Permit CITY OF TIGARD
Aw i DEVELOPMENT SERVICES
f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 ELECTRICAL PERMIT
PERMIT #: ELC96 -0652
DATE ISSUED: 10/15/96
PARCEL: 1S1260C -01107
SITE ADDRESS...: 09400 SW WASHINGTON SQUARE RD #MERV
SUBDIVISION ZONING:C —G
BLOCK LOT •
Project Description: Target Dist Mngr's Office in Mervyn's
- -- 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 1 W /SERVICE OR FEEDER: 0 PER INSPECTION : 0
201 — 400 amp : 0 1st W/0 SRVC OR FDR.: 0 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
OMNI ELECTRIC OF OREGON type amount by date recpt
PO BOX 1788 5PCT $ 3.00 TAT 10/15/96 96- 285194
PRMT $ 60.00 TAT 10/15/96 96- 285194
LAKE OSWEGO OR 97035
Phone #: 635 -4306
Contractor:
OMNI ELECTRIC OF OREGON $ 63.00 TOTAL
PO BOX 1788
REQUIRED INSPECTIONS
LAKE OSWEGO OR 97035 Ceiling Cover Underground Cove
Phone #: 503- 635 -4306 Wall Cover Elect'l Service
Reg #..: 41789
This permit is issued subject to the regulations contained in the % c-C,i,I X,� � J
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permitt 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 / I 't
than 180 days. I s _ ed By /l
OWNER INSTALLATION ONLY 1111
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:
LICENSE NO:
Call for inspection — 639 -4175
FROM : OMNI ELECTRIC PHONE NO. : 503 635 1391 Oct. 15 1996 09:56AM P1
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # C t_C4( -6(6,5" '�° ' -. Phone (503) 639 -4171 Date Issued 1D -
r ` ' ' - FAX (503) 6847297 Issued by
CITY OF TIGARD TOD No. (503) 684 -2772
Inspection (503) 639 -4175 / S/ &0 - U // d 7
•
1. Job Address: JOB NO. 62166 4. Complete Fee Schedule Below:
•
Name of Development Mervyn' 3 • Number of Inspections per permit allowed
Address SW Washington Square Rd. Service included: Items Cost(ea) Sum
Tigard, O R da Residential - per unit 4
City/State/Zip
Target District Mgr : , s n" $110.00
Name (or name of business) OP£ice in Mervyn E $ 5.00 1
a2s.00
2
Commercial ® Residential ❑ Each Manure Home or Modular
De ling Servicu or Feeder $68.00
2a. Contractor installation only: 4b, Servi or Feeders
Installation, alteration, or relocation / 2
a,,
Elect Contractor Omni Electric of Oregon 200,paorlase I $60.00 (�"� uc1 2
Address PO Box 17 8 8
201 amps to 400 amps $80.00 2
401 amps to 600 �„� $120.00 2
City Lake Oswego State OR Zip 9 eo, amps to 1000 amps $160.00 2
Phone No. 635-4306 Over 1000 amps or volts $340.00 2
Contractor's License No. 2695C Reconnect only $50.00 -
Contractor's Board Reg. N . 03 4o. Temporary Service. or Feeders
Inststiation, alteration, or relocation 2
Signature of Supr. Elec'n - 200 amps or boa $50.00 2
License No. 23455 Phone No. 635 -4306 201 amps to 400 am Pa $76.00 - 2 401 empato600 $ 100 . 00
Over 600 amps to 1000 volts
2b. For owner installations: sa above.
dd. Branch Circuits
Print Owner's Name New, alteration or extension per panel
• Address a) The tee for branch drastic with
pWdhsae of sonic* or /seder tee. 2
City , State Zip • Each bfsnch circuit $5
• Phone No. b) The tee for brand' circuits w thout
The installation is being made on property I own which is porch of wilco or feeder kw 2
Fie brarwh circuit $35.00
not intended for sale, lease or rent.
Each eddrlior,el branch circuit $6.00
Owners Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation aide $40.00 2
Each sign or mane lighting $40.00
Signal circuit(e) or a Fruited energy 2
Please check appropriate item and enter fee in section 5B. panel, alteration or o„enaion $40.00
4 or more residential units in one structure Minor labels (10) 5100.00
Service and feeder 225 amps or more
System over 500 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 impeaion $35.00
Per hour $55.00
In Plant $65.00
Submit 2 sets of plans with application where arty of the above
apply. Not required for temporary construction services. 5. Fees:
NOTICE Se. Enter total of above fetes $ 60.00
5% Surcharge (.05 X total teas) $ 3.00
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ 63.00
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 Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS / Subtotal $
COMMENCED. K][ Trust Account # $ (63.00)
Balance Due $ -0-
RECEIVED
OCT 151996
COMMUNITY DEVELOPMEN1
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover 4 FINAL:
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: JJ
Date: A.M. /b / 1 (94 P.M. Entry: n
Address: _ 7 4 7 1 6 0 LO » - , S 0 . (R AC
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Tenant: Vl/J Ste: MST:
BUP:
Con /Own: MEC:
/, PLM:
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THE F OE S ARE REQUIRED: ELR:
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Inspector I i C , ..1 Gt l.,.... Date:/4 -.24 A
, XAPPROVED DISAPPROVED /CALL FOR REINSP. CF CO
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