Permit CITY OF T I GA R D ELECTRICAL PERMIT
w ' PERMIT #: ELC2001 -00236
yrll
DEVELOPMENT SERVICES 1639 -4171 DATE ISSUED: 05/08/2001
PARCEL: 2S101 DC -00200
SITE ADDRESS: 13535 SW 72ND AVE
SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (2) services /feeders and (10) branch circuits. Job #170600 -78831
Location of work: Server Room -first floow.
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 HMI SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 2 W /SERVICE OR FEEDER: 10 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:
PACIFIC NW PROPERTIES LTD PTNS BROADWAY ELECTRIC - COCHRAN INC
9665 SW ALLEN BLVD STE 115 626 SE MAIN
BEAVERTON, OR 97005 PORTLAND, OR 97214
Phone: Phone: 234 -6564
Reg #: LIC 00072942
SUP 3148S
ELE 37 -546C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 05/08/2001 $227.10 2720010000( Elect'I Service
Elect'I Final
5PCT CTR 05/08/2001 $18.17 2720010000(
Total $245.27
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)
246-6699 or 1 -800- 332 -2344.
Permit Signature: ,
Issued By: AO
OWNER INSTALLATION ONLY
The installation is being made on property I • n which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: L a02J_�t IL DATE:
LICENSE NO: �7
Call 639 -4175 by 7:OOpm for an inspection the next business day
, - . A . - - Electrical Permit Application
• `�� Date received: 6 O / Permit no.:' op / i
... �Ij.r ?1 I! City of Tigard �e Project/appl. no.: • Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR17 1 Date issued: • By: Receipt no.: --
Phone: (503) 639 -4171 %0 d
Fax: (503) 598 -1960 `r 00-`O 0 0E1AI - Case file no.: Payment type:
Land use approval: 000 -.. -
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory • 02tommercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
JOB SITE INFORi\9AT10N
Job address: 3353S 5t - 72 • - ) 4 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name•72, la Me. ?ot \IC,Nc, 1Description and location of work on premises: S,.• J e.r ?t t ?0w el.. \S r 1
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCIIEI)ULE
Job - no: — rib catt 0 - % - ,` ` • _ - - — - Fee Max
Bu name: C-Oe�ra,.r, \rG, . „y �L��s..a, "s--. � 0° Qty. (ea.) Total no. hup
'� New res singleormulti- family per
Address: (2C. SG /`No -. ,r. dwelling unit. Includes attached garage.
City: * P C , -r\v,N, I State: bR I ZIP: qr4"2.14 Service included:
Phone5S3 23 I Fax:223S-2f j{ E-mail: 1000 sq. ft. or less • 4
2-g 4 2 1 3 7 — 5 m (, L Each additional 500 sq. ft. or portion thereof
CCB no.: Elec. bus. liC. no: Limited energy, residential 2
City /me lic. n Limited energy, non- residential 2
V 4 _.�. ` -----.. 5. ! ( {1C ( Each manufactured home or modular dwelling
Signature of su rvising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): - .. _ _.,. License no: 3 S Services or feeders installation,
'; alte or relocation:
PROPERTY ONTEIt 200 amps or less Z 1(11) P 2
Name (print): Rc,c� }k[ N W •t` ® Z - lc 201 amps to 400 amps 2
99 $c5 5w `l„n.n `4 401 amps to 600 amps 2
Mailing address:
�� 601 amps to 1000 amps 2
City: ? L .r∎ State: oI ZIP: °l 76c3,S Over 1000 amps or volts 2
Phone: I Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services orfeeders . -
which is not intended for sale, lease, rent, or exchange according to hrstallstioa , alteration, °rrelocation:
200 amps or tens 2
ORS 447, 455, 479, 670, 701.
201 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 , (6 („4„� 2
City: I State: • I 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 ith:vll• :11' (Please 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
❑ Service over 320 amps- rating of 18r.2 0 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,
❑ System over600 volts noininal more residential units in one structure alteration, or extension* - - 2
O Building over throe stories 0 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:
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 $ 2.21 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 %) .... $ t.'?
Ex accepted as complete. TOTAL $ 2 4 S, 21
Name of cardholder as shown on credit card
Cardholder signature Amount 440-4615 (6A0/COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Restricted Energy Fee
of Inspections per permit allowed .
(FOR ALL SYSTEMS)
$75.00
S)
Service included: • Items Cost Total 4, Check Type of Work Involved:
Residential - per unit - - -- - _ - . . _
1000 sq. R or Tess $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 El Garage Door Opener*
Ser(ices or Feeders - ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 El 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 orwolts , - • - - , . • $454.65 2 •, /..1 •• , • /,,, _, ,
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 ❑ 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 ofservlce ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ H VAC ,
Miscellaneous ❑ 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 El 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 $6
In Plant _ • . _ _ ! . $73.75 _ - _ _ ___ ❑ Outdoor Landscape Lighting` _
Fees: ❑ Protective Signaling
Enter total of above fees $ ❑ Other •
8% State Surcharge $ Number of Systems
25% Plan Review Fee ' No licenses are required. License
See "Plan Review section on $ 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\forn s\elc- fees.doc 10/09/00