Permit (22) q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELR2012 00241
'
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/22/2012
Parcel: 2S110DD14000
Jurisdiction: Tigard
Site address: 10650 SW SUMMERFIELD DR
Project: Summerfield Rec Building Subdivision: SUMMERFIELD Lot: B
Project Description: (2) low voltage for protective signaling and CCTV. 10/23/12, correcting scope of work to security alarm and CCTV.
Contractor: STONER ELECTRIC Owner: SUMMERFIELD CIVIC
1904 SE OCHOCO ASSOCIATION
MILWAUKIE, OR 97222 10650 SW SUMMERFIELD DR
TIGARD, OR 97224
PHONE: 503 - 462 -6500 PHONE:
FAX: 503 - 659 -4968
FEES
Description Date Amount
Specifics: 12% State Surcharge - Electrical 10/22/2012 $18.00
Restricted Energy Permit 10/22/2012 $150.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: Y Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: Y Other: N Total $168.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTI• • e -••n law requires you to follow the rules adopted by the Oregon Utility Notificatioi Center. Those rules are set forth in OAR
952 - 001 -00 • rough OAR 95 - =.1 -01 • :. You may obtain a copy of the rules or direct questions to OUNC b •.1 or 1.800.332. 2344.
Issue• By: f Permittee Signa .i /tt
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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s COMMUNITY DEVELOPMENT Permit #: ELR2012 -00241
TI 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/22/2012
Parcel: 2S110DD14000
Jurisdiction: Tigard
Site address: 10650 SW SUMMERFIELD DR
Project: Summerfield Rec Building Subdivision: SUMMERFIELD Lot: B
Project Description: (2) low voltage for protective signaling and CCTV
Contractor: STONER ELECTRIC Owner: SUMMERFIELD CIVIC
1904 SE OCHOCO ASSOCIATION
MILWAUKIE, OR 97222 10650 SW SUMMERFIELD DR
TIGARD, OR 97224
PHONE: 503 - 462 -6500 PHONE:
FAX: 503 - 659 -4968
FEES
Description Date Amount
Specifics: 12% State Surcharge - Electrical 10/22/2012 $18.00
Type of Use: COM Restricted Energy Permit 10/22/2012 $150.00
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: Y Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: Y
Security Alarm: N Other: N Total $168.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
tIssued By: 1`yI&{.t Lc (f Permittee Signature: rim 4 fPL1 i L If)I.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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
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.
Oct. 19. 2012 1:54PM Stoner Electric Group No.4168 P. 1
�
iVED
Electrical Permit Applicr relit tmFlcE tlsn: ONLY
C1 of Tr and OCT .2 2 202 Received o.: PenniiN Date/13 :
b 131 \VllaIIglvd „'figard,OR 97223 Plat Revietr f U / e�la - 17�.
' I Phone: 503.639.4171 Fax: 503 OET �D Dal• : - Other Permit:
TIC :1 R D Inspection Line: 503.639.4 175 ^ pc Date Ready/By; r El See page 2 for
Internet: www.ligard- or,gov p lfl �� l e {rti: Ill VV�t��77 NorIBcd/Medwd: p Supplemental Information
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❑ New construction /14 Addition/alteration /replacement PION check ell that apply (submit 2 sets of plans wfttems checked below);
❑ Service or feeder 400 amps or more 0 Building over three stories,
❑ Demolition ❑ Other: where the available fault current 0 Merinas and boatyards.
' n Ci41'75 l ; ;. "': ' . , ' E. _ J:
� r .r :: :T . =' ;* — exceeds 10.000 amps at 150 volts or ❑ Flossing btnldinge-
� , •,; , r ,�,, .: :. ... .. : ' .C . , ... RY....OF•' t..JST'.t.. • ,, ,_' :;�''.. beam ground, rc s at 15 14,000 gr ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling •.i Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
O . •,..:. �:.,., .....:.......... , .: ❑ Emergency system. larger separately derived system.
*, ..1TE„ i,I�(EORMAT�ON:AND' LOCA'I`IUN a ' . y .,,,-''. ? � ❑ Addition of new motor load of ❑ "A ",' s " 12 ". " 1 -3 ".
( /34 , Job site address: /'Q�,�D SN( Six or more residential Recreational Job no.: 16434 tion
�UH►e+1 iP/ +pt ❑ Six ormore residential undo. ❑ Recreational vehicle perks.
❑ HealdsearoIlclirien. ❑Supply voltage for more than
City/State/ZIP: oR 97 (24
❑ Hazardous locations. 60D write nominal.
Suite/bldg./apt. no.: 1 Project name ,, 6, EL I) Ry ❑Service or feeder 600 amps or more.
CDI(a •:•::•;:- :•:,:,.: „gEE:SHEDUI;E:'::':
Cross street/directions to job site: ne,rrtp,ten t Qtr. I Tee. I torsi I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: l Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add S00 sq. fl or portion 33.92 1
Limited energy, residential 75.00 2
``-,' ?.: .. . I a v ;:::- = iiFfi v with above It.
: �' _ `7:y _. �_ A7 �J .OR'tiVOItICS�:.• .... ( sq. It)
I Limited energy, multi - family 75.00 2
6c..) i Re !/C'C 5 `0N7' Eby tlr d e — residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
• 200 amps or less 100.70 2
. .:, a �• atW ..t,_
D 031 9NT .;': ; :....::•..`.,:. 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: -
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders Installation, alters lion, and/or
relocation _
Phone: ( ) Fax: ( ) 200 amps or less 59,36 1
Owner installation; This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 tunes 168.54 2
_ branch circuits—new, alteration, or extension, per panel
Owner signature: Dale: A. Fee for branch circuits with
, • • • ,::� � � above service or feeder fee,
_I7'ApPI,ICANT'••:•.: :' . V...CONt AC 7'''..j. 1.i.. :, :: ^ ,-$ a: 7.42 2 • each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'1 branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling. service end/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.94 2
E- mail: outline h' 67
° ;'� rr „ �; > - ..
Sign or ou r e fig ling 84 2
0
N .... : ::;.: :.': .:,'...::'<:::':;.:.. •.•:; Signal circuit(s)orlimited- energy �
Business name: STONER ELECTRIC, INC, pal, alteration, or extension. ` Page 2 / ), CO 2
Each additional Inspection over allowable in any of the above
Address; 1904 SE OCHOCO Additional inspection (lbrmin) 66.25/ hr
Investigedon (1 hr min) 66.25/ hr
City/State/ZIP: MILWAUKIE, OR 97222 Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 44z—S° o Pax: ( 503) 659 -4968 Inspections ; at which , no i 90.00/ hr
CCB Lie.: 44823 1 Electrical Lie.: 26 -122C Suprv. Lie.: 3496S g'g a i> • 4ICAr -P. Rt1IT PEPs' .. • . .
At ' J Subtotal: ;/�p. 410 Suprv. Electrician signature, required: �6„gir. -r1 Plan review (25% ofpemut fee):
Print name: MICHAEL FALCONER Date : / /, /,. State surchargo(12% of pomait fee): /,8. 0
TOTAL PERMIT FEE: ' /dg, tV
Authorized signature: Tbls permit application expires If a permit Is not obtained within 180
days after it has been accepted as complete.
print name: Date; ' Number of inspections allowed per permit.
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Oct. 19. 2012 1:54PM Stoner Electric Group No. 4168 P. 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT PEES:
Fee for all residential systems combined $75,00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
. ', firTIM ; ': 6
Fee for each commercial $75,00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
[] Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
1K Protective Signaling
ix Other Colt
Total number of commercial systems:
*No licensee are required. Licenses are required
for all other installations
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