Permit 7 . „ .: -' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
4 ; , ° COMMUNITY DEVELOPMENT Permit #: ELR2009 -00350
Date Issued: 12/02/2009
T tGARE) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 101 CA00200
Jurisdiction: Tigard
Site address: 7904 SW HUNZIKER RD
Subdivision: Lot: 0
Project: Plas2Fuel
Project Description: Installation of low voltage for data.
FEES
Owner:
WALL STREET INDUSTRIAL LLC & Description Date Amount
A RICHARD VIAL EXEC CENTER LLC, 7000 SW Restricted Energy Permit 12/02/2009 $67.84
VARNS ST 12% State Surcharge - Electrical 12/02/2009 $8.14
PHONE:
Contractor:
DICKINSONS ELECTRIC
8449 SW BARBUR BLVD
PORTLAND, OR 97217
PHONE: 503 - 246 -3550
FAX: 503 - 213 -6049
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc: •
This permi ' - 4 - • •sect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don= in accordance wit - •prov- • • - ns. 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 la• require y•u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-4.41-0010 through OAR 95 ' 1 -0104j ou may obtain a copy the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Is ed By: _ I _ Permittee Signature: 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:
CO TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' 4 Date: _ AT.. ,
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.
I1r:\ l• n f r r r • �'_! +s c &gyp R: 4 F l s,1 d
,�.1ectr�cal • Permit Application • ,; : ; . R 0Rt (IR I lcl: u5I , Ni0 v t i . + :4,, •
7-',V;7- _ ?' Received 4
.'"
11,4 w City of Tigard Date/By: Ia O/ n Permit No.: E219-425),.9...400,55D ° 13 SW Hall Blvd., Tigard, OR 97223
g Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
;I. f G n 1-t7 Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
. YPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/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.
CATEG • RI' 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 is 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 ",
t I OOHP or more. occupancy.
Job no.:
Job site address: f�� /f Z t ) ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 7 (9 f� ❑ Health -care facilities. ❑ Supply voltage for more than
J l ' / ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: J Iii - a Y' f L ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. I Total 1 •
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. 11. or portion 33.92 l
Limited energy, residential 67.84 2
' DESCRIPTION OF WORK (with above sq. R.)
• C.711-4t4-191, � t// /) � ���
Limited energy, multi-family
family
4-- 6-1/4_, residential (with th above sq. R.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY .OWNER
1 ❑ TENANT • 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
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, alteration, 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 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
Business name: (D
�/✓ � A/1 ,� a-...1 al,....., / /, energy panel, alteration, or / v `(
Address: Y 11/-1 l l Gtr ja.ter6a 121#--d___ extension. DegcJibeij y Page 2 2
- City/State/ZIP: . ,L /< q 2- J Each additional inspection over allowable in any of the above
��" i Per inspection 66.25
Phone: (6`03) 24 6 35 .- V Fax: ( re. 21 60 9 Investigation per hour (1 hr min) 66.25
CCB Lic.:6, ' ' 3 e( Electrical Lic.:a /iUG Suprv. Lic.: 3/a, j Industrial plant per hour 78.18 _
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: - Subtotal: 6, 7. WY
Print name's/m/14 , ) , e „ c - Date:/2_2._- Plan review (25% of permit fee): -
State surcharge (12% of permit fee): 8, / Sl
Authorized signatu : TOTAL PERMIT FEE: 7 5 • 9g
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.doe 10/01/09 440- 46t5T(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 ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
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
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09