Permit 4111111, CITY OF T ELECTRICAL PERMIT
1t
DEVELOPMENT L SE ERMIT
ISSUED:
PARCEL: 1S126OC -01107
SITE ADDRESS...:O94O0 SW WASHINGTON SQUARE RD #MERV
SUBDIVISION • ZONING:C —G
BLOCK • LOT JURISDICTION:
Proj ect Descri pt ion : instl 5 branch circuits // job 897026
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 50OSF...: 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: 4 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
TARGET /MERVYN'S type amount by date recpt
33 SOUTH SIXTH ST PRMT $ 55.00 TAT 05/22/97 97- 294960
MINNEAPOLIS MN 55440 SPCT $ 2.75 TAT 05/22/97 97 -294960
Phone #:
Contractor:
NEW TECH ELECTRIC $ 57.75 TOTAL
1400 NE 48TH AVE
REQUIRED INSPECTIONS
HILLSBORO OR 97124 Ceiling Cover Underground Cove
Phone #: 648 -1900 Wall Cover Elect'1 Service
Reg #..: 000418
This permit is issued subject to the regulations contained in the C -4 /1,Ciatd
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permi Signature
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 1.4111i _ L kiP/ 4
than 180 days. I s s ed 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: /23/P7
LICENSE NO: d//3
Call for inspection — 639 -4175
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
•
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Print or Type
Inspection (503) 639 -4175 Permit #
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: ,,,�� � / inn /fd p 4. Complete Fee Schedule Below:
Name of Developmentedp4% Yv r Z � erL Number of Inspections per permit allowed
Name (or name of business) ' Service included: Items Cost Sum
I
Address 0 . _•,.. / : .i/ / ' d ..r ZG 6 AA' Cr 4a. Residential - per unit
�• n � 1000 sq. ft. or less $110.00 4
City /State /Zip //9 W 1 l , Each additional 500 sq. ft. or IR-
Commercial Li
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 I urrent men s)�+ 4b. Services or Feeders
/',U L,
Electrical Contractor ((if (; G Installation, alteration, or relocation
Addre s /y0' 2' ,v. �c9 V� 200 amps or less $60.00 2
201 amps to 400 amps $80.00 2
City (fiZer2/21 State _Zip 9'7/24' 401 amps to 600 amps $120.00 2
Phone No. Vr? - - /90O 601 amps to 1000 amps $180.00 2
Job No. q70.,26• Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. 026 / SSG Exp.Date
OR State CCB Reg. No. h/lc-? 6d 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 %? I 14.40--,--- 201 amps to 400 amp $75.00 2
401 amps to 600 amps $100.00 2
2 //3 S' / _�_ �� O ver 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No. l' er -/9a9
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
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit f $35.00 ✓ 2
The installation is being made on property I own which is not Each additional branch circuit A / $5.00 „7 �1. - 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: Of�
Not required for temporary construction services. 5a. Enter total of above fees $
5% Surcharge (.05 X total fees) $ e •
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 # " 7/ 7_5
Total balance Due $ '
I: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION
. 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: 4/2 9 7 A.M. P.M. MST:
Location: q (yr) 5-( (, l (2 BUP:
Tenant: in e S p � t Suite: �/ Bldg: MEC:
Contractor: ' ! �"X- ,2 . Phone: 4 irt. 6 4 q (V -! ! PLM: /� f /
Owner: Phone: y ELC: / 7v
ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL E L CTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Coy rv ice Sewer /Storm
Footing Roof UndFl/Slab Rough -In eiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp I .a. , . Storm Furnace Temp Service MISC.
Masonry -��.= - %. . in Drain A/C UG Slab
Shear /Sheath - re p I 1 rawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
(---- , , , ,.., ? , Cc5 (J -e ir -e ei \ 4
c si _.,-, -e/c 4
A Call for reinspection O Reinspectio fee of $ required before next inspection O Unable to inspect
Inspector: �! \ - r� P I R sec( / Date: / — 7.0 ^ 7 Page of /
61. -- —
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: 6//g' ,' A.M. P.M. MST:
• C OO Location: Ct `/ , 1 SL W Q4QI'( ...S,_ i BUP:
Tenant: M v A d S Suite: Bldg: MEC:
Contractor: Phone: )-0 9 - / / 3 PLM: q /� ^^�� L .�
Owner: Wi Phone: ELC: / �7 _Od-q /
C X L� D M„Q 'O fine,. 4. (4 C.2-- ELR:
SIT:
BUILDING BLDG (con't) PLUMBING MECHANICAL ZRICAL SITE
Site Post/Beam Post/Beam Post/Beam rvice Sewer /Storm
Footing Roof UndFl/Slab Rough -In 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 A`pproved ' Approved
Appr /Sdwlk Not Approved Not Approved Not Approved ved Not Approved
FINAL FINAL FINAL ( FIN " FINAL
. lee.- - f --- r- i\ Q' I l >Cr./ cC r e /�n l Cr (( -Q1l _� 07
Q p ca "C.-j. (j e e
P-
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5 r Cep Wt.- S- L.e) 7d
d r ,
e ( (i ....--7). ce-o 4..., -q i r-- i2,7f-- ,%32//f-,5 4) -e,(
Call for r''eiinsspection 0 Reinspec ion fee of $ required before next inspection 0 Unable to inspect
Inspector: /�"(! <44're ( !\ /,( Date: —( oZ ---- 7 Page ( of /