Permit (190) CITY OF TIGARD
4 DEVELOPMENT SERVICES ELECTRICAL PERMIT -
= 13 125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 RESTRICTED ENERGY
PERMIT #: ELR97 -0306
DATE ISSUED: 10/29/97
PARCEL: 2S 1 15BA--OO 1 O 1
SITE ADDRESS...: 16200 SW PACIFIC HWY #X
SUBDIVISION • ZONING:C -G
BLOCK • LOT • JURISDICTN: TIC
Pro .j ect De scr i. pt i on : Add signal circuit or a limited energy panel, alteration or
extension to a commercial tenant occpy.
A. RES I DENT I AL--- - - - - -- - B. COMME RC I AL•-- • - - --- - - - - -- -- - - - - -- - - -- - - -- -- _ - --
AUDIO & STEREO...: AUDIO K STEREO..: INTERCOM & PAGING..:
BURGLAR ALARM BOILER.........,. LANDSCAPE/ IRRI GAT. .:
GARAGE OPENER • CLOCK • MEDICAL •
HVAC • DATA /TELE COMM..: NURSE CALLS
VACUUM SYSTEM • FIRE ALARM • OUTDOOR LANDSC LITE:
OTHER: .. HVAC • PROTECTIVE SIGNAL..:X
INSTRUMENTATION.: OTHER..: ..
TOTAL # OF SYSTEMS: 1
Owner: - - - - - -- - • - - - - -- FEES -- ---- - - - - --
MARSHALL'S type amount by date recpt
16200 SW PACIFIC HWY PRMT $ 40.00 GEO 10/29/97 97- 300490
SUITE X 5PCT $ 2.00 GEO 10/29/97 97- 300490
TIGARD OR 97224
Phone #:
Contractor: - - - - -- ------- - - - - -- -----
ROSE CITY EL` CT R I C CO INC $ 4 :. 00 TOTAL
4012 NE CULLY BLVD
REQUIRED INSPECTIONS
PORTLAND OR 97213 Low Voltage Insp _
Phone #: 287-6164 Elect' 1 Final
Reg #..: 000035
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 sore than 180 days. ATTENTION: Oregon law requires you to follow rule adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 95 -00i -0010 through OAR 952 -001 -0080. You may obtain copies of
these rules or direct estions t DUNC t (503)246 -1987.
Issued by Perniittee Signature_
-- - - - - -- 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: l0 /7 f
LICENSE NO:
+ + h++++++++++++++++++++++++++++++++++++++++++++++ + + + ++ ++ + + ++ + + + +++ + + + ++ ++ + ++ + + ++
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
+ ++++++++++++++++++++++++++++++++++++++++++++ +++ + + + + + ++++ + +++ + + + +++t ++ + + ++-h +-h + ++
Community Development ELECTRICAL PERMIT APPL�TIQN
A 13125 SW Hall Blvd. �L,e � O
Tigard, OR 97223 Permit #
,�4, �, Date Issued
. � 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 Developmerll7 ' ' 1 i " / Number of Inspections per permit allowed
Address/ 42a? ..9,!/ ../X ci X Service included: Items Cost(ea) Sum
City /State /Zip / 1 am 6A -/j ?7 4a. Residential - per unit
�Ii�I 5v l`5 ��11�� /// 1000 sq. ft. or less $110.00 4
Name (or name of business)M /,N Each additional 500 sq. ft. or
portion thereof $25.00
Commercial 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
Electrical Contractor // E Installation, alteration, or relocation 860.00
i `` lfi// 200 amps or less 2
Addre ,,•• .- L:f . 201 amps to 400 amps $80.00 2
City / r - -� Stat : .r , ' Zip '/ L/ 401 amps to 600 amps $120.00 2
`1 601 amps to 1000 amps $180.00 2
Phone No. , rks � Over 1000 amps or volts $340.00 2
Job NO. 7 7 7 ,! // Reconnect only $50.00 2
contractor's license NO. 2--LP 11 . 4c. Temporary Services or Feeders
Contractor's Board Reg. No. , , i Installation, alteration, or relocation
Signature of Supr. Elec'n r /Li 200 amps or less 2 2
License No 201 amps to 400 amps $50.00
i`e� Phone No. „7 �7 �O /(� / 401 amps to 600 amps $75.00 2
r 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
The installation is being made on property I own which is purchase of service or feeder fee. 2
not intended for sale, lease or rent. First branch circuit
Each additional branch circuit $ 5.00
$5.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation 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 04 --'
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.C. 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:
5a. Enter total of above fees $ 4/Q -
NOTICE 5% Surcharge (.05 X total fees) $ _ Subtotal
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
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. wordlcomdevIeleo- ❑ Trust Account #
$
Prm..PP
Balance Due
6/30/99 Activities for Case #: ELR97 -00306 •
4:43:12 PM
. Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
ELRC001 APPlication Received 10/29/97 GEO RECD GEO 10/29/97
ELRC003 Permit Created 10/29/97 GEO PASS GEO 10/29/97
ELRC725 Low Voltage Inspection 10/29/97 11/18/97 MJR PASS • MJR 11/18/97 support TV cable
ELRC799 Elecfl Final 10/29/97 11/18/97 MJR . PASS MJR 11/18/97 •
ELRC500 (F) Issue permit • 10/29/97 GEO PASS GEO 10/29/97
ELRC700 Ceiling Cover 11/18/97 MJR PASS MJR 11/18/97 support TV cable
ELRC800 Case finaled 11/18/97 MJR PASS MJR 11/18/97
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