Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00628
AL DEVELOPMENT SERVICES DATE ISSUED: 10/13/03
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S115BD -02600
SITE ADDRESS: 16875 SW PACIFIC HWY
SUBDIVISION: ZONING:
S
BLOCK: LOT : JURISDICTION: KIN
Project Description: JOB NO. 0I -1578
Temporary power pole
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: 1 W /SERVICE OR FEEDER: 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:
SPACE AGE FUEL INC BOYLES ELECTRIC, INC.
PO BOX 607 P.O. BOX 1227
GRESHAM, OR 97030 BORING, OR 97009
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Phone: 503 - 665 -5693 Phone: 503 - 668 -7440
Reg #: LIC 137002
ELE 3 -465C
FEES SUP 3404 -S
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 10/13/03 $66.85
[TAX] 8% State Tax 10/13/03 $5.35 Elect'I Service
Elect'I Final
Total $72.20
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 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-6699 or
1- 800 - 332 -2344.
Issued By: T Permit Signature:
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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
Electrical Permit Application
Date received: Permit no.: , , , 1i Date
, ,� ..� �
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� City of Tigard R ECEIVED Project/appl. no.: Expire date:
_
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9 223 Date issued: By: [ Receipt no.:
Phone: (503) 639 -4171 OCT 10 2003
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: CITY OF TIGARD
ING
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory tommercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 1(o g -q,S S Li QC , t o y Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: I Description and location of work on premises: - e yi Q. e a o E if'
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDILE
Job no: OT • 1� �6 71 _ Fee Max ..._
Business name: b o l e s C (e c t - L. a,v,, Description Qty. (ea) Total no. insp
n f � a � New sesidential- single or multi - family per
i
Address: l7
dwelling Emit. Includes attached garage.
City: B I State:o I ZIP: 0009 . Service included:
Phone: (j %. f y l(0 ax: c ( 9., 7(4CI E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB o.: 131 COO, Elec. bus. lic. no:, 3 U (.r- 5 n
l._
l ' o Limited energy, residential 2
Cit etro lic O • � l S Limited ener
gy, non-residential 2
/0• - ?, , Each manufactured home or modular dwelling .
Si _ •r ure of supervisin , ectrician (required) Date Service and/or feeder _ 2
•0 elect. name (print): b yy J I e S License no: 3 C/ NS Servicesorfee installation,
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PROPERTY OWNER alteration or re location:
2 00 amps or less 2
Name (print): „sgac e 3 e - PA_ e_.. 201 amps to 400 amps 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I 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, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less I ( o � - --∎. - 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
Name: or extension per panel:
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 REVIEII' (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 l &2 ❑ 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 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/lightingplan ❑ 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 ail jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ (..e6 5
❑ 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 %) .... $ _ `� 3 5
Expires TOTAL as complete. TOTAL $ f a • 0
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6/00/COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
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Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Number of Inspections Restricted Energy Fee $75.00
p 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
Limited Energy $75.00 ❑ Burglar Alarm
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
201 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 I $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 ❑
or feeder fee. Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous
(Service or feeder not included) ❑ Instrumentation
Each pump or irrigation circle $53.40
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 p Medical
the allowable in any of the above
Per inspection __ $62.50 _ — ❑ 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 $
Enter total of above fees $
❑ Trust Account #
8% State Surcharge $
All New Commercial Buildings require 2 sets of plans.
Total Balance Due $
i:\dsts \forms \elc- fees.doc 08/30/01