Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00468
r; DEVELOPMENT SERVICES DATE ISSUED: 9/21/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S101DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY 200
SUBDIVISION: TRIANGLE CORPORATE PARK ZONING: MUE
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Installation of (9) branch circuits for kitchen equipment.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 8 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
PACIFIC REAL ESTATE MGMT ENCOMPASS ELECTRICAL TECH
6650 SW MACADAM AVE. 200 7379 SW TECH CENTER DR
PORTLAND„ OR 97201 PORTLAND, OR 97223
Phone: 503 - 224 -1460 Phone: 503 - 684 -3600
Reg #: LIC 52288
ELE 34 -247C
SUP 3863S
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 9/21/01 $100.05 2720010000( Wall Cover
Elect'I Final
5PCT CTR 9/21/01 $8.00 2720010000(
Total $108.05
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 direct questions to
Permit Signature: \ Issued By: 4
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: C 1 I / DATE:
LICENSE NO: -3glo3 S
Call 639 -4175 by 7:OOpm for an inspection the next business day
` • Electrical Permit Application
Date received rya/ O / Permit no.: 05/C / - owl, V
'err` I ii, • •
�1 j- ';.J City of Tllg Projecdappl. o.: Expire date:
City of Tigard Address: 13125 S W I � , tgard I I � "�3 2 G Date issued: 113MI Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 SEP 1 8 2001 Case file no.: Payment type:
Land use approval: _ -
fi1. 6
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 4 enant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: 1 322 ( S . 6 ,e F),M2,kt..„, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: (Block: (Subdivision: ry,g c.."PtiVi-. c,o4,,,,,,,p,3s,
Project name: CAts ,g I Description and location of work on premises: ,Ap K .11 -- cklit+t.) ixg1/4.30P1ka,
Estimated date of completion/inspection: r °'1 'Lot)
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: an( Fee Max
Business name: E+,o�,ls pj {crgl. ' it ow it's Description Qty. (ea.) Total no. insp
New residential- singleormutd- family per
Address: -- ,�, 1 L6 e.- OdA\vla dwelling unit. Includes attached garage.
City: '> tq I State:0,,, I ZIP: gYatt.S Serviceincluded:
Phone: C - u,,ce, I Fax:(p$ -= 3 ,/ / I E-mail: 1000 sq. ft. or less 4
a I 3 4 . - - 't -1. C
Each additional e 500 sq. ft. or portion thereof
CCB no.: S2 22 Elec. bus. lic. no: _ Limiteeenergy, d energy, residential 2
City /metro lic. no.: Limited energy, non- residential 2
1 1 atdA Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name ( print): M f tJ o'- . ICv'�w•.4 License no: 3 86 3 S. r tees or feeders — installation,
alteration or relocation:
PROPERTY OWNER
200 amps or less 2
Name (print): Coin socA deNt,e 201 amps to 400 amps 2
401 amps to 600 amps • 2
Mailing address: l S. W (vt'vt 4,) ` L• 601 amps to 1000 amps 2
City: —n(, Artap I�State: a I ZIP: 9112,3 Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 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, orrelocation:
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 2
Branch circuits - new, alt. ,1'
or extension per panel:
Name: A.. for branchcircu ^« will nr ha a .,f
Address: service or feeder fee, each branch circuit 2
State: ZIP: B. Fee for branch circuits without purchase
City: I I of service or feeder fee, first branch circuit: t , , ,. , , „ 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial • 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 0 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,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection 1 1
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 1 S7(J.0 —_
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ _
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ g. Ov
Expires accepted as complete. TOTAL $ /D8 0 `J
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6100/COM)
•
Electrical Permit Fees: Limited Energy Fees: ',
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
P Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total si, 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 ❑ Garage Door Opener
Dwelling Service or Feeder $90.90 _ 2
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
200 amps or Tess $66.85 2 Fee for each system $75.00
201 amps to 400 amps $100.30 2 (SEE OAR 918 -260 -260) .
401 amps to 600 amps $133.75 2 .
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above. •
- ---- -. ---- ------ - - - - - -- - - -- ❑ Audio -and Stereo Systems__...
Branch Circuits
New, alteration or extension per panel ❑
a) The fee for branch circuits Boiler Controls
with purchase of service or
feeder fee. ❑ Clock Systems .
Each branch circuit $6.65 2
b) The fee for branch circuits ❑ Data Telecommunication Installation
without purchase of service
or feeder fee. 0S ❑ Fire Alarm Installation
_
First branch circuit _ $46.
Each additional branch circuit 8 _ : $6.65 -SS . ZO ❑ HVAC •
Miscellaneous
(Service or feeder not included) • ❑ Instrumentation -
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑
Signal circuit(s) or a limited energy Intercom and Paging Systems
panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑ Landscape Irrigation Control •
Each additional inspection over ❑ Medical
the allowable in any of the above . .
Per inspection $62.50 ❑
Per hour $62.50 Nurse Calls .
In Plant $73.75 ❑
Outdoor Landscape Lighting'
Fees:
OS El Protective Signaling
Enter total 'of above fees $ ` 00.
8% State Surcharge $ 8 , 00 r7 Other _
25% Plan Review Fee Number of Systems -...
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
•
Total Balance Due $ 108.°5- Fees:
❑ Trust Account # Enter total of above fees $
- 8% State Surcharge $
T otal Balance Due $
i:\dsts \forms \elc- fees.doc 10/09/00