Permit A .
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
L DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00109
" ! ' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/30/2006
PARCEL: 25101 AB -01606
SITE ADDRESS: 07357 SW BEVELAND RD 110 ZONING: MUE
SUBDIVISION: CLARKE BUILDING LOT: 017 JURISDICTION: TIG
Project Description: Data /phone and sound.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
TOM CLARK NW SOUND AND SECURITY .
7357 SW BEVELAND 10300 NE MARX ST
TIGARD, OR 97223 PORTLAND, OR 97220
Phone: 503- 793 -2621 Contact #: PRI 503- 254 -2811
FAX 503- 254 -2818
FEES Reg #: ELE 34- 423CLE
LIC 112538
Description Date Amount
[ELPRMT] ELR Permit 5/30/2006 $150.00
[TAX] 8% State Surcha 5/30/2006 $12.00 REQUIRED ITEMS AND REPORTS
Total $162.00
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.
Issued By: �� Permittee Signature: i / 1
7
s
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:
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.
, r
Electrical Permit Application st) FOR OFFICE USE ONLY
City of Tigard D ateB d' p /ii., Per mit NW .. , — be
13125 SW Hall Blvd., Tigard, OR 9 223 3 C Plan Review
AY 2r
Phone: 503.639.4171 Fax: 503.598.1 6 2006 B 1 h Date : Other Permit:
Inspection Line: 503.639.4175 ARD - e � Date Ready/By: ®See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIG N Notified/Meth Supplemental Information
G DiviSiw .
IiPE' WORK .` 'PLAN.REVIEW,
` New construction ❑ Addition /alteration/replacement Please check all that apply:
b Demolition ❑ Other: EService over 225 amps, comm'I Hazardous location
OService over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
. - CATEGOR OF CONSTRUCTION _: of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ' .Commercia (industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑Other: ❑Building over three stories OFeeders, 400 amps or more
".JOB SITE INFORMAT AND LOCATION ❑Occupant load over 99 persons ❑n tured structures or
❑ Egress /lighting plan RV P ark
❑Health -care facility ❑Other:
Job no.: Job site address: 1 7 sw 13e „e land 5 i lQ Submit 2 sets of plans with any of the above.
City/State /ZIP: "r" I 0 ja 417223 The above are not applicable to temporary construction service.
CIP • ldg. /apt. no.: 1 10 Project name: mare, ""J' f3 /� :FEE* SCHEDULE ;: *
Description Qty Fee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less I 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: • Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK . ' - Each manufactured or modular
5 fYl � �tred w r dwelling, service and/or feeder 90.90 2
rc r(�, pitol S 1 5 euma
c f � Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I t TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: ' _ 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
. ❑ APPLICANT • .-- 1 g CONTACT ;PERSON A. Fee for branch circuits with
e //^�' �I� �,,, , service or feeder fee, each 6.65 2
Business name: b c l e s r st tfL[ d CeY1 S7 Y L(.G.han branch circuit
Contact name: 7 C.,a,vk e, B Fee for service circuits
es
without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: (573) 7e13 _24 I Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR • - - - : - energy panel, alteration, or
�"� extension. Describe: Page 2 2
Business name: N lk 50t,, 4 , see -ty TecG>L otoS s
Address: 1 6 300 /t ��� X 5+ J Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: pp- a , p d 0 l e., g 72.z0 .� Investigation per hour (1 hr min) 62.50
Phone: (j 3) 251 7411 I Fax: (503) (/- 7- � i0 G Industrial plant per hour L 73.75
'ELECTRICAL PERMIT FEES* , . ' " ' ..
CCB Lic.: if z.3 8 I Electrical Lic.: 3y... z3& - Suprv. Lic.: 30 71,6 - 4 Subto
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: D ,6 W 6i C� Date: 5 /zs /O State surcharge (8% of permit fee) /9 ■
I ` TOTAL PERMIT FEE 1 / L 07)
Authorized signature: At ii.te6— This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete
Print name: J e- d io 1 , 5 1 , ki Date: 54? -�l04 * Fee methodology set by Tri- County Building Industry Service Board
` ** Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PernitApp. doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
CONaVIERCIALWURKONLY: r ' ,
Fee for each commercial system $75.00
(SEE OAR 918 -260 -260)
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*
❑ Protective Signaling
❑ Other
Total number of commercial systems: •
*No licenses are required. Licenses are required
for all other installations
is\ Building \Permits\ELC- PemritApp.doc 04/03