Permit CITY OF T I G A R D ELECTRICAL PERMIT
. A PERMIT #: ELC2000 -00695
d "I�^ DEVELOPMENT Ipr SERVICES ) 639 -4171 DATE ISSUED: 12/18/00
PARCEL: 2S102BD -00701
SITE ADDRESS: 12785 SW PACIFIC HWY
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: C -G
BLOCK: LOT : 008 JURISDICTION: TIG
Project Description:
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: 1 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:
SPADA, FRED TRUSTEE BECK ELECTRIC INC
WIENER, NORMAN J TRUSTEE 9318 SE CHURCH ST
72907 BEL AIR RD CLACKAMAS, OR 97015
PALM DESERT, CA 92260
Phone: Phone: 656 -7396
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Reg #: SUP 1326S
LIC 00002629
ELE 3 -5C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 12/18/00 $53.50 2720000000( Elect'I Final
5PCT CTR 12/18/00 $4.28 2720000000(
Total $57,78
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.
PERMITTEE'S SIGNATURE — Ina je ISSUED BY: '
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 7:00pm for an inspection the next business day
A
• Electrical Permit Application •
. t ' Date received: / //Oz) Permit no cps _o ( 9 c
I! City of Tigard Projecdappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory >ommercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction OAddition/aiteration/replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: 427,PS SA, /°h"/,n . ,z/' Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: f E/tl,0 y zr I Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCI IEDU,E
Job no: - . 6 X.6- Fee Max
Business name: ,aECK cLECTi2/ c_ Description Qty. (en.) . Total no. insp
New residential - single or famlly
Address: 93 if S6 '�yrmI,Q6V dwelling mdt.In attadredgarage.�
City: CMeiedeliltS I State:0/L I ZIP: ?70,,5 Serricehtcluded:
Phone: c , 5 , - 7394, I Fax: I E-mail: 1000 sq. ft. or less 4
CCB no.: .,2c a9 I Elec. bus. lic. no: 3 -S Each additional 500 sq. ft or portion thereof
Limited energy, residential 2
City/metro lic. no.: Limited energy, non- residential 2
..c&—E- ,g ,7 ,& s f6 ^N ,ec- Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
. Sup. elect name (print): License no:/5026 --5• Services or feeders — Installation,
alteration or relocation:
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: I ZIP: 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 or feeders - .
which is not intended for sale, lease, rent, or exchange according to Installation , alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
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: 'State: • I ZIP: B. Fee for branch circuits without purchase /
Phone: Fax: E-mail: Each service or feeder fee, first branch circuit: 2
Each additional branch circuit: /
PLAN ItEVIENV (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps- commercial O 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* 2
O Building over three stories 0 Feeders, 400 amps or more ' *Description:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other Per inspection 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 $ 53 ,s v
0 Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
• Credit card number / / within 180 days after it has been State surcharge (8 %) .... $ 9. 2e
Expire' accepted as complete. TOTAL $ 57' -7,p •
Name of cardholder as shown on credit card
Cardholder signature Amount 4404615 (6 V0K:OM)
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Electrical Permit Fees: Limited Energy Fees: • ..
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee $75.00
Number 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 ❑ Burglar Alarm
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 ❑ 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
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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 of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit / $46.85 Y4.4'5 Each additional branch circuit ' $6.65 4. . (o-s ❑ HVAC
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 anel, alteration l r extension $75.00 ❑ Landscape Irrigation Control
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Minor Labels (10) - $125.00 ❑
Medical
Each additional Inspection over
the allowable in any of the above ❑ Nurse Calls
Per inspection $62.50
Per hour $62.50 El Plant $73.75 Outdoor Landscape Lighting
Fees: ❑ Protective Signaling
Enter total of above fees $ S' 3 -SO ❑ Other
!
8% State Surcharge $ ' Ze 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 $ - 7' 7?
