Permit 1 ' �� � Y CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00530
1 --DEVELOPMENT SERVICES DATE ISSUED: 11/1/01
'I I� 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135DD-05106
SITE ADDRESS: 11999 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install surge suppressor on circuit panel.
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 FOR: 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:
WEIREX CO INC + COCHRAN ELECTRIC
CCC PROPERTY MANAGEMENT LLC BROADWAY ELECTRIC
14001 WILLAMINA CREEK RD 626 SE MAIN
WILLAMINA, OR 97369 PORTLAND, OR 97214
Ph one: Phone: 234 -6564
Reg #: LIC 77942
SUP 3184S
ELE 37 -546C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cove
Wall Cover E XPIRED
PRMT CTR 11/1/01 $46.85 2720010000( Elect'l Final
5PCT • CTR 11/1/01 $3.75 2720010000(
Total $50.60
. 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)
246-6699 or 1 -800- 332 -2344.
Permit Signature: Issued By: D_
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: d)1 ri2- DATE:
LICENSE NO: 8c447
Call 639 -4175 by 7:00pm for an inspection the next business day
• --
- Electrical PAppIi
.a Date received: ( D ) Permit no.:� av/ -0053
w i . ' � ∎1 ' City of Tigard ro ect/a 1 no.: Exit
:_ . `J g OCT o li 1 1 2� �� P 1 PP Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171 CITY OF TIGARD
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: -7--/
TYPE OF PERMIT
E l l & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: Il Si,V •naG G Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: Subdivision: ij
Project name: WA model j, ylk-lI Description and location of work on premises: Ins&l) ( 2 42 , 1e & yy
Estimated date of completion/inspection: : r M • Colt
- t : . . CONTRACTOR APPLICATIOI' - _ ,. 1 1 I.� SCIiEDU_v;,..• - •
Job no: 14y?,0 v7 -19l2 Fee Max
Business name: C-o��ra,,,.1inc . £' �04..L . _. Description (ea.) Total no. tarp
't New residential - single or multi -family per
Address: (,,j2..(„ 5E Mo.: ■ dwelling unit Includes attached garage.
City: V , 6 r I State: 0, I ZIP: C2%4 Service include&
Phone553 234--(664 I Fax: 23S -2r5 E -mail: 1000 sq. ft. or less • 4
2 '/ _ 5 c C Each additional 500 sq. ft. or portion thereof
CCB no.: L(2_ / , 'Elec. bus. lic. no: Limited energy, residential 2
City /me lic. n .: 5 - 05 qV/O /IO �— Limited energy, non- residential 2
_RA 2-9/01 Each manufactured home or modular dwelling
Signature of su rvising electrician (required) Date 14 -0 / -Q Service and/or feeder 2
Sup. elect. name (print): - _ _, .. Licenseno:3 S Services or feeders — installation,
alteration or relocation:
I'ROI'ERTY 0%1'N Ell 200 amps or less 2
Name (print): 12, A V LV 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: ., W a tate: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: E -mail: Reconnect only i
Owner installation: The installation is being made on property I own Temporary services or feeders - . •
which is not intended for sale, lease, rent, or exchange according to installatloo , alteration, orrelocation:
200 amps or less 2
20
ORS 447, 455, 479, 670, 701. 201 1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am s 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit ! 2
City: IState: • IZIP: B. Fee for branch circuits without purchase � �$ i
of service or feeder fee, first branch circuit: I 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all Iliac apply) Misc. (Service or feeder not included):
❑ Service over 225 amps-commercial 0 Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps -rating of I &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ 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 ❑ Other. Per inspection I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call Jurisdiction for more information. Notice: This permit application Permit fee $ �-4 �D $
❑ Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number. _ / / within 180 days after it has been State surcharge (8 %) .... $ - :1
Expires X p%R WA1L $ 50 . (o 0
Name of accepted as com
cardholder as shown on credit card t II
$ /�
Cardholder signature , Amount 440 -4615 (6A0/COM)
f r A
Electrical Permit Fees: Limited Energy Fees: -
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed . (FOR ALL SYSTEMS)
Service included: Items Cost Total `, Check Type of Work Involved:
Residential - per unit - - 4 ❑ •
1000 sq. f . or less $145.15 Audio and Stereo Systems •
Each additional 500 sq. ft. or 1 ❑
portion thereof $33.40 Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular 2 ❑ Garage Door Opener
' Dwelling Service or Feeder $90.90
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 ❑ Vacuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2 El O ther
601 amps to 1000 amps , $240.60 2
Over 1000 amps or volts $454.65 2 • •
Reconnect only $66.85 2
TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, �. C gfCi r. or l ocal on - - 1''ae for aacil sysizir .$ 5.on
Installation. alterac or relocation
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. Audio and Stereo Systems .
Branch Circuits ❑ Boiler Controls New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee. . 1 -- I
Each branch circuit $6.65 2 I I D ata Telecommunication Installation
b) The fee for branch circuits
without purchase of service �� ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 L
Each additional branch circuit $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems '
Each sign or outline lighting $53.40 •
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 ❑ Landscape Irrigation Control
•
Minor Labels (10) - $125.00'
Each additional Inspection over ❑ Medical
the allowable in any of the above ❑ N urse Calls
Per inspection $62.50
Per hour _ $62.50
In Plant $73.75 ❑ Outdoor Landscape Lighting
Fees: • ❑ Protective Signaling
Enter total of above fees $ ❑ Other
8% State Surcharge $ Number of Systems
•
25% Plan Review Fee
See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
• Total Balance Due $
Enter total • of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
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