Permit ' l} CITY OF TI GARD ELECTRICAL PERMIT
• PERMIT # ELC20 -00245
0,01 DEVELOPMENT SERVICES DATE ISSUED: 5/11/00 "
11 f 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 -
PARCEL: 2S 11380- 00600
SITE ADDRESS: 16060 SW 85TH AVE
• . SUBDIVISION: ZONING:, I -P
BLOCK: • LOT JURISDICTION: TIG -
Project Description: Installation of 24 branch circuits in the Administration Building._Job No. 051100.
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 HMI 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: 23 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:
UNIFIED SEWERAGE AGENCY GUSTAFSON ELECTRIC IN C
150 N 1ST AVE 921 CASCADE DR
HILLSBORO, OR 97123 SALEM, OR 97304 ,
Phone: Phone: 503.588 -9166
Reg #: LIC 66608. -
ELE 27 -48C .
SUP 3661 S - -
FEES Required Inspections •
Type By Date Amount Recei Elect'I Service
PRMT DEB 5/11/00 $160.55 0002090 •Elect'I Final • .
5PCT DEB ' 5/11/00 $12.84 0002090 • -
Total $173. - .
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and 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 • - - : les or direct questions to OUNC at (503)
246 =1987. • / _
PERMITTEE'S SIGNATURE ��- i ISSUE n BY : • AO
0 ." v WIN . 1 1 .
The installation is being made : n property I own which is not intended for sale, lease,_ or rent. '
OWNER'S SIGNATUR • DATE: //. / c7t7 •
CONTRACTOR IN `r'" LATION ONLY .
.
SIGNATURE OF SUPR. ELEC'N:
God a • TE:
LICENSE NO cCJ
Call 63' -4175 by 7:00pm for an inspection the next business day .
CITY OF TIGARD Plan Che IKA -
� 13923 SW HALL BLVD. Electrical Permit Application `
Recd By
TIGARD OR 97223 Date Rec'd .5 ° li'C 10
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST
Inspection (503) 639 -4175 Print of Type Permit # f.LC - CO PIS
Fax (503) 598 - 1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development 17,1,- A i4.1 I,JL She we.>Eu. -t- Number of Inspections per permit allowed
Name (or name of business) _ .51..1; .•• /3 i4,, • Service included: Items Cost Sum 4
Address /4, 046 5. w, S . t h 4a. Residential - per unit
1000 sq. ft. orless $ 117.75 4
City/State /Zip 7 t/i.� e 9,- 1 ,457 - 9'72.z y Each additional 500 sq. ft. or
portion thereof $ 2615 1
Commercial Residential ❑ Limited Energy $ 60.00
Each Manut'd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit issuance, applicants must provide contractor license 4b. Services or Feeders
information for COT data base). Installation, alteration, or relocation
Electrical Contractor GL[ S t4r 1 Qv. ( 4 N-1 C, , +•, (, 200 amps or less $ 64.25 2
Address 9,2 / C u j e 4 el.* n ✓. 111. leJ' 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
City ,S /, r+7 StateOr.c4-7 Zip ' 7304, 601 amps to 1000 amps $ 192.50 2
Phone No. ` } � b 3 - 5 u ed - q G !,, Over 1000 amps or volts $ 363.75 2
Job No. -,f�. O ,£j // oo Reconnect only $ 53.50 2
Elec. Cont. Lice. No. a - L/Sc Exp.Date /® // / 00 4c. Temporary Services or Feeders
OR State CCB Reg. No. (a 4 6 O f Exp.Date GM/o/ Installation, alteration, or relocation
COT Business Tax or Metro No. 4,4 xp.Date 200 amps or less $ 53.50 2
201 amps to 400 amps $ 80.25 2
Signature of Supr. Elec'n !� _ _,, , �tii _ _ 401 amps to 600 amps $ 107.00 2
Over 600 amps to 1000 volts,
4 (o / S Exp.Date ty
see "b" above.
�
License No. � p / !/ / D�
Phone No. $ 3- 5 9/6 New, , alteration Circuits
- � New, alteration or extension per panel
a) The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Address b) The fee for branch circuits
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit / $ 37.50 c 7 50
Each additional branch circuit 73 $ 5.35 7 j am
The installation is being made on property I own which is not 4e. Miscellaneous
intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 42.75
Owner's Signature Each sign or outline lighting $ 42.75
Signal circuit(s) or a limited energy
(if required):* panL alteration or extension $ 60.00
3. Plan Review section
( Minor Labels (10) $ 49446
Please check appropriate item and enter fee in section 5B. 4f. Each additional inspection over 7M
4 or more residential units in one structure the allowable in any of the above
Service and feeder 225 amps or more Per inspection $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing special occupancy as
described in N.E.C. Chapter 5 5. Fees: /�
5a. Enter total of above fees $ /)0'
* Submit 2 sets of plans with application where any of the above apply. g r1a t Surcharge (.0'X total fees) $ / a • � •c// Not required for temporary construction services. btotal $
5b. Enter 25% of line 5a for
NOTICE Plan Review if required (Sec. 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account # 39
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ /73
is \dsts \forms \electric.doc