Permit :CITY OF T I G A R D ELECTRICAL PERMIT
r• PERMIT #: ELC2002 -00170
. DAT DEVELOPMENT SERVICES E ISSUED: 4/16/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 112DC -01400
SITE ADDRESS: 15865 SW 74TH AVE 105
SUBDIVISION: CREEKVIEW INDUSTRIAL PARK ZONING: I -P
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BLOCK: LOT : 004 JURISDICTION: TIG
Project Description: Install 3 branch 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: 2 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 AMERICAN PROPERTY EXCH RURAL ELECTRIC INC
PACIFIC SANTA FE CORP 5285 NE ELAM YOUNG PKWY
17700 SW UPPER BOONES FERRY RD SUITE A900
PORTLAND, OR 97224 HILLSBORO, OR 97124
Phone: Phone: 503 - 648 -6696
Reg #: LIC 00047478
SUP 4062S
ELE 34 -82C
• 17' % ~ FEES Required Inspections •
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 4/16/02 $60.15 2720020000( Wall Cover EXPIRED
Elect'I Final
5PCT CTR 4/16/02 $4.81 2720020000(
Total $64.96
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: L / Issued By: 6 84, 1_ 6(„%. _ 6
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: 4 7f)("7- -5
Call 639 -4175 by 7:OOpm for an inspection the next business day
10/04/00 WED 14:02 FAX 503 598 1960 CITY OF TIGARD 0 002
- Electrical FermitApplication
Date received: NA= Permit no.: --1, ... ,00 I v
srPh e �I Iii `�
!ry City `�
� of T>< and D E U Project/appl:no.: Expire date:
a, �• u
City of Tigard Address: s g 13125 SW Hall Blvd; Ti r`a OR 9 223 Date issued: Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 A.QR t • rinri Case file no.: Payment type:
Land use approval: d' IN Iii. [ AAD _
TYPE OF PERMIT .
0 1 & 2 family dwelling or accessory ommercial/industrial 0 Multi- family 0 Tenant improvement
0 New - - -0 Addition/alteration /replacement D. Other: 0 Partial -- — -
JOB SITE INFORMATION .
Job address: 15865 SW 74th; Portland 97224 Bldg. no.: Suite no.:j00 Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: Cognex I Description and location of work on premises: (3) c-i rru i t s 7 (1) rPrepl 1
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDULE
Job no: 07 -076 Fee Max
Business name: RURAL ELECTRIC , I NC . Description Qty. (ea.) Total no. insp
5285 NE Elam Young Pkwy New residential -single or multi-family per
Address:
5 )clay A900 dwelling unit Includes attached garage.
City: Hillsboro I State:0g I ZIP: 97124 Service included:
Phone: 503/648 -6696 Fax: I E -mail: 1000 sq. ft. or less • 4
_
CCB no.: 47478 j /F C7 34 _82C Each additional 500 sq. ft or portion thereof
Ele bus. tic. n o: Limited energy, residential 2
City/ 'c. no.: 52$?7 /0 -1 - �Z Limited energy, non- residential 2
! 4/12/02 Each manufactured home or modular dwelling
Signature of supe ising electrician (required) • Date 16 _( - 014 Service and/or feeder 2
Sup. elect name (Print): Ra A. Fl 1 i s Li no [ 1062 S cervices orfeeders— instatllation,
P -- -- - _ —alteration arre!ccatie - -
PROPERTY OWNER 200 amps or less 2
Name (print): Cognex 201 amps to 400 amps 2
• 401 amps to 600 amps 2
Mailing address: 15865 SW 74th • 601 amps to 1000 amps 2
City: Portland IState: op I ZIP: 47774 Over 1000 amps or volts 2
Phone: !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
ENGINEER 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 1 16.85 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2 13.3C 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that a misc. (Service or feeder not included):
0 Service over 225 amps-commercial 0 Health-carefacility Each pump or irrigation circle 2
0 Service over320 amps-rating of 1 &2 0 Hazardous iocation 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,
0 System over600 volts nominal more residential units in one structure alteration, or extension* 2
0 Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lightingplan 0 Other. Per inspection L 1 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ 60.15
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Plan review (at _ %) $ Cif Visa 0 MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ 4_81
, Ex accepted as complete. TOTAL $ 64.96
Name of cardholder as shown on credit card $ EXPIRED Cardholder signature Amount 440 -4615 (6100 /COM)
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TYPE OF WORK INVOLVED - RESIDENTIA (?Nt ,
4. Complete Fee Schedule Below:
Number of Inspections per permit allowed Restricted Energy Fee $75.00
Service included: Items Cost Total 4- (FOR ALL SYSTEMS)
4a. Residential - per unit Check Type of Work Involved:
1000 sq. ft. or less $147.15 4
Each additional 500 sq. ft. or n Audio and Stereo Systems
portion thereof $33.40 1
Limited Energy $75.00 n Burglar Alarm
Each Manufd Home or Modular .
Dwelling Service or Feeder $90.90 2
❑ Garage Door Opener'
4b. Services or Feeders
Installation, alteration, or relocation ❑ Heating, Ventilation and Air Conditioning System*
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 n Vacuum Systems*
401 amps to 600 amps $160.60 . 2
601 amps to 1000 amps $240.60 2 n Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
4c. Temporary Services or Feeders
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.
n Audio and Stereo Systems
4d. Branch Circuits
c
New, alteration or extension per panel n Boiler Controls
a) The fee for branch circuits
•
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 n
b) The fee for branch circuits Data Telecommunication Installation
•
without purchase of service
or feeder fee_ C, n Fire Alarm Installation
First branch circuit t $46.85 , LA S
Each additional branch circuit $6.65 Arm n HVAC
4e. Miscellaneous • ❑
(Service or feeder not included) Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline fighting $53.40 • n Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control*
Minor Labels (10) $125.00.
4f. Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 . n Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting`
5. Fees: . n Protective Signaling
` n
5a. Enter total of above fees $ r
8% Surcharge (.08 X total fees) $ V-,2/D) n Other
Subtotal $
5b. Enter 25% of line 5a for Number of Systems
Plan Review if required (Sec. 3) $
Subtotal $ r • No licenses are required. Licenses are required for all other installations
❑ Trust Account # FEES
Total balance Due $ '4 90 ENTER FEES $
8% SURCHARGE (.08 X TOTAL ABOVE) $
TOTAL $