Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00716
COMMUNITY DEVELOPMENT I DATE ISSUED: 12/19/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 DC - 04500
SITE ADDRESS: 07555 SW TECH CENTER DR A ZONING: I -P
SUBDIVISION: TECH CENTER BUSINESS PARK LOT : 001 JURISDICTION: TIG
Project Description: BLUEBIRD TRANSFER. Reconnect gas pak #1.
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: 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:
SUMMIT PROPERTIES INC PRO CIRCUIT ELECTRIC LLC
4444 NW YEON PO BOX 3948
PORTLAND, OR 97210 • WILSONVILLE, OR 97070
Phone: Contact #: PRI 971- 563 -8211
FAX 503 - 266 -1349
FEES
Description Date Amount Reg #: ELE 3 -60IC
[ELPRMT] ELC Permit 12/19/200( $46.85 LIC 161382
[TAX] 8% State Surcharge 12/19/200( $3.75 SUP 5107S
Total $50.60 REQUIRED ITEMS AND REPORTS
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: S f � Permittee Signature: _j
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 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
a
yl Electrical Permit Application
_ F'OR OFFICI.: l 'SF ONLY
City of Tigard u� t 1 . ia'• ' :, > >�' R • .
13125 SW Hall Blvd., Tigard, OR 972: • " 1 i - 7I/ " ,' _ Datc/B . -- / Fermit N 1
Phone: 503.639.4171 Fax: 503.598.1960 �.
Plan Review �° I
I Dn CC y i . I :'4 . Date/By.. Other Petmit:
inspection Line: 503.639.4175 • U.Lr. L 0 r� t
Internet: www.ci.ligard.orus
- Date Ready/By. lurk I See Page 2 for
NotificdN
FI Suppt Info
N
f
El New construction ddition/alteration/replacement Please check all that apply REVIEW
PLAN
❑ Demolition ❑ Other. ❑Service over 225 amps, comm'l ❑liarardous location
CATEGORY OF CONSTRUCTION ['Service over 320 amps — rating ❑Bulling over 10,000 sq. fl.,
of I - n
of and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling Commercial /industria[ ❑ Accessory building QSystem over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other:
JOB SITE INFORMATION AND LOCATION ❑Occupant load ova 99 persons ❑Manufactured structures or
❑Egress/lighting plan RV park
Job no.: 1 Job site address: 7 555 5 3 TEj+ Ce� facility ❑Other:
City /State/ZIP: -TEN-6 O t J 7 �f plans with any of the above.
Q� The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: I Project name: FEE* SCHEDULE
Doe rip tlen I Qly. I Fee. I Total I -•
Cross street/directions to job Site: New residential single -or multi- family dwelling unit.
Includes attached garage.
1,000 sq. tt or fess 145.15 I 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I l
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK
Limited energy, non-residential 75.00 2
Each manufactured or modular
PlEC..1:0 GiAes PPtCXL T
— {-_ 1 dwelling, service and/or feeder 90.90 2
� Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 ' 2
201 amps to 400 amps 106.85 2
❑ PROPERTY OWNER I ❑ TENANT
Name: B t Je` `bi 0.1> 1 � 401 amps 10 600 amps 160.60 2
l , f'W -� 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Reconnect only 66.85 2
Temporary services or feeders installation, alteration, and/or
Phone: ( ) / Fax: ( ) relocation
Owner installation: This installation is being trade on ro 200 amps or less 66.85 I
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 70 not 2 01 amps to 400 amps 100.30 2
Owner signature: 401 amps to 600 amps 133.75 2
Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A Fee for branch circuits with I
Business name: service or feeder fee, each
branch circuit 6.65 2
Contact name: B. Fee for branch circuits
without service or feeder fee. • ( • /
Address: 46.85 t-IG, first branch circuit I o sS Z
City/Stale/ZIP: Each add'I branch circuit l I 6.65 2
Miscellaneous (service or feeder not included)
Phone: ( ) I Fax:: ( ) Pump or irrigation circle 53.40 ' 2
E - mail: Sign or outline lighting 53.40 2
_ Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: f 7 r „c i�tJ - i• ty-� _ r 7i� '� extension. Describe: Page 2 2
r a Address: `�� t rt, r �v ��� Each additional inspection over allowable in any of the above
t� City/State/ZIP: � n � � �j Q Per inspection 6230
1 1)1 4�- d` ` 1 7070 Investigation per hour (1 hr ruin) 1 i 62.50
0■ Phone: (17i) 51-- 772.- I I . — I Fax: (/--5 -Z `•l J - e) I V I Industrial plant per hour 73.75
CCB Lic.: t 6 8 Electrical Lic.: '��OD1 Suprv. Lic.: St Q� ELECTRICAL PERMIT FEES*
Subtotal r
Suprv. Electrician signature, required:
Plan review (25 %of permit fee)
Print name; te,- n( �q .� te: ( r. — I -0 / b State surcharge (8% of permit fee)
Authorized s attire:
Y Cry TOTAL PERMIT FEE 1 � a .�17
This permit application expires if a permit Is not obtained within 18 1
Print name: days after It bas been accepted as complete
Date: • Fee methodology set by Tri- Colmty Building Industry Service Board
i -Perm itApp.doe 17
•• Number of inspections per permit allowed. / �1
44046 15 T(I ryp•}/Co�trw® , A U (J
Z 6ti£ 6-992-£09 AEON area e6l Z 6 90 61. ono