Permit r - , 'e
n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1,
, 2 COMMUNITY DEVELOPMENT Permit #: ELR2010 00002
, n .. Date Issued: 01/08/2010
41 G :A.R p 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S 136CA06900
Jurisdiction: Tigard
Site address: 7590 SW SPRUCE ST
Subdivision: Lot: 0
Project: Kennedy
Project Description: Install restricted energy for speaker wire.
. FEES
Owner:
ROUSE, CHARLES Description Date Amount
11916 SW ELEMAR CT Restricted Energy Permit 01/07/2010 $67.84
TIGARD, OR 97223 12% State Surcharge - Electrical 01/07/2010 $8.14
PHONE: 503 - 708 -3211
Contractor:
CLACKAMAS ELECTRIC INC.
PO BOX 51
BEAVERCREEK, OR 97004
PHONE: 503 - 969 -5684
FAX: 503 - 632 -2421
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: Y
Security Alarm: N
Garage Door Opener: N
HVAC: N Total $75.98
Vacuum System: N
Other N Required Items and Reports (Conditions)
Other Desc:
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 wit
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 160
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
•
Issued By: V. 01 IP... • _IL- _.. ! L .16 Permittee Signature:
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 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.
i . . %From:Kennedy Restoration REC IN t41.) 01/08/2010 08:50 #864 P.002/002
SAN 08 Zp1Q
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Electrical Permit Application RECE '• ; r `� 3' L L t }� „xar
Q City of Tigard nn ry Zola ?mind NO : ( '�
13125 SW Hall Blvd., "Tigard, OR 97223 JAN V a ZU {Q Ila Rev e_l �_ 0.1.
• Other P
�� "'tttJ Rec Review Pamir • P hone: 503.639.4171 Fax 503.598.1960 Dace /Oy
Ins ection Line: 503,639.4075 �sce Page i for
tt< 2t,1? p j 2:11\IO FTiGA.Pd,D,,„„taYisY: m 1 �
as .. ^'.�+ Interne www.tigard- or.gov t 1 ; ('�+1,
__ TSt ill nl.i ,DINT ,� 1 Supplemental Infarmotlan
TYPE OF WORK V -•• P:) Get R> ?EFt{r s'::.
❑ New construction ,Additio tie /replacement Please check all that app(. (submit j sets of plain w/6ems cheesed below):
❑ Service or feeder 400 amps co more ❑ Building over three stories
❑ Demolition ❑ Other: where the avail0bk fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Pioating buildings.
less to ground, or ...MIS 14,000 ❑ Commercial -use o icuhural
` 'it . 1 -and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for a0 other installations. baddinga.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Iasteltation or 75 K
JOB SITE INFORMATION AND LOCATION ❑ E,'mergeacy system. large, separately derived system.
❑ Addi:ice or new motor load of ❑ "A ", "6 "I -2 ", "I -3 ",
10011? or more, occupancy .
Job no.: Job situ address: 7S 9p j /� , S � / � � ❑Si or mole residential units. ❑ Recreational vehicle parka.
City /StateJZIP: l E r +1. T" � nom' r /� `" l7 - "' % j 0 Heultbearo facilities. ❑ Supply voltage ter more than
/
_........_... ._.__ ❑I•Iaaardaa+losations. 400 volts nominal.
Suite/bldg./apt. no,: 4 Project name: ,/2LJJ ❑ Serviceor feeder 600 emps or more.
Cross street/directions to job site: FEE SCFIEDULE
j ! 0,10110001 I oil I Nee I Total I•
New residential single- or multi- family dwelling unit.
_ Includes attached garage._
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 ( 4
Tax map/parcel no.: - • Ea. add'I 500 sq. ft or portion 33.92 1
Limited energy, residential I 67.84 2 i
DESCRIPTION OF WORK Witt, above a n.
Limited energy, multifamily
4 - `7 rl f <-;/,+ ', r L) j /,-. LL 7 residential (with above sq. fl ) 67.84 2
Services or feeders installation, alteration, and/or relocation
_ 200 amps or less r 100.701 ' 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amEs _ 200.34: 2
601 amps to 1,000 amps ( 301.04
2
Address Over 1. amps or v ol t s 1 52 J.
City /State/ZIP: _ ^x Temporary services or feeders installation, altera andlor
relocation _ __.- _ __
None: ( ) i Fax: ( ) 200 amps or less i I 59 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 457, 449 670, and 701. 401 amps to 599 amps l , 68.54 j 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date; r
_ _ A. Fee for branch circuits with
❑ APPLICANT f ❑ CONTACT PERSON above service or feeder Tee,
each branch circuit 742 I 2
Business name: 4 B. Fee for branch circuits l
without service or feeder fee, I
Contact name: i first branch circuit 56.18 ,
Address:
�� Each add'1 branch circuit 1 742 2
Miscellaneous (service or feeder not Included)
City /State /ZIP: Each manufactured or modular 7
" dwelling, service andlor feeder 67.84 12
Phone: ( ) I Fax: : () Reconnect only 67.84 12
E-mail: I Pump or irrigation circle 67.84 2
CO RACTOR , Signor outline lighting 67.84 2
f � �-�^ Signal circuit(s) or limited -
Business name: (, lfi (4r�'tvit'rr , e,(5 , '1c, S4v9L energy panel, alteration, or
Address: . ? 0 1 : , (0 .. /... S' j extension. describe: Page 2 2
City /State /Z1P: ,V C\ Each additional inspection over allowable in any of the above
�� ` 3 3 Per inspecion GC.25 I _
Phone: ( 32 - 2i -4 Fax (50)
Investigation per horn 0 hr min) 66.25
CCB Lic.: Electrical Lic.: - , ao G, Suprv. Lic,: st) t{ l S Industrial plaint per hour 78J8 }
1--- — . . cite `RIC AB ioti ;.F&BS':`.'
Suprv. Electrician signature, required'. (A) 41' 9 --f Subtotal: 1
Plan review (25 of permit fee):
Print name: t l
S �� � S . Date' / `7 i State surcharge (12% of permit fee): 1
Authorized signature: - _ _ 'TOTAL PERMIT FEE: f - 9 n
/ This permit application expires if a permit is not obtained within 180
Print flame: 811 , t-e u).NG.I'f bsi ...__ )_)ate: 1 1 I o • day, niter a hos been accepted us complete.
. Number of inspections allowed per permit.
i' ailing Ntrrnis1raLC- PumnAnn rim 10)01/09 440 57(I 1i057C00JWRll