Permit CITYOFTIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
AS DEVELOPMENT H BMEN 1639 -4171 DATE PERMIT #: ISSUED: 9/9/02
2
SITE ADDRESS: 12909 SW 68TH PKWY 400 PARCEL: 2S101 AD -03200
SUBDIVISION: TIGARD OFFICE BUILDING ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
Project Description: Low voltage for HVAC
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300 -WMI 807 NE COUCH
PORTLAND, OR 97224 PORTLAND, OR 97232
Phone: Phone: 233 -6911
Reg #: ELE 26- 1063CRE
LIC 38868
SUP 2613RET
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 9/9/02 $75.00 2720020000 Elect Final
5PCT CTR 9/9/02 $6.00 2720020000
Total $81.00
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 •' :ct questions to OUNC at (503)
246 -1987.
Issued by & 40,(4. (/(J'1ijL Permittee 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: 07 I C4t . DATE:
LICENSE NO: I 3 tee —
CaII 639 -4175 by 7:00 P.M. for an inspection needed the next business day
r
00: Electrical Permit Application
Date received: co pt Permitno.: cueJoa — O& / 3
,,L .i j City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
•
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: , - , - tr - . , g Wd Bldg. no.: Suite no.: Tax map /tax lot/account no.:
' Lot: Block: Subdivision:
P .J' t . - :N Description and location of work on premises: L „ w ,ns el AG,
Estimated date of completion/inspection:
CONTRACTOR APPLICATION • . FEE SCHEDULE .
Job no: Fee Max
Business name: Description Qty. (ea.) Total no. insp
'� �*'� i� New residential - single or multi- family per
Address: , , .r , _, dwelling milt. Includes attached garage.
reM j ZIP: 47 ' Service included:
Phone: E -il: 1000 sq. ft. or less 11 4
t 1 ma Each additional 500 sq. ft. or portion thereof __
CCB no.: 3 rg Elec. bus. lic. no: - ip . - C " Limited energy, residential ___ 2
City /metro lic. n•.: ylSSei Limited energy, non- residential ___ 2
'7� 7 . 7 , 02 Each manufactured home or modular dwelling
Signa re of supervising electrician (required) Date Service and/or feeder ..1 2
Sup. elect. name (print): — –, ..•,-, License no: A Services or feeders – installation,
alteration or relocation:
• PROPERTY OIVNER 200 amps orless 2
Name (print): 201 amps to 400 amps ___ 2
Mailing address: 401 amps to 600 amps MIME 2
g 601 amps to 1000 amps ___ 2
City: State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: E -mail: Reconnect only 11111111111_ 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration,orretocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps ___ 2
Owner's signature: Date: 401 to 600 amps MEN 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: ■■ 2
Phone: Fax: E -mail: Each additional branch circuit: __
PLAN REVIEW' (Please check all that apply) Misc .(Service orfeedernotincluded): ■■ ■
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1 &2 ❑ Hazardous location Each sign or outline lighting ___ 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension' �■ 2
O Building over three stories ❑ Feeders, 400 amps or more •Descri . lion:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / 1 within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 (6/00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEE
lla
•
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
(� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑
Dwelling Service or Feeder $90.90 2 Garage Door Opener
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑
201 amps to 400 amps $106.85 2 Vacuum Systems'
401 amps to 600 amps $160.60 2
601 amps to 1000 amps"' $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2 •
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260) . .
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved: ' -
Over 600 amps to 1000 volts,
see "b" above. ❑ Audio and•Stereo Systems
Branch Circuits . .
New, alteration or extension per panel ❑ Boiler Controls
a) The fee for branch circuits •
with purchase of service or • ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 . ❑ Data Telecommunication Installation
b) The fee for branch circuits • - • .
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ n Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
All New Commercial Buildings require 2 sets of plans. Total Balance Due $ • 00
i:\dsts \forms\elc - fees.doc 08/30/01