Permit CITY OF T' G A R® ELECTRICAL PERMIT
PERMIT #: ELC2001 -00020
r. DEVELOPMENT rd OR 639 -4171 D ATE ISSUED: 01/12/2001
04- PARCEL: 2S112DC -01400
SITE ADDRESS: 15865 SW 74TH AVE 105
SUBDIVISION: CREEKVIEW INDUSTRIAL PARK ZONING: I -P
BLOCK: LOT : 004 JURISDICTION: TIG
Proiect Description: Installation of one (1) branch circuit.
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:
PACIFIC AMERICAN PROPERTY EXCH RURAL ELECTRIC INC
PACIFIC SANTA FE CORP 5285 NE ELAM YOUNG PKWY
17700 SW UPPER BOONES FERRY RD SUITE A900
PORTLAND, OR 97224 HILLSBORO, OR 97124
Phone: Phone: 503 - 648 -6696
Reg #: LIC 00047478
SUP 4062S
ELE 34 -82C
FEES Required. Inspections
Type By Date Amount Receipt Eiect'I Service
5PCT CTR 01/12/2001 $3.75 2720010000( Elect'I Final
PRMT CTR 01/12/2001 $46.31 2720010000( EXPIRED
Total $50.06
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 SIGNATUREN / eJ 4 , / ,i J ISSUED BY: .. . / /e
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:OOpm for an inspection the next business day
10/04/00 WED 14:02 FAX 503 598 1960 CITY OF TIGARD Q)002
•
Ele Permit Application
, A . RECEIVED Date received: / /.2-- O/ Permit no. :ELC ZOO/ — OOo20
_74 City of Tigard Pr oject/appl.no.:
Expire date
Ci o Ti and Address: 13125 SW Hall Blvd, Tig5a� OR 97223 Date issued: Receipt no.:
rY f 8 Phone: (503) 639 -4171 N �. z z Q d 1 � I P
Fax: (503) 598 - 1960 Case file no.: Payment type:
COMMUNITY DEVELOPMENT
Land use approval: �Le 2 0 o o -Op y7,3
•
. TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory XXCommercial/industrial 0 Multi - family 0 Tenant improvement
❑ New construction 0 Addition/alteration/replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: 15865 SW 74th Ave Bldg. no.: Suite no.: 105 Tax map /tax lot/account no.:
Lot: I Block: Subdivision:
Project name: Cognex `Description and location of work on premises: correct overloaded circuit in w/h ar
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCIIEDULE.
Job no: 01 -020 • Fee Max
•
Business name: RURAL ELECTRIC , INC . Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Address: 5285 NE Elam Young Pkwy #A900 dwelling unit. Includes attachedgarage.
City: Hillsboro I state:oR I ZIP: 97124 Service included:
Phone: 503/64${696 I Fax: I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft_ or portion thereof
CCB no.: 474.78 Elec. bus. lic. no: 34 Limited energy, residential 2
City /m 287 Limited energy, non - residential 2
1/8/01 Each manufactured home or modular dwelling
Signature of supervising electrician (required) • Date Service and/or feeder 2
Su . eet name (Print): nt 1 i s License no4062 -S _ cervices or feeders
Sup ..elect. P ) Paul_A. F"1 I -- -
alt stiano; relocation: — — —
PROPERTY OWNER - 200 amps or less • 2
Name (print): Creekview Business Park 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 17700 SW Upper Boones Ferry Rd #1 1 601 amps to 1000 amps 2
City: Portland I State:OR I ZIP: 97224 Over 1000 amps or volts — 2
Phone: 503 /670 -93001 Fax:unkna xl 1E-mail: urkroAn Reconnect only 1 -
Owner installation: The installation is being made on property I own Temporary sernces or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocadon: E <; • x'
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: n/a Date: 401 to 600 amps 2"
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: n/a A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder, fee, first branch circuit: 1 46,8E 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Pl check all that apply) Misc. (Service or feeder not included):
O Service over 225 maps - commercial ❑ Health- carefacility Each pump or irrigation circle 2
O Service over320amps-rating oft &2 ❑ 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
❑ Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan 0 Other: Per inspection [ 1 1 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $— `7 , .3 /
Not all jurirdiccons accept credit cards, please call jurisdiction for more information. Notice: This permit application Pl re view (at %) $
_
0
0 Visa 0 MasterCard expires if a permit is not obtained / 5 r ,?
Credit card member: / / within 180 days after it has been State surcharge (8 %) $ •
' Ex accepted as complete. TOT AL S
Name of cardholder as shown on credit card ° r D
Cardholder signature Amount \
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY --
4. Complete Fee Schedule Below:
Number of Inspections per permit allowed Restricted Energy Fee $75.00
Service in Items Cost Total (FOR ALL SYSTEMS)
4a. Residential - per unit • Check Type of Work Involved:
1000 sq. ft. or less $147.15 4
Each additional 500 sq. ft. or n Audio and Stereo Systems
portion thereof $33.40 1
Limited Energy $75.00 n Burglar Alarm
Each Manufd Home or Modular .
Dwelling Service or Feeder $90.90 . 2
n Garage Door Opener'
4b. Services or Feeders
Installation, alteration, or relocation ❑ Heating, Ventilation and Air Conditioning System*
200 amps or less $80.30 2
201 amps to 400 amps $106.85 2 n 4a�
401 amps to 600 amps $160.60 2 a:u�i� Systems*
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2 TYPE OF WORK INVOLVED - COMMERCIAL ONLY
4c. Temporary Services or Feeders
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.
n Audio and Stereo Systems
4d. Branch Circuits
New, alteration or extension per panel ❑ . Boiler Controls
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 ❑ •
b) The fee for branch circuits Data Telecommunication Installation
without purchase of service
or Eder fee. ri Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 El HVAC
4e. Miscellaneous
•
(Service or feeder not included) ❑ Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline fighting $53.40 • n Intercom and Paging Systems
Signal arcuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control'
Minor Labels (10) $125.00.
4f. Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50 n Nurse Calls
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting*
5. Fees: n Protective Signaling
5a. Enter total of above fees $
8% Surcharge (.08 X total fees) $ n Other
Subtotal $
5b. Enter 25% of line 5a for Number of Systems
Plan Review if required (Sec. 3) $
Subtotal $ • • No licenses are required. Licenses are required for all other installations
❑ Trust Account # FEES:
Total balance Due $ ENTER FEES $
•
8% SURCHARGE (.08 X TOTAL ABOVE) $
TOTAL $