Permit , `._ r � CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
''- l'' = , COMMUNITY DEVELOPMENT Permit #: ELR2010 -00053
T1GARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/31/2010
Parcel: 2S101BCO2800
Jurisdiction: Tigard
Site address: 8250 SW HUNZIKER RD
Subdivision: Lot: 0
Project: Centrex
Project Description: Data telecommunications cabling
Owner: FEES
SEVERSON, JAMES A & ROBIN O Description Date Amount
29404 SW HEATER RD Restricted Energy Permit 03/31/2010 $67.84
• SHERWOOD, OR 97140 12% State Surcharge - Electrical 03/31/2010 $8.14
PHONE:
Contractor:
CHRISTENSON ELECTRIC INC
111 SW COLUMBIA ST, STE 480
PORTLAND, OR 97201
PHONE: 503 -419 -3354
FAX: 503 -419 -3695
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 Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
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 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 the 180
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 0 952 -0 1 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.66999 9 �� fr/ti- 1.800.332.2344. /
Issued By: Permittee Signature: t // L / e�77 -"V
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.
MAR -26 -2010 FRI 01:39 PM CHRISTE N. ELECTRIC, INC FAX NO. 95034193695 P. 01/03
Electrical Perm it Application .. ° . i ' r(.)lt i>rhlr'u,11si.: ONLY
City of Tigard MAR 2 6 2010 Received ,, 3i /� Perm 6 -0075
1 111 11 Date/13
-- 31 125 SW Hall 131vd., Tigard, OR 97223 Plnn Review
' Phone: 503.6394171 Fax; 503,598.1 other Permit:
I r i :. Dnre/By:
1' k�: i ;i'A,; .i0 Dnte Randy /1iy: m See Page .1.1c; ;11t 1) Inspection Linc: 503.639.4175 4_�t'r I Notified/Method; Supplemental Information
Internet; www,tigard- or.gov f�U1LD1111�^ Bt visi� "� pP
1 31
YPI :o WORi ; t ?''"` `'i �, :ATTAIN :
:,T V? * :7,
❑ New construction Addition /altcration/repiacement Please check all that ripply (submit 2 sci. of plans wlitcros checked below);
❑ Service or feeder 400 amps or more CI riuilding over three statics.
❑ Demolition ❑ Other: where the available fault current ❑ Mminns and boatyards,
. i s CATEGORY Oh CONSTRUCTION., exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceed. 14,000 D Commercial -use agriculwrd
❑ 1- and 2- family dwelling Colnmcrcial /industrial ❑ Accessory building amps for nil other installations. buildings.
❑ Multifamily ❑ Master builder ❑ Other, 0 Fir. pump, a Installation of 75KVAor
. -- Emergency system. larger sepnmtely derived :.yaem .
o b n o JOB' 91T�' 1N1'ORMATION AND. LOCATION, ID Addition of new motor load of ❑ "A ". "E" "1 -2" "1 -3'
Job 63 \ 1 1 -- Job site address: Qs) 5v ilig..< W1 10014P or more, occupancy.
0
0 Six or more residential units, Recreational vehicle parka.
City /State/ZIP: 7` (L/ i th1,i`ii< ❑I-lonith- cpnef:iciiiircs, ❑ Supply voltage for more tlrnn
` ' ['Hazardous locations. 600 volts nominal.
Suitc /bldg. /apt. no.; 1 Project name; c ❑ Service or feeder 600 amps or more.
'- � i?E SCI
Cross street/directions to job Site: 4a� ►ein Ens rS� -� 4 nurriniimt 1 Utv I F.„. i fa MI
'- New residential single- or multi- family dwelling unit.
Includes attacked garage.
Subdivision_ Lot no.: 1.000 sq. ft. or less 168.54 4
Ea. add'I 500 so, ft or portion _ 33,92 1
Tax map /paree1 no.: Limited energy, residential ,
i)p$CR!PTION OF WORK g (with above so. ft,) 67.84
I _ 67.84 - - - Limited energy, multi - family 2
- • residential (with above sq, ft,)
'" - - - J -'- — Services or feeders installation, alteration, and /or relocation
4 _ 200 amps or lass 100.70 2
_
PROPERTY OWNII','R 0` TENAN"P 201 amps to 400 amps 133.56 2
Q: .
