Permit ' � .C2 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t r ':
i c `: COMMUNITY DEVELOPMENT Permit #: ELR2010 -00075
cn� Date Issued: 04/30/2010
t FG ARQ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S104BB07900
Jurisdiction: Tigard
Site address: 14300 SW BARROWS RD
Subdivision: RUSSELL'S SCHOLLS FERRY SUB Lot: 2
Project: Albertsons
Project Description: Low voltage for voice & data.
FEES
Owner:
NEW ALBERTSON'S INC Description Date Amount
ATTN: 70428 - CORPORATE TAX, PO BOX 20, Restricted Energy Permit 04/30/2010 $67.84
250 PARKCENTER BLVD 12% State Surcharge - Electrical 04/30/2010 $8.14
PHONE:
Contractor:
AF TECHNOLOGIES
1418 HEMLOCK ST. NW
SALEM, OR 97304
PHONE: 503 - 932 -6657
FAX: 503 - 362 -2382
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 perm issued subjectto"t e regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don in accordance with approv". 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 - q , ires ou o follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 01 -0010 throu.h OAR 952- .'1 -010r. Y. ay obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 .800.33 344.
/ / / '
I ued B 1�I . Permittee Signature: Ce' d �j
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.
� �, to FI ( )12 I Il(Id U 4 l ° ,v I l t'imemxt y ', mg
Electrical Permit Application tt
C •
of Ti and Received ,/ S / a0(Q- 7
`J g DateB 55//j O Permit No.:
Ea
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review D
,: C - Phone: 503.639.4171 Fax: 503.598.1960 DateB : Other Permit: r��0 4:0
1 -- Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for
'H'.1 ( i-.ilL I N otified/Method: Supplemental Information
_... _i :: ` Internet: www.tigard-or.gov PP
' TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
0 New construction XAddition/alteration/replacement
❑ 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 INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "I -3 ",
I Q 1 OOHP or more. occupancy.
Job no.: Job site address:
[- 3 J � C) �W V' t/tO t [i' 4 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: -� " ❑ Health -care facilities. ❑ Supply voltage for more than
L i7 r CC' Gt / ! �� ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: ( J P roject name: 6A ^ ❑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: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK • (with above sq. ft.) 67.84 2
Limited energy, multi - family
--- l ��; 7 , ' ( residential (with above sq. 11.) 67.84 2
�f G d Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 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
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
y relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
I 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not
- intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 am 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 without
service or feeder fee, first 56.18 2
Contact name: branch circuit -
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: dwelling, service and/or feeder 67.84 2
R only 67.84 2
Phone: ( ) Fax::( ) -
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
. CONTRACTOR Signal circuit(s) or limited - energy ) -
panel, alteration, or extension.
Business name: q_ / ! Page 2 67 1 2
14 ` ��� " 7�! ���� � Each addi tiona l inspection over allowable in any of the above
Address: `(�� 1 ak Z -- i ti tz ) Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: S / t�� 6 .3.6 Ind p ant hr min) 78.28/ hr
a'd Industrial plant (1 hr min) 78.18 / hr
Phone: 6 :a 3e I Fax: ( 5) 6 . a . , — ] g Ins for which no fee is
90.00 / hr
0 specifically listed (%2 hr min)
\ CCB Lic.:`4, 7 ( Electri 1 Lic.: 0 S u . Lic .:9R 936,&� . c . ' ELECTRICAL PERMIT FEES
(� / / � Subtotal: //,,,, '/
Suprv. Electrician signature, required: �� �, ¢ 7�l ll Plan review (25% of permit fee): lY � T
Print name: C' r( E .62,44) 5 Date: 4/ _3 _O State surcharge (12% of permit fee):
Authorized signature: ._ " -•�J TOTAL PERMIT FEE: ? 9
� �ne �,� This permit application expires if a permit is not obtained within 180
, .G ,X28 Date: 4/— 9) *
days after it has d been accepted as complete.
Print name:
a� � i � � '�Q Number of inspections a llowed per permit.
I :\Building\Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(1 t /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
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n 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
X Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n 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 10/01/09