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:',dsts\forms\eic- fees.doc 10/09/00
•. If V0. 0 0 liiVii 11: L0 CAA ous DUO j. ou \1'): OF 11("AHD 4J002
CITY OF TIGARD Electrical Permit A� PlanchecJc
13125 SW HALL BLVD. Redd By
TIGARD OR 97223 - _ , 2 00® Date Rec'd .
J Date to P.E.
Phone (503) 639 -4171, x304 Q�
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Inspection (503) 639 175 DEVELOPM Date It to DST
Print of T p Permit#
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: • 4. Complete Fee Schedule Below:
Name of Development W RAI l t,I-.5 Number of Inspections per permit allowed
' Name (or name of business) Service Included: Items Cost Sum 4
Add I a 1 S.5 5 LA) f'C f tc y 4a. Residential • per unit
City /State/7ip • D r 1000 sq. ft. or less $ 117.75 4
Each additional 500 sq. ft. or
• Commercial Residential ❑ portion thereof $ 26.75 1 •
Limited Energy • S 60.00
• Each Manufd Home or Modular
2a. Contractor Installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit Issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base Installation,, alteration, or relocation
Electrical Contractor I �c I f' 200 amps or less $ 64.25 2
Address 931 8 5 r✓ C.(cµr c 201 amps to 400 amps $ 85.50 2
City CIA ckavn aS State O ie- Zip 9 70 /5- 401 amps to 600 am $ 128.50 2
601 amps to 1000 amps $ 192.50 • 2
Phone No. 503- i.570 -7 3 % Over 1000 amps or volts $ 363.75 2
Job No. ;2P/0 Reconnect only $ 53.50 2
Elec. Cont Lice. No. 3-5C_ Exp.Date (I - I - 0
P I 4c. Temporary Services or Feeders
OR State CCB Reg. No. ,3 ceac1 Exp.Date 10 - 1 - 15 I installation, alteration, or relocation
• COT Business Tax or Metro No. 5a5S' Exp.Date I -0 I 200 amps or less $ 53.50 2 -
g p ��� • / 201 amps to 400 amps $ 80.25 2
Signature of Sur. Elec'n / f�( 401 amps to 800 amps S 107.00 2
b' Over 600 amps to 1000 volts,
License No. I 32_6 - S .Date /0 t) / see "� above. - .
Phone No. 5 (v 51,- 73 R , 4d. Branch circuits
New, alteration or extension per panel • , ' ,- .
' a) The fee for brand, circuits
2b. For owner installations: with purchase of service or - • -
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Address • b) The fee for branch dreults
without purchase of service
City State Zip or feeder fee- � 7
Phone No. First branch circuit / S 37'�
Each additional branch circuit ( S 5.35 5, 35
The installation is being made on property I own which is not 4e. Miscellaneous lP , 6 5
intended for sale, lease or rent (Service or feeder not included) .
Each pump or Irrigation circle S 42.75
Owners Signature Each sign or outline lighting $ 42.75
Signal dreuit(s) or a limited energy
• d) •* panLa Labels (10) or extension $ 60.00
3. Plan Review section (if required):* Minor Labels (10) _ $ 107.00
Please check appropriate item and enter fee In section 5B. 4f. Each additional inspection over
4 or more residential units in one structure the allowable in any of the above •
• Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal - In Plant S 59.00
Classified area or structure containing special occupancy as
described In N.EC. Chapter 5 5. Fees:
6a Enter total of above fees S3 .5 0 S
* Submit 2 sets of plans with application where any of the above apply. 7% Surcharge (.05 X total fees) r � S 3 , 2. •
Not required for temporary construction services. Subtotal / ' ( .. 7
- Sb. Enter 25% of line 8a for Q
NOTICE_ P lan Review if required (Sec. 3) , i° $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR • -
WORK IS SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS ❑ Trust Account#
AT ANYTIME AFTER WORK IS COMMENCED. Total balance Otte S it $ i f ==�
iAdstslforrnsklecI ic.doc
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