Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00459
DEVELOPMENT SERVICES DATE ISSUED: 7/28/03
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S135AB -00100
SITE ADDRESS: /D 3 So Sal L/A/GeV - itl S7
SUBDIVISION: TOWN OF METZGER ZONING: R -4.5
BLOCK: LOT : 005 JURISDICTION: TIG
Project Description: Temporary electrical service for construction.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: 1 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: 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:
WASHINGTON CLACKAMAS CO COCHRAN ELECTRIC
SCHOOL DIST 23J BROADWAY ELECTRIC
6960 SW SANDBURG STREET 626 SE MAIN
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Phone: 234 - 6564
Reg #: LIC 77942
SUP 3184S
FEES ELE 37 -546C
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 7/28/03 $167.15
[TAX] 8% State Tax 7/28/03 $13.37 Elect'I Service
Elect'I Final
Total $180.52
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 m.: • - - . ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
'
fo in OAR 952 -001 -I. I 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.
Is ed By: hh, t 7,4/ � �i 1 • Permit Signature: )qie (.:
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: . 0 u--1 a DATE:
LICENSE NO: g /e
Call 639 - 4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY
Received Electrical N ..
Date/By: ` O 1 yQ
Permit No X- _l
City of Ti and Planning Approval Sign
ty g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Pa � Post - Review Land Use
itw "U 0' Date/By: No.:
Internet: www.ci.tigard.or.us ■ r�l I Contact J ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 " r Name /Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: 1167i 7 £•lust Description Qty Fee (ea.) Total
9 New residential - single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: ` I Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - Installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: 7. e 93 Reconnect only 66.85 2
Address: Temporary■services or feeders - installation,
alteration, or relocation: / • g7
City /State /Zip: 200 amps or less ./ 66.85 4 I
201 amps to 400 amps ( 100.30 /(O. Be) 2
Phone: FaX 401 to 600 amps 133.75 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City/ State/Zip: B. Fee for branch circuits without purchase of
Ty p : service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: alteration, or extension Page 2 2
C20 — cup) I'� � � C �L T - I I Description:
Address: 1 b - b-i /} 1
City/State/Zip: p �{ 794 Each additional inspection over the allowable in any of the above:
y p: T (..� _ Per inspection per hour (min. 1 hour) 62.50
Phone:. 3 -(15(ell Fax! Investigation fee:
CCB Lic. #: 1 - 7z7 42, Lic. #: V 4 6 Other. Electrical Permit Fees*
Supervising electrician Subtotal $ / [0 7- / S
signature required: Plan Review (25% of Permit Fee) $
Print Name: I Lic. #: $ 1$tIS State Surcharge (8% of Permit Fee) $ / 3. 3 �
TOTAL PERMIT FEE $ / tin • 52+
A t orized �� /� Notice: This permit application expires if a permit is not obtained within
Signature: / Date: 7 Z Q l 180 days after it.has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
r �4,oe ! / 1‘-...--a-
G
(Please print name)
i :\Dsts\Petmmit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard - --
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
El Audio and Stereo Systems
0 Burglar Alarm
0 Garage Door Opener
0 Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
0 Boiler Controls
El Clock Systems
p Data Telecommunication Installation
L i Fire Alarm Installation
HVAC
Instrumentation
01 Intercom and Paging Systems
El Landscape Irrigation Control
El Medical
Ei Nurse Calls
El Outdoor Landscape Lighting
Protective Signaling
0 Other
Number of Systems •
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPetmmitAppPg2.doc 01/03
f3'Rote-- 2311 cs 'f
COCHRAN *BROADWAY ELECT Fax :503- 238 -2098 Jul 30 '03 9 :30 P.01
CITY OF TIGARD •
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
COCHRAN ELECTRIC Env ED
BROADWAY ELECTRIC l'ke •
626 SE MAIN JUL - 0 1003
PORTLAND, OR 97214
Electrical Signature Form o1NGD�
e u„
Permit #: ELC2003.00459 '
Date Issued: 7/28/03
Parcel: 1 S135AB -00100
Site Address: / 0 35a L i 1 1-- n/
Subdivision: TOWN OF METZGER
Block: Lot: 005
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Temporary electrical service for construction.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
•
WASHINGTON CLACKAMAS CO COCHRAN ELECTRIC
SCHOOL DIST 23J BROADWAY ELECTRIC
6960 SW SANDBURG STREET 626 SE MAIN
TIGARD, OR 97223 PORTLAND, OR 97214
Phone #: Phone #: 234 -6564
Reg #: LIC 77942
SUP 3184S
ELE 37 -546C
AN INK SIGNATURE IS REQUIRED ON THIS FORM • .
X .34 (1
Signature of Supervising Electrician
If you have any questions, please call 503.718.2433.
, 3,8 4i.
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