Permit ELECTRICAL PERMIT
CITY OF TIGARD RESTRICTED ENERGY
-
GY
�F�I DEVE H B SERVICES ) 639 -4171 DATEESSU 04/04/2001 00097
SITE ADDRESS: 13535 SW 72ND AVE PARCEL: 2S101 DC -00300
SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of low voltage: burglar, access and CCTV. Job #S1808
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: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 3
Owner: Contractor:
PACIFIC NW PROPERTIES LP SELECTRON INC
9950 SW ARCTIC DR 7225 SW BONITA RD
BEAVERTON, OR 97005 TIGARD, OR 97224
Phone: Phone: 639 -9988
Reg #: Lac 00064341
ELE 26- 497CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 04/04/2001 $225.00 2720010000 Elect'l Final
5PCT CTR 04/04/2001 $18.00 2720010000
Total $243.00
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 direct questions to OUNC at (503)
246 -1987.
Issued by _ ! _ /// _ �L Permittee Signature ( gi / kpitea r - I D A 1 '/ Mk
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 7:00 P.M. for an inspection needed the next business day
#)■ Electrical Permit Application
Date received: ze D / Permit no.: _..,_► ` •l/ - 000
�1C,I • ' - ; . 1 .. City of Tigard �,�5® Project/appl. n..: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, TIfk R 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 P ( 0 . 20® Case file no.: Payment type:
Land use approval: NIW'11� pFV
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory • ommercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction • Addition/alteration /replacement 0 Other: 0 Partial
. `, '30B SITE -INFORMATION
Job address: 13535 ) iP Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: J Block: Subdivision:
Project name: � o2ur ,� Q� I Description and location of work on premises:/ v , 9 Q J A�, / JJJ1
Estimated date of completion/inspection: _ / �T /
CON 1 RACI'014 t\I'PI ICATION FEE SCIIEDU.E
Job no: :419 Fcz Mar
Business name: i XI
, l Description Qty. , (ea.) I Total I no. insp
New residential - single or multi- family per
Address: A — • % _ f/, �% / dwelling milt. Includes attached garage.
City: PligiT_/_21.1111.111M7'J ZIP: 'i = Service included:
Phone: - - , - ;_, :', 101 sq. ft. or less 4
=� U , � `S c • ch additional 500 sq. ft. or portion thereof
CCB no.: (p �f- Elec. bus. lic. no: —�9 A. ,
Limited energy, residential 2
City /metr c. m 1 -/ ..'Q,, �� / Limited energy, non- residential 2
■'% -vim 512 9 / 0/ Each manufactured home or modular dwelling
Si : .cure o–'-‘‘r" • tsmg . ectrict. (required) Date ` Service and/or feeder 2
tvices or feeders – installation,
Sup. elect. name (print): ;; t 0122- ell ' License no: • ,,, S 'iteration or relocation:
PR_OPERTY O51'N 200 amps or less 2
Name (print): 201 amps to 400 amps 2
/ 401 amps to 600 amps l 2
Mailing address: 601 amps to 1000 amps I 2
City: I State: I 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 on 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, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
t Address: _ _ service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase l
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN RI VIEN1' (Please check : all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial ❑ 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*
) 1) 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:
❑ Egress/lightingplan ❑ Other. Per inspection I 1 I I
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 $ a"... 6 ,co
❑ 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 $ c 3 .00
Name of cardholder as shown on credit card •
$
Cardholder signature Amount .. �� 440 -4615 (6/00 /COM)
C ...____t
- <y
Electrical Permit Fees: Limited Energy Fees: .- a .
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 (0
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, aItOPB'uGn, vi' iGiJCcJtii i
- . - - _' Fac: for eea:.i. oy :te,r $1 5.Uu
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 . ❑ Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of servlce or ❑ Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b) The fee for branch circuits
•
without purchase of servlce ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous 1 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 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 • ❑ Nurse Calls
Per inspection $62.50
Per hour $62.50
In Plant _ __ __ $73.75 ❑ Outdoor Landscape Lighting
Fees: Protective Signaling C2
Enter total of above fees $ I I Other
8% State Surcharge $ 3/ 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:
T
/
otal Balance Due $
Enter total of above fees,' $ C
El Trust Account # 8% State Surcharge .�G �� Lf
Total Ba D $ e A `
•
i:\dsts \forms\elc - fees.doc 10/09/00