Permit , ELECTRICAL PERMIT
I,' 1 OF TIGARD PERMIT #: ELC2000 -00646
,iIlj"
DEVELOPMENT
SERVICES (503) C 639 -4171 DATE ISSUED: 11/28/2000
PARCEL: 25101 AA- 03800B
SITE ADDRESS: 12259 SW 69TH AVE
SUBDIVISION: TIGARD CORPORATE CENTER ZONING: MUE
BLOCK: LOT : 00B JURISDICTION: TIG
Project Description: Temporary service. Job No. 8958.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL:
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: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
TIGARD CORPORATE CENTER LP BACHOFNER ELECTRIC INC
15400 SW MILLIKAN WAY 55 SE MAIN
BEAVERTON, OR 97006 PORTLAND, OR 97214
Phone: Phone: 233 -2006
Reg #: LIC 00044569
SUP 2808S
ELE 26-451C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT CTR 11/28/200C $66.85 2720000000( Elect'I Final
5PCT CTR 11/28/200C $5.34 2720000000(
Total $72.19
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 OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATUREDN x.50 -7-7 ISSUED BY:‹0
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:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
r /
Electrical Permit Application
Datereceived: /0 7/, Permit no.:C j_0)65tv
.hp ,
., d :. City of Tigard RECEIVE Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: ,b/fFReceipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 NOV 2 _
I Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory '•' CommerciaUindustrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 12 � I .— Q a 1 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: j i , , 0 I Description and location of work on premises: •Y , ) . L'
Estimated date of ompletion/inspec ; • n:
CON7RAC70R`APi'LI CAT ION ,., -, , � 1'YE•SCWE13dtiE =_ .,..•:;. 7- ---.�, ,,..:
Fee Max
Job Ito: r g Description Qty. (ea.) Total no. insp
Business name: v / • New residential- single or multi- family per
Address: cf� SE Mti.in dwelling unit. Includes attached garage.
1311 I • State: CC ZIP: °I 7 Z i La Service included:
Phone: 233-2,0D , Fax: Z33 -Z%, 3 E -mail: 1000 sq. ft. or less 4
( j 2(D - (4 Each additional 500 sq. ft. or portion thereof ___—
CCB no.:
Elec. bus. lic. no: s l Limited energy, residential ___ 2
City /metro lic. no.: lit ice- , / Limited energy, non- residential ___ 2
Each manufactured home or modular dwelling
Signature of supervising a ectrician requ '.) Date Service and/or feeder Ell
Services or feeders — installation,
Sup. elect. name (print): f • it' . r it • • . , License no: alteration or relocation:
_... -.. _..; ,.... PROPERTY :' - -- 200ampsorless 2
0�� I� L,It . .. —
Name (print): 201 amps to 400 amps ___ 2
401 amps to 600 amps ___ 2
Mailing address: 601 amps to 1000 amps ___ 2
City: State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: • 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 Ilation , alteration, orrelocation:
IN
ORS 447, 455, 479, 670, 701. 200 amps or less N/ 2 • 201 amps to 400 amps ___ 2
Owner's signature: Date: 401 to 600 am . s ___ 2
ENGINEER J Branch circuits - new, alteration,
cr 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 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 MEM 2
family dwellings ❑ 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 ❑ Feeders, 400 amps or more sDescri . tion:
❑ 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 ❑ 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 $ 5
O 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 %) .... $ 5 S. 'St-(
Expires accepted as complete. TOTAL $ 7t. 1 �1
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00 /COM)
Electrical Permit Fees: Limited Energy Fees: '
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total y 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 n Vacuum Systems
201 amps to 400 amps $106.85 2
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
W
200 amps or less 1 $66.85 W .C�J 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 ❑ Boiler Controls
New, alteration or extension per panel
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 ri HVAC
Each additional branch circuit $6.65 I '
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited ene rgy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above I � Nurse Calls
Per inspection $62.50 1 1
Per hour $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting*
Fees: ❑ Protective Signaling
Enter total of above fees $ pi 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 $
Total Balance Due $
i:\dsts \forms \elc- fees.doc 10/09/00