Permit It, A CITY OF TIGARD ELECTRICALPERMIT -
RESTRICTED ENERGY
4 DEVE ICES 639 -4171 DATEES ISSUED: ELR2002-00019
2/12/02
SITE ADDRESS: 11507 SW PACIFIC HWY B PARCEL: 1S136AD -04000
SUBDIVISION: VILLA RIDGE ZONING: C -G
BLOCK: LOT: 007 JURISDICTION: TIG
Project Description: Low voltage supply to rooftop HVAC.
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: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SMITH, EDITA M WILLAMETTE HVAC
833 NW 170TH DR 27655 SW LEPLEY LN
BEAVERTON, OR 97006 HILLSBORO, OR 97123
Phone: Phone: 628 -6841
Reg #: LIC 56951
ELE 34 -346CR
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 2/12/02 $75.00 2720020000 Elect'I Final
5PCT CTR 2/12/02 $6.00 2720020000 EXPIRED
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 -w
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OA"
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct que 'ons to OU :t (503)
246 -1987.
Issued by , Permittee Signature/
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: flr' Q 42420 DATE:
LICENSE NO: 2 (7- D57k" U
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application
k, A
Date received: p/e 2— Permit no.: ,20Q —000 /
:� ..) City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: qlp I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory )(Commercial/industrial 0 Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: ,/ S'0' Su „t, l� c') )% Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: // S O ? 3„,11.e_ f3, ,5al 1...i✓ Gds Description Qty. ( Fee Max
ea.) Total no. p
Business name: e,>, //et, NI t; N1/4 New residential -single ormuld- family per
Address: I ' O 73 e 3 vZ 3 ”? 7 </ • dwelling unit. Inchides attached garage.
City :174 , ,, I State:0y I ZIP: '7' 2 8 . Service included:
Phone 8- g3// I FaxecI 5 7-4E-mail: 1000 sq. ft. or less 4
�G q S ! / 0 I I� ,cT ? Each additional 500 sq. ft. or portion thereof
CCB no.: Elec. bus. lie. no: pp
- G7 Limited energy, residential 2
City /metrolic.no.: f0/1 02 � 4_3 Ll(p(�e.- Limited energy, non- residential it v/ ,... j 2
a .- / _ 02 Each manufactured home or modular dwelling
S attire of supervising electrician (required) Date Service and/or feeder 2
s S.1. a
License no: Services or feeders — installation,
Sup. elect. name (print):
alteration or relocation:
PROPERTY OIVNER 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: 'ZIP: Over 1000 amps or volts 2
Phone: "Fax: I E -mail: Reconnect only I
• 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, or relocation:
200 amps or less 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 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
—
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps - rating of l &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' 2
O Building over three stones O Feeders, 400 amps or more *Descripti on• Q Q
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan O Other. Per inspection I I 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 $ -7
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / I within 180 days after it has been State surcharge (8%) .... $ l> . lJ 0
Ex accepted as complete. TOTAL $ • �/ U V
Name of cardholder as shown on credit card
$
EXPIRED
Cardholder signature Amount 440 -4615 (6/00/COM)
•
r t dL
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ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
•
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
'lumber of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 4, 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 0 Burglar Alarm
Limited Energy $75.00
Each Manufd 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 El 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 $46.85 _
Each additional branch circuit $6.65 C8 HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included) •
Each pump or irrigation circle $53.40 El 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 El Medical
the allowable in any of the above
Per inspection $62.50 0 Nurse Calls
Per hour $62.50
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
• See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees: •
_
Total Balance Due $ S . oG
Enter total of above fees $
❑ Trust Account # 8 %State Surcharge $ ` /
Total Balance Due $ /. 00
All New Commercial Buildings require 2 sets of plans.
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