Permit .i CITY OFTIGARD
4 ,,, DEVELOPMENT SERVICES ELECTRICAL PERMIT
'i,l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE : /
PARCEL: 2S112DD -00700
SITE ADDRESS...:1577O SW UPPER BOONES FERRY RD #BLD.
SUBDIVISION ZONING:I—P
BLOCK LOT JURISDICTION: TIG
Project Description: instl 3 branch circuts
- -- 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/0 SRVC OR FDR.: 1 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 2 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
PACIFIC REALTY ' type amount by date recpt
15115 SW SEQUOIA PKWY PRMT $ 45.00 TAT 04/11/97 97- 293166
STE 200 5PCT $ 2.25 TAT 04/11/97 97- 293166
PORTLAND OR 97224
Phone #:
Contractor:
JOHANSEN ELECTRIC INC $ 47.25 TOTAL
1130 NE 174TH
REQUIRED INSPECT IONS
PORTLAND OR 97230 Ceiling Cover Underground Cove
Phone #: 503 -252 -4881 Wall Cover Elect' 1 Service
Reg #..: 000515
This permit is issued subject to the regulations contained in the .%/ i // k, _____
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permit / 7 Signature,
applicable laws. All work will be done in accordance with
T approved plans. This permit will expire if work is not started
within 180 days of issuance, or if work is suspended for•more IL ,,� I�L_
than 180 days. I s s '_ 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 SURR. ELEC'N: _ DATE: 1— /7-97
LICENSE NO: (2DS33 ____
Call for inspection — 639 -4175
4.
Community Development ELECTRICAL PERMIT APPLICATION
Allh 13125 SW Hall Blvd. '/
Tigard, OR 97223 Permit # 1 � L & q7- b Z J 1
,At, Date Issued i - // - 9 7
A Ii Phone (503) 639 -4171
" 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 '' ff • Number of Inspections per permit allowed
Address a 57 1 0 Sik tiPP ,bA J i 5 Service included: Items Cost(ea) Sum
City /State /Zip I I - (�{ � r9 4a. Residential - per unit
�f //►► I- 1000 sq. ft or less $110 00 4
Name (or name of business) ¢-►1 - Te- I Each additional 500 sq ft or
portion thereof $25.00
Commercial y Residential ❑ Limited Energy $25.00 1
/ Each Manufd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
. 4b. Services or Feeders • A L Installation, alteration, or relocation
Electrical Contractor , • Pito S I i : l� 2 2 00 amps or less $6000 2
Address 0 l r iE it ( 201 amps to 400 amps $80 00
i 4 01 amps to 600 amps $120 00 2
City D • (ter /.� State / I. Zip • $180.00 2
601 amps to 1000 amps
Phone No. 1' - --.I R' "/ Over 1000 amps or volts $340.00 2
Job NO. Reconnect only $50 00 2
contractor's license NO. 3_ a 4.3c 4c. Temporary Services or Feeders
Contractor's Board Reg. No. S t‘ 1 Installation, alteration, or relocation
CA--
Signature of Su r. Elec'n 200 amps or less 2 2
License No. c f 5' S Phon o. r9. -�-/n/ 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 without
5 $.00 i
The installation is being made on property I own which is purchase of service or feeder fee. 2
Ea
a additiona l l branch b
not intended for sale, lease or rent. First t ddch ur l $ 00 o
anch circuit 2. $5 U —
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or imgation 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.0 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: ' I rr
5a. Enter total of above fees `'(J J
NOTICE 5% Surcharge (.05 X total fees) $ v , a 5
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Reevivi of
if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. xorercomdMelec- ❑ Trust Account #
$
prm app
Balance Due $ yr . a t
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /Flr /Slab Plbg. Top Out Insulation
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -= dg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other:
Date. ov-/s2.7/7' 7 A M1■ 494:9 M. Entry:
Address: /
Tenant: T�_AO Ste MST o �
BUP:
Con /Own: MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
clri r
C_9 _9(
cc)a...2
Inspector f — A. Date: '—
X APPROVED _ DISAPPROVED /CALL FOR REINSP. CF CO