Permit (8) CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
:g t COMMUNITY DEVELOPMENT
PERMIT #: ELR2008 -00053
T 4 9A la 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/12/2008
PARCEL: 2S112AC
SITE ADDRESS: 14655 SW 72ND AVE ZONING: I -P
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: PGE
Project Description: Installing (1) low voltage system for new gate.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA /TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
ALPHA LIMITED PARTNERSHIP ENTRANCE CONTROLS INC
14725 SW 72ND 1923 E 5TH ST STE D
TIGARD, OR 97224 SUITE C -100
VANCOUVER, WA 98661
Phone: Contact #: PRI 360- 256 -4416
FAX 360 -256 -4939
FEES Reg #: ELE CLE140
LIC 179165
Description Date Amount SUP 36I0LEA
[ELPRMT] ELR Permit 3/12/2008 $75.00
(TAX I 12% State Such 3/12/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: / i -- --- Permittee Signature: i���
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:
Cali 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Electrical Permit Application r ro 6E 0N l �
ramitamo City Of Tigard Received ��
,. g � Date/B Permit No.: _. U/�^
� °. 7 !3125 SW Hall Blvd., Tigard, Ili' _ "�9 Plan Review • %' Q Phone: 503.639.4171 Fax: 50 ;1-NI 1 ``� ' �)��`
C Da Re Other Permit: �u 2c `�7 — cr....)/2/
rt '.. Inspection Line: 503.639.4175 D ate Ready/By: orr is:
I ■ I G 'A I. D p A n p� !� � ® Y Y El See Page 2 for
�1 Internet: www.tigard or.gov Al 43k. 0j.,Pk 4-* Notified/Method: Supplemental Information
TYPE OF W 1, v , PLAN REVIEW
❑ New construction grAddition/alterIN 1 replacement Please check all that apply (submit 2 sets of plans w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current
❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling rsi Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: I J/_ { / ItJ!� 100HP or more. occupancy.
"T [o� JW 72. �� / ❑Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: AR/) �j l ❑ Health -care facilities.
0 Supply voltage for more than OIL L ( ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
'FEE SCHEDULE
Cross street/directions to job site: a...►l.rw Description 1 Qty. 1 Fee. 1 Total 1 "
� t7 � _ New residential single- or multi- family dwelling unit.
Fl2-0M r� "T i 14J
to nt. - 7
r /a 6,V 72 ' " �' 1 ?& oAi jZIGNT Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or Tess 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
AC C 4 Cox i>{'eot_ F »— A /.lei i (x/47. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or Tess 80.30 2
❑ PROPERTY OWNER *TENANT 201 amps to 400 amps 106.85 2
Name: F(_ 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: / /,S' 6, WC A U t: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
lG Ala - ice O q - 7 - z'/ relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
CNT -ANec 4 rVn . wz_ � energy panel, alteration, or
Address:
/ C� J 5 t.1- 5 6 extension. Descrlbe: / Page 2 2
5 .7! �
City/State /ZIP: V ot WA qn / Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (3(,O) ZS4 -0-i/(p Fax O) Z51. `9 Investigation per hour (1 hr min) 62.50
CCB Lic.: i /L E l ectrical Lic.: u _ �
b Suprv. Lic.: 340 IU�A Industrial plant per hour 73.75
�y U�
l' �// r J �� 7 (U /t (ur ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: /�,, / / . Subtotal: , —
l�' ,/ !n - ----- --
, / Date: Plan review (25% of permit fee):
Print name: 3iz�N� / O/15 % IZUUf�I 3/1 I iti State surcharge (12% of permit fee): —
Authorized signature: TOTAL PERMIT FEE: a 7. --
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
" Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM)WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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:
r COMMERCIAL WORK ONLY: -
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*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
��� Other ACI- -x-- ..- f1 - Fed- 'aT� .
•
Total number of commercial systems: i
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 03/23/06