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Permit CITY OF TI GARD • ELECTRICAL PERMIT PE RMIT #: ELC2001 -00282 11 L 13125 DEVE PMENT r S ERV ACES 639 -4171 DATE ISSUED: 5/31 /01 // all 5 PARCEL: 1S136CD-00102 SITE ADDRESS: . 4€61 SW PACIFIC HWY SUBDIVISION: ZONING: C -G BLOCK: LOT : JURISDICTION: TIG Project Description: Installation of 4 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: 3 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: ROSE CORPORATION 89976 DAY LANE EUGENE, OR 97402 Phone: Phone: 541 - 686 -0905 Reg #: LIC 54431 ELE 20 -253C SUP 1568S FEES Required Inspections Type By Date Amount Receipt Elect'l Final PRMT CTR 5/31/01 $68.60 2720010000( 5PCT CTR 5/31/01 $5.49 2720010000( Total $74.09 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: 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: /S6 Call 639 -4175 by 7:00pm for an inspection the next business day Electrical Permit Application A Datereceived: ®Q/ Permit no.: ELe ZOO A I 1 City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: 414), r� Phone: (503) 639 -4171 � eceiptno.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION Job address: / _ , Bldg. no.: / Suite no.: Tax map /tax lot/account no.: Lot: Block: 'bdivision: Project name: 7-"L. r .. I Description and location of work on premises: �,P ��.. Estimated date of completion/inspection: !! CONTRACTOR APPLICATION - -''' FEE SCIIEDLLE Job no: Fee Max Business name: ) '- CnL ' Description Qty. (ea.) Total no. insp / New residential - single or multi- family pe Address: • ,9'9, 7b ,,,z,,,,, dwellingmdt .Includesattachedgarage. • City: PA/07" I 5tat *,,e I ZIP: T7gez Service included: Phonecgi...6gt ,97,sf Fax ' / -1'.°r�e 1 E -mail: 1000 sq. ft. or less 4 CCB no.: .5 I Elec. bus. lic. no: 76- ,e536., Each additional 500 sq. ft. or portion thereof Limited energy, residential 2 City /metro lic. no.: /� / g.-- /6 /D //Q Limited energy, non- residential 2 /// 11.1 0 / / Each manufactured home or modular dwelling Signature of supervising electrician (required) ate B /01 n / Service and/or feeder 2 Sup. elect. name (print): r j 411111 Q - —, License S Services or feeders— installation, ! alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name (print): 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 2 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 am. s 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 REVIEW (Please check all that apply) Misc. (Service or feeder not included): rte' O Service over 225 amps - commercial Cl Health-care facility Each pump or irrigation circle 2 — ❑ Service over 320 amps- rating of 1 &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 Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other C/ Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ a , �p� ❑ 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 %) $ c5.5/ Expires accepted as complete. TOTAL $ • 7 • O ° I Name of cardholder as shown on credit card Cardholder signature Amount 440 -4615 (6/00 /COM) Electrical Permit Fees: Limited Energy Fees: - Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Inspections per Restricted Energy Fee $75.00 Number of Ins pe pe 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 El 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 $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 `f"U . ie J Each additional branch circuit .•- $6.65 /�j, 95 n 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 ❑ 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 $ (D D �j . (o() n Other 8% State Surcharge $ 5 , y 9 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 $ Total Balance Due $ • i:\dsts\forms\elc- fees.doc 10/09/00