Permit ELECTRICAL PERMIT
CITY OF TIGARD g' - o g1/4
PERMIT #: ELC2006 -00457
� * 14 DEVELOPMENT SERVICES DATE ISSUED: 8/16/2006
f -u - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 102 DA -00200
SITE ADDRESS: 08720 SW BURNHAM ST ZONING: CBD
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: (4) branch circuits for UPS system.
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:
TIGARD, CITY OF OREGON ELECTRIC GROUP
13125 SW HALL 1010 SE 11TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Contact #: FAX 503- 535 -2763
PRI 503 - 234 -9900
• FEES
Description Date Amount Reg #: ELE 26 -95C
[ELPRMT] ELC Permit 8/16/2006 $66.80 LIC 203
[TAX] 8% Statc Surcharge 8/16/2006 $5.34 SUP 44605
Total $72.14 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: Permittee Signature: LP>L
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.
AUG -15 -2006 04:27PM P! E, t C SVC 5035352763 T -734 P.001/002 F -304
"L('ledrical Yerml i. t.p f viol'
City of Tigard • 1 1p ? %1S D Permit No.: t✓� �i7
,, ``�
13125 SW Han Blvd., Tigard, OR 9722 \ Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ^ i 0 , i t , I ; I Datc/By Caber Permit:
Inspection Line: 503.639.4175 ' sl ul `01, -' _ .. Date RcedylBr• lwta+` as I ® See Paso l roe
7► Neti6eethod: l SupplementalInformotion
Internet www.ci.tigatd.ar.us �� � g � � �j(' - � , ; d/M
2 , . XPE OF WORK • PLAN REVIEW
•
❑ New construction 0 Addition/alteration/replacement Please check all that apply:
❑Service over 225 amps, comm'1 ❑Hazardous location
❑ Demolition ❑ Ocher: ❑Service over 320 amps - rating ❑Buidng over 10,000 sq. h,
CATEGORY OF CONSTRUCTION oft- aad 2- family dwellings 4 or more new residential
building Q System ova 600 volts nominal units in one structure
❑ 1 -and 2- family dwelling Commercial/industrial ❑Accessory g 0 Bu>ilding over three stories ['Feeders, 400 amps or more
❑ Multi- family ❑ Master builder ❑ Other. ❑Occupant load over 99 persons OManufacuaed structures ar
' JOB SITE INFORMATION AND LOCATION • ❑F-dlishting plan RV park
❑Health- care fitcility ❑Other:
Job no.: 93358 I Job site address: 8720 SW BURNHAM Submit 2 sets of plans with any of the above.
City/State/ZIP: TIGARD, OR The above are not applicable to temporary construction service.
FEE" SCHEDULE
Suite/bldg./apt. no.: j Project name: THE NICHE -nomads' Q , y , L Vet I Tab.' 1 ••
Cross street/directions to job site: New residential single -or multi - family dwelling unit.
Includes attached garage. _
1,000 sq fl. or less 145.15 4
Subdivision: l Lot no.; Ea. add'I 500 sq. R or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each mtutufactnrcd or modular
CIRCUITS FOR UPS SYSTEM dwelling, service and/or feeder 90.90 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT . — 201 amps to 400 amps , 106.85 2
401 amps to 600 amps 160.60 2
Name: CITY OF TIGARD 601 amps to 1,000 amps 240.60 , 2
Address. Over 1,000 amps or volts 454.65 2
- Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation _
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 70L 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch drcuits - new, alteration, or crtenslon. per panel
❑ APPLICANT I 0 CONTACT PERSON ^ A Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fcc, i 46.85 410 2
each branch circuit
Address:
Each add'l branch circuit 5 6.65 1115 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone ( ) I Fax' ; ( j Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
_
E-mail: ' CONTRACTOR energy panel, alteration, or
extension Describe: Page 2 2
Business name: Oregon Electric Group
Address: 1010 SE 11th Ave Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Portland, OR 97214 Investigation per hots (1 hr mm) 62.50
Phone" (503) 234 -9900 L Fax: (503) 535-2763 , Industrial plant per hour 73.75 -
ELECTRICAL PERMTf FEES"
CCB Lic,: 203 I Electrical i.ia: ic.: 44605 Subtotal (DO . 8 0
,
Suprv. Electrician signature, required: J Plan review (25 % of permit fee)
Print tonne: v1ate IA . 1. 2hV1 . - 0 State surcharge (8% of permit fee) 5.-3 If
TOTAL PERMIT FEE 1 a . I Li
Authorized signature: ' � � = Tats pormlt aPPlrmtioo c plrss It a Permit m not obtained vrlehro 180
days after it has been accepted us complete
Punt name: 1\11,0,E' (/-■ a . my, e1 T; te: 1 :115/ OF • Fee methodology set by T.i- County Building lad,svy Service Bond()
Nmabor of irtapeeticms per permit allowed.
Imuitsioswermia'5 C- PamkAPP. I2/03 4404e157(l0/02/COMnvSB