Permit V'l CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
7 Fit i. q
1 >s COMMUNITY DEVELOPMENT Permit #: ELR2010 00049
T 1 G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/26/2010
Parcel: 2S101BCO2401
Jurisdiction: Tigard
Site address: 12650 SW HALL BLVD
Subdivision: Lot: 0
Project: Snyder Roofing
Project Description: Install limited energy for CCTV.
FEES
Owner:
KING, JAMES F Description Date Amount
12650 SW HALL BOULEVARD Restricted Energy Permit 03/26/2010 $67.84
TIGARD, OR 97223 12% State Surcharge - Electrical 03/26/2010 $8.14
PHONE:
Contractor:
HECKTEC TECHNICAL LLC
3484 HILLSIDE CT
HUBBARD, OR 97032
PHONE: 503 - 572 -1938
FAX: 503- 982 -4823
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: Y Clock Systems: N
Data & Telecommunications: N 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 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: Mal or\ Sz_ W Q AJ\ 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' S Q — AP Date:
LICENSE NO.
Cali 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 10 09:28a Hecktec Technical 5039810478 p.1
Electrical Permit Applicatiot>REc rVJ D FOR OFFICE USE ONLY
City of Ti and Received Permit No.:
g Date/By: f l
: tq 1-'�
V 13125 SW Hall Blvd., Tigard, OR 97223 n iAD n , , - Plan Review Nay
Phone: 503.639.4171 Fax: 503.598.196OI Date/Bv: Other Permit:
TIGARD Inspection Line: 503 639.4175 Date Read ru is
y /By' 0 See Pagc2 for
Internet: www ti and or ov CM( Notified /Method t ( Supplemental Information
u. c r•F`. 3 'P4p 1 1 - ' -r i 1 `i 4Ya hr't r c: !'43 i�h r'.I.:'VI'a' i T l_ ' t,
, 1 :e #�k .+F 40 1.tt' .,',�a400� , VA. i,y7 1 , --+ II. f.l �,- 8 - f
, i•'(?� ;'trl,_� i a (414 , ' * �r..I'�..!�
Please check all that apply (submit 2 sets of plans w /i[ems checked below):
❑ New construction ❑ Addition/alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
+, x }- :" 1 f , exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
� 4 , ,� �C4 t'�A7 OF GQ�iRC�ONsY 4 Y P s
�fts = " (o ri r•r n. •,', ,i e,�„ less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ I- 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
. , CI Emergency system. larger separately derived system.
. ,
,,` ''r` r :� „ 4,7, 7 dJ?1 4NliJ, W.. T1 II) ^.t: F. ,Xi,- ife, l r .. ,�. ❑ Addition of new motor load of ❑ .. .. ,,
n ^ - 1 Hal( e.: , Six oI or more residentia units
Por e r
❑ Six residential occupancy.
Job no.: Job site address: �' U �( n I J� r ❑ Recreational vehicle parks.
City/State/ZIP: fl 0\ w (' l2 on 2, 3 ❑ Health -care facilities. ❑ Supply voltage for more than
1 ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: J Project name: ❑ Service or feeder 600 amps or more.
. s
Cross street/directions to job site: Description 1 Qty. 1 Fee. r 1 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
Ea add'l 500 sq. 11. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
+ k" vt d7 T k "'DE�$G�1R'CPtili Uo ivOiik j ' =rr 4 ,, # i _, rt .;e. (with above sq. ft.) 67.84 2
Limited energy, multi - family 67 84 2
. Y
j 15 l ((1� J[� v .. n C' 6 - 1 1 residential (with above sq. ft.) _
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
} '' a :v i# ` ;t ' , '` '� ti i X i'� ri; g a` ) triti' - +° 7 ° � "' . 201 amps to 400 amps 133.56 2
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 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale. lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, . er panel
Owner signature: Date: A. Fee for branch circuits with
r . r . �, � , .,+ t+ e „A,,,, 1 t r s . ;i i above service or feeder fcc, 7.42 2
r. 1
..... ' { X7 1 s
._ ., z;� - p�•L� t , 1 t . c y each branch circuit
Business name: B Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84 2
City/State /ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
F i ,: ' a.; ct)i +. K�7 f rft'e`+. al '�ReCC OIL '.;t, 4 ' ' `. " - k #. - I . ,. -
1- -: f; Signal circuit(s) or limited- energy
Business name: �nn �j panel, alteration, or extension. Page 2 t 2
L��t' ^� Li k• .. Each additional inspection over allowable in any of the above
Address: 1 (6 et. Additional inspection (1 hr min) 66.25/ hr
� — # D Investigation (1 hr min) 66.25/ hr
�A L ^r
City/State /ZIP: 'C Di\ 7 o �
_ 111 111 p ' Industrial plant (I hr min) 78. I R/ hr
Phone: (. ) _ 3 F ( ) Inspections for which no fee is 90.001 hr
CCB Lic.:
specifically fisted ('' /r h m
i (,, 3C1 Electrical i 6N, ,- E t i h,FrJi #wl'`t l:j ' / ���yy ([ 1k ,jy.- ' . 4
f � S prv. Lic.: CL G,L��rst4��IC.�itS::F ^�4_ * *� �,G� F ! f -(� } '+
Subtotal: (O S.
Suprv. Electrician signature, required:` �' 1 Plan review (25% of perrnit fee):
n'
Print name: Ku i V\ RPC� Date: 3 _) 5 -f 0 S tate surcharge (1 2% of permit fee): - j
TOTAL PERMIT FEE: -75, q'J g
Authorized signature: �} 1 � This permit application expires if a permit is not obtained within 180
� � e 1 `- R e c days inspections has been accepted as complete.
Print name: Date: 3 - a� � r 0 Numbe of i nspecbtiorts allowed d per permit.
: 18uitding \Permits\Et.GPermitAppdoc 10/01/09 440- 46151311/05/COM"WEB
\(.....k : k n --\ - e .C. k