X 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 eC CEc.�,,✓-� • a 201 amps to 400 amp $75.00 2
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. c //3 s Exp.Date B/ /Q ,'- see "b" above.
Phone No. 64/cf- /Q00 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 NameW -D ie, w , Q feeder fee.
Address /3'1o6 j Boet•dc-s fifaa-re e- - Each branch circuit $5.00 2
CI �' o 05rp State ' L Zi e '3 S b) The fee for branch circuits
ty P without purchase of
Phone No. service or feeder fee. /��
' First branch circuit 1 $35.00 . 35 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: 2 �/rl/�
Not required for temporary construction services. 5a. Enter total of above fees $ ✓
5% Surcharge (.05 X total fees) $ i
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
TIME AFTER WORK IS COMMENCED. ❑ Trust Account #
$
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96