Permit CITY OF TIGARD, ELECTRICAL PERMIT
PERMIT #: ELC2001 -00114
.Y� DEVELOPMENT SERVICES DATE ISSUED: 2/27/01 •
'�� J- ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 101 AC -01900
SITE ADDRESS: 12615 SW 72ND AVE
SUBDIVISION: LOWE'S HIW, INC ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Protect Description: Miscellaneous wiring of modular fixtures & racks, extension of existing circuits.
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: 50 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:
LOWE'S HIW, INC TUALATIN ELECTRIC
HWY 268 EAST PO BOX 655
NORTH WILKESBORO, NC 28659 WILSONVILLE, OR 97070
Phone: 336 - 658 -7519 Phone: 682 -2955
Reg #: LIC 00065650
SUP 3483S
ELE 3 -268C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT CTR 2/27/01 $379.35 2720010000( Elect'l Final
5PCT CTR 2/27/01 $30.34 2720010000(
Total $409.69
This Permit is issued subject to the regulaf . ntained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance • approved • lans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 d s. ATTENTION: •regon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 95 - 001 -0010 through *AR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987. w
PERMITTEE'S SIGN TORE rie` /�' / -� = t :Y:
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 7:00pm for an inspection the next business day
•
•
i Electrical Permit Application
r Date received: ;_ Permitno..g_e p / ooj/
li.:``.)11 City of Tigard Project/appl.no.: Expire date:
City of Tigard 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
E l l & 2 family dwelling or accessory ❑ Commercial/industrial U Multi - family Cl Tenant improvement
CI New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
Job address: la C S s. (.w 1 w A '('g.,,.,t o K. Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: I Subdivision: GI 1).213
Project name: u cs ; K <,t v Description and location of work on premises: M; SG . t.. ; K. ..s o 4 to toJ,,/L.. v
Estimated date of completion/inspection: % . aig,,S G O ., o - ' rv.
Job no: r,1 1 L Fee Max
Business name: w„/1,, i C (� v7 r; L Description Qty. (ea) Total no. insp
New residential- single ornwld- family per
Address: po. .1.... joS.r dwelling tmit .Includes attached garage.
City: w; (k? „,,; /4-. I State: o R. I ZIP: °) [ 0 7 o Service lncluded
Phone: 6 g - j c} J: I Fax:b V -')% LA E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 3(, s-c. !Elec. bus. lic. no: 3 i e, Limited energy, residential 2
City/metro lic. no.: Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date laile I Service and/or feeder 2
Sup. elect. name (print): License no:3y 3_5 Services or feeders — installation,
alteration or relocation:
200 amps or less 2
Name (print): 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
g 601 amps to 1000 amps 2
City: I State: • l ZIP: 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
20
ORS 447, 455, 479, 670, 701. 1 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
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: I CV 2
Phone: Fax: E -mail: Each additional branch circuit: 0 6s S'
PLAN RL:VIL:\/' check all that appl)) 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 145t2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 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 *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
❑ Egress/lightingplan O Other. Per inspection
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other _
Permit fee $ 3')' 3�
Not all jurisdictions accept credit cards, please call jurisdiction for more infomration. Notice: This permit application ✓
xp permit Plan review (at _ %) $ •3a ��
0 Visa O MasterCard expires if a burin is not obtained
Credit card number: I / within 180 days after it has been State surcharge (8 %) $ u a!o
Expires accepted as complete. TOTAL $ y D q - '9._
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6000/COM)
I
Electrical Permit Fees: Limited Energy Fees:
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. fL 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 Manuf d 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 I $46.85 ji
Each additional branch circuit so $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 ❑ 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 $ 3 ')9 3- ❑
Other
8% State Surcharge $ 3 o c 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 $ L..+ 09 ,
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\clsts\formAelc-fees.doc 10/09/00