Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
- COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00323
TIGA'RD1 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/20/2008
PARCEL: 2S 111 CA -00800
SITE ADDRESS: 09900 SW SATTLER ST ZONING: R -7
SUBDIVISION: ALDERBROOK FARM LOT: 009 JURISDICTION: TIG
PROJECT: EVEN
Project Description: Low voltage for audio system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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: •
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
EVEN, MARC ROBERT /MICHELLE ANNE OWNER
WIEBE, MACK/MEREDITH S
9900 SW SETTLER ST
TIGARD, OR 97224
Phone: 503- 806 -4795 Contact #:
Reg #:
FEES
Description Date Amount
[ELPRMT] ELR Permit 11/20/200€ $75.00
[TAX] 12% State Surch 11/20/200€ $9.00 REQUIRED ITEM = D REPORTS
• Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. S•-cialty C•des and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work . not st -rted within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon la equires you to folio rule- adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through O • • 952- 001 -0100. You .1 = y obtain copies of these
rules or direct questions to OUNC at 503. _ •' - 800.332.2344.
Issued By: / _ Permittee Signature: A ilk,
ApJ - I
OWNER INSTALLATION ONL
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:
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.
•
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Electrical Permit Application �� 1' FOR of IC usE oly�vt ti
_
Received �
'{ fr* ' V C of Tigard I ° !, CEIVED DateB : GiJ/ �� Permit No.: � e i .-00 3)-
sl 13125 SW Hall Blvd., Tigard, OR 972 ' Plan Review
:j : Ph one: 503.639.4171 Fax: 503.598.1960 p q DateBy: Other Permit: 7115
GO /A
•T I It I�; Inspection Line: 503.639.4175 NOV 2 0 6008 Date Ready /By: — Ju � ris: � ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: !24 Supplemental Information
Q T Y OF TIGARD AR
• T YPE OF W W.
❑ New construction ❑Addition /alte PLAN REVIEW
ii ��jj�� tfl P� C DI a cement t !�`O� 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 ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORM AND .LOCATION - . ❑ Emergency system. larger separately derived system.
• • ❑ Addition of new motor load of ❑ "A" "E" "I - 2" "I - 3"
Job no.: Job site address: ��j� �) p er , y�
occupancy.
G�W�� �+ � 1 ) �l v � I OOHP or more.
❑Six or more residential units. ❑ Recreational vehicle parks.
❑ Health -care facilities. ❑ Supply voltage for more than
� � ❑ 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: Description 1 Qty. 1 Fee. 1 Total 1
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 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
1 G1-4) (i / 44410) residential (with above sq. ft.)
(�f` Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
.. ❑ -- PROPERTY .OWNER . ❑ TENANT.': 201 amps to 400 amps 106.85 2
n 401 amps to 600 amps 160.60 2
Name: 1 — �� 601 amps to 1,000 amps 240.60 2
Address: c ' 1 v ST')j S-- Over 1,000 amps or volts 454.65 2
City /State /ZIP: —y Temporary services or feeders installation, alteration, and/or
1-7) �pl�Tj/1`� C��-' y relocation
Phone: () w - 2--1--7 S ( ) 200 amps or less 66.85 1
Owner installation: This ' stallation is being m: e on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rL i r - xchange, acco» e .': to ORS 447, 449, 670, and 7E 1. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: n • ate: (1 Z,d t l A. Fee for branch circuits with
.. ❑' APPL ANT ❑ CONTACT PERSON . above service or feeder fee, 6.65 2
each branch circuit
Business name: _,�,„�/„„c as c ,a 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
v Signal panel, or t o limited-
Business name: or
energy panel, alteration, or
Address: extension. Describe: 1 Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) I •i' : ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
.'.:. ELECTRICAL PERMIT FEES . :
Suprv. Electrician signature, required: Subtotal: 75
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): 1 �
Authorized signature: v L TOTAL PERMIT FEE: 5[ I�f e Y
This permit application expires if a permit is not obtained within 180
Print name: � Date: (l (1,01 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1: \Building\Permits\ELC- PermitApp.doc 05/23/06 440 615T(1I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIALWORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
udio and Stereo Systems*
❑ Burglar Alarm
TI Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
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
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 03/23/06
Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701.055 (4)]
This statement is required for residential building, electrical, mechanical and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Please check the appropriate box and complete the following statement:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
Fr*
I I will be performing work on property I own, a residence that I reside in or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will contract with a
contractor who is licensed with the CCB and will immediately notify the office issuing this building
permit of the name of the contractor.
I have read and understand the Information Notice to Property Owners about Co str tion
Responsibilities contained on these two pages and I hereby certify that the inform : do checked and
completed above is correct and accurate.
MMC, /! � ilk .
Print name of permit applicant Signa u e of per it applicant
Ili' C_)6
Date
Permit #: o� `°0303
This form is supplied to building
permit offices by the Oregon `= Address: 9 56V, c trilk /"
Construction Contractors Board, ; a h Y r F. ;
as required by ORS 701.055 (6) / ' `1
5 Issued by: 6 r• Date:
This copy to issuing permit office