Permit CITY OF TIGARD
ELECTRICAL E NERG ERG
Y
RESTRICTED E
, DEVELOPMENT SERVICES PERMIT #: ELR2001 00155
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/6/01
SITE ADDRESS: 10255 SW 90TH AVE PARCEL: 1 S135AB 00100
SUBDIVISION: TOWN OF METZGER ZONING: R - 4.5
BLOCK: LOT: 005 JURISDICTION: TIG
Protect Description: Installation of low voltage wiring for freezer monitor. Job No. 1569 - -108
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:
INSTRUMENTATION: OTHER: FREEZER X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WASHINGTON CLACKAMAS CO SONITROL PACIFIC
SCHOOL DIST 23J 1975 SW 6TH AVE
13137 SW PACIFIC HIGHWAY PORTLAND, OR 97201
TIGARD, OR 97223
Phone: Phone: 223 - 5822
Reg #: LAC 00053535
ELE 26370CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 6/6/01 $75.00 2720010000 Elect'I Final
5PCT CTR 6/6/01 $6.00 2720010000
Total $81.00
•
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 yo I .w rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 -0010 throug OAR 9 01 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 987. , /7
Is ued by � .A� P ermittee Signature / //, , /� i , // „,,.
OWNER INSTALLATION ONLY
The installation is being made on property 1 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 S . ° . ' .; ,
Date received: 6 5 Q/ Permit no.: ZG 2apD /-'40/5
�' I
I!1 City of Tigard IFtEcE/ Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 973 ®r. Date issued: By: Receipt no.:
Phone: (503) 639 -4171 tt a >\ r � ;� 7®
Fax: (503) 598 -1960 ., a ` Case file no.: Payment type:
Land use approval: t ,na►1
� wV . DEV? -k- ° ? 11
.� ; .W� , TYPE' OF. P E R MIT ' .±t,:`
❑ 1 & 2 family dwelling or accessory . 121 Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction Addition/alteration/replacement ❑ Other: ❑ Partial
_. • • i..:: - :.JOB SITE ;° INFORMATION
Job address: tGa S(,,) C\ (Y Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision: _ t
Project name:�"Sj -met,) r �(�tm I Description and location of work on premises: Gp l.( 3Y\ '\l'p S .
Estimated date of completion/inspection:
_;- ,-.... .:::.CONTRAC O t -A P PLICiI p1, ..;_. ..,_' _ -FEE2SCHEDU E:° r a
M
Job no: 15 L . - �g �_ _ _ . Ece Max
Description Qty. (ea.) Total no. insp
Business name: • t -t-YQ \ V QG - V \ L
l g -- r ' L New residential d garage per
`
Address: l� Q dwellinguni nit .lncldudes desatt ttachechedgarage.
City: 'o J State:&y ZIP: 11 ap \ Seniceincluded:
Phone: aa3 - Sg a,a Fax: -lath/ E -mail: 1000 sq. ft. or less 4
CCB no.:
( f _ Each additional 500 sq. ft. or portion thereof
3F ? 5 Elec. bus. lic. no: 3� V Limited energy, residential 2
City /metro lic. no.: Limited energy, non- residential 2
- / Each manufactured home or modular dwelling
Signature of supervising electri s. -.. '^'d ('f? Date Service and/or feeder 2
/r. Zane
or feeders - installation,
Sup. elect. name (print): fy,tjph/ License no: �z7 .0e Y `� alteration or relocation:
n - ,: "� : ;'' ' ' i 200 amps or less 2
Name (print): 201 amps to 400 amps 2 .
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only l
Owner installation: The installation is being made on property I own Temporary servicesorfeeders -
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:
Nurse: ___ A Fee forbr2.rrh circuits with purchase of
A ddress: service or tee, each branch circuit 2
City: • I 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):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of 1&2 ❑ Hazardous location Each signor outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ 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 $
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application -
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $ QI � • DO
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 I I Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof ' - $33.40 1 I I Burglar Alarm .
Limited Energy • $75.00 ... .
• Each Manufd Home or Modular I Garage Door Opener"
Dwelling Service or Feeder $90.90 2
Services or Feeders In 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 17 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 F=eeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
alteration, or relocation
200 amps or less $66.85 2 Fee for each system $75.00
201 amps to 400 amps $100.30 2 (SEE OAR 918 - 260 -260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above.
Branch Circuits n Audio and Stereo Systems
New, alteration or extension per panel •
a) The fee for branch circuits Boiler Controls
with purchase of service or .
feeder fee. In Clock Systems
Each branch circuit $6.65 - 2
b) The fee'forbranch circuits • I I Data Telecommunication Installation
without purchase of service _
or feeder fee. I I Fire Alarm Installation'
First branch circuit $46.85 •
Each additional branch circuit $6.65
HVAC
Miscellaneous
(Service or feeder not included) In Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 PI Intercom and Paging Systems
'Signal circuit(s) or a limited energy ,n AN
panel, alteration or extension t $75.00 ` �
Minor Labels (10) $125.00 n. Landscape Irrigation Control
Each additional inspection over In Medical '
the allowable in any of the above
Per inspection $62.50
Per i-icu7 $67 59 Nurse Calls
--
in Plant $73.75 -- ri i Outdoor Landscape Lighting
Fees:
1 . f I Protective Signaling •
Enter total of above fees $ 1 �y
` 3
8% State Surcharge $ 6 ,' N Other 4.-e--7P-1 � ‘ t
Number of Systems
25% Plan Review Fee
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ O 1 .06 Fees: Q°
Trust Account # Enter total of above fees $ .1 5 " ��cc
8% State Surcharge $ L - CS
• Total Balance Due $ D • CSU
is \dsts \forms \elc- fees.doc 10/09/00 .