401 amps to 600 amps 200.34 2
Name: —
— 601 amps to 1,000 amps 301,04 2
Address: • Over 1,000 amps or volts 55 226 2
Temporary services or feeders installation, stlteratiort, and /or
City /State /ZIP: relocation
Phone: ( ) y Fax: ( ) 200 amps or less 59.36 7 1
201 amps to 400 amps 125.08 2
Owner installation: Ti' is installation is being made on property that I own which is not 401 amps to 599 amps 168.54 - 2
intended for sale, lease, rent, or exchange, according 10 ORS 447, 449, 670, and 701.
Branch circuits - new, nitersrtion. or extension, per Nine!
Owner signature: Date; A, Fee for branch circuits with
' above service or feeder fee,
0 APPI:ICAINT 1=1 .CONTACT PE 2
each branch circuit 1.42 _
Business name: 13. Fee for branch cirtulis without
,,,, - service or feeder fee. first
56.18
Contact name: branch circuit J _
•----- Loch add'l branch circuit I 7.42 2
Address: Miscellaneous (service or feeder not included)
City/Stale/21P: /Slate /Z1P: - Each manufactured ur motlul:,i 67 84 , 1
y dwelling, service seal /or feedar
— ` Reconnect only 67.84 2
Phone: ( Fthx.:: ( ) Pump or irrigation circle 67,84 2
E - mail; Sign or outline lighting 67.84 2
CONTRACT o R _ : Signal circuits) or limited energy
Q panel, alteration, or extension. L Page 2 2
Business name :1 ' ` ,�L f , I
> _,, _ aeh additional inspection aver :allowable in any of the ahnve
Address: \ V`-� \ l� ..I I . ' • 4A6 l�r Additional inspection (1 hr min) 66.25/ hr
lnvesu (1 hr min) 66.251 hi
City /State /ZIP: , + I industrial plant (1 hr min) 78.18/ hr M^
J � � 7\91 M 1• Inspections l ' or which no tae is
Phone: � � - spetiLcallY listed (h hr min) 90.00/ hr
CCB Lie.: Electrical L.ic. :: i ; i S 'lip - i..ic.: ` l �, - .. . - . II•L.�:cTistiCAL PERMIT :FEES
Subtotal; lirM 1
Surrv. Electrician signature, required: • Plan review 2� °not omit Fee):
Print name: M Dal ` '� �� State surcharge (12°/0 of permit fee): - ,
TOTAL. PERMIT FEE: - ,.'
Authorized signature: This permit application expirez if n permit is not obtainer` within 1811
�.. days sifter it has been accepted ns complete. /
Print name; I Dale: • Number nr inspect inns allowed per Omail.
f 1R.IIdinylncrmit; lit 1 -peryml app doc I1Vh l/ars Q.In- '16 1 5 1 1 /n51('tttv1/WI:R
MAR -26 -2010 FRI 01:39 PM CHRISTENSON ELECTRIC, INC FAX NO. 95034193695 P. 02/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMXTED ENERGY PERMIT FEES:
RESIDEISIT 'AL
49 &$.QNLY:::. ,...
Fee for a residential systems combined $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
Pleating, Ventilation and Air Conditioning System*
Vacuum Systems*
n O ther:
COMMERCIAL WORK ONLY
Fee for ugh commercial $67.84
system
(SEE OAR 918 - 309 - 0000)
Check Type of Work Involved:
❑
.Audio and Stereo Systems
❑ Boiler Controls
Clock Systems
.44 Data Telecommunication Installation
43 Fite Alarm Installation
n I.IVAC
E .instrumentation
n Intercom and Paging Systems
n L andscape Irrigation Control*
❑ Medical
• Nurse Calls
n O utdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses arc required. Licenses are required
for all other installations
E: ∎5.61d1,,,o lmit:\LLC•Psimli 10IU1 /09