Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t � 4
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00337
Date Issued: 12/02/2009
T[GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S101AC90000
Jurisdiction: Tigard
Site address: 7125 SW HAMPTON ST
Subdivision: Lot: 0
Project: Special Districts Association of Oregon
Project Description: Install restricted energy for fire alarm.
FEES
Owner:
HAMPTON STREET BUILDING CONDO Description Date Amount
OWNERS OF ALL UNITS Restricted Energy Permit 10/27/2009 $67.84
00000 12% State Surcharge - Electrical 10/27/2009 $8.14
PHONE:
Contractor:
SIGNALING SYSTEM SOLUTIONS
6816 NE HWY 99
VANCOUVER, WA 98665
PHONE: 360 - 694 -9199
FAX: 888- 511 -7734
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: N Fire Alarm: Y
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 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 wit 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 503.24 6649.4ft3.800.332.2344.
Issued By: q_CSIKAS 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' 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.
A E lectrical Permit Application REC 1i (iNr:
City of Tigard Date/By:
No.: [ V Cco , a
Ill
q 13125 SW Hall Blvd., Tigard, OR 97223 OCT 2 7 Plan Review
? ' Date
/By: o On .00104-
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit: s Y
Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
T.1 G A R D p CITY OF TIG Notified/Method: / Juris l�y G / f G , • Internet: www.tigard- or..41 Supplemental Information
BUILDING DIVISION
TYPE 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.
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 '63 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: 1 , 25 S L) 00 tv -21z-s S 1 100 or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: j ;T r 4 j 0 iZ 5 Z2 3 ❑ Health -care facilities. ❑ Supply voltage for more than
(�
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name)c ;,.-,A 0:3 } _ 0 F O . ❑ Service or feeder 600 amps or more. •
J FEE SCHEDULE
Cross street/directions to job site: 5 (n1 ' Znd Avg CO Description 1 Qa. l Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
SSW I-I A +iero >J 57 - Includes attached garage.
Subdivision: Lot no.:
1,000 sq. ft. or less 168.54 4
Tax map /parcel no.:
DESCRIPTION OF WOR K / Ea. add'l 500 sq. ft. or portion 33.92 1
RO (No.ic /12eP /A //e.S C�ocl r 'A, -,eI / - Aid .2uil S- i 9 Tid ,0 5
Limited energy, residential 67 84 2
1j 5 }O.tigr "a 4),-,--,, ,- i z-„,4.,....,_,-- (with above sq. ft.)
Ifr PROPERTY OWNER I ❑ TENANT
Limited energy, multi - family
67.84 2
Name: S 1 2 6'6 i ‘,,, I (7, } 1--,.c. / o r Pr - residential (with above sq. ft.)
Address: ' ) 1 5 _5 4/9,-7 ., S l 5,)- l yU Services or feeders installation, alteration, and/or relocation
City/State /ZIP: % `/ 9 /L - 7 2 2-3 200 amps or less 100.70 2
� f
Phone: ( 503 ) `i 1-13 2 3 1 •L Fax: ( )
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 133.56 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Owner signature: Date: 401 amps to 600 amps 200.34 2
,APPLICANT 1 a CONTACT PERSON
Business name: S;c t.; 5,/s Se 1, , t u l Nc . 601 amps to 1,000 amps 301.04 2
Contact name:
• i„ t_ , e . (
L G Over 1,000 amps or volts 552.26 2
Address: 60 l(' iU /-1,,,, 7 ‘-6
U��L� w � ��� Temporary services or feeders installation, alteration, and/or
City/State/ZIP: p relocation
Phone: ( 3 60 ) 6-, �c / ti ('7r'/ Fax:: (0 �� ) .7 // 7 3 200 amps or less 59.36 1
E -mail:
CONTRACTOR
201 amps to 400 amps 125.08 2
Business name: S;, i �, ;,, 5 ..S ; 0N3 , liUC _
Address: h� /( N L - >li,✓� �'f5 401 amps to 599 amps 168.54 2
City/State /ZIP: U L 1.J cf-66) Branch circuits - new, alteration, or extension, per panel
Phone: (3 bU ) 6 G I y 11 Fax: ( e ),, / 1 7 7 3 L_\ A. Fee for branch circuits with
above service or feeder fee,
7.42 2
CCB Lic.: 1 Z y Electrical Lic.: 5"1 Suprv. Lic.:3 63 6 L4.:71 -_ each branch circuit
B. Fee for branch circuits
Suprv. Electrician signature, required y� without service or feeder fee, 56.18 2
first branch circuit
Print name: L 5/ e I e� Date: / / 2O . U1
Each add'l branch circuit 7.42 2
Authorized signature:
Miscellaneous (service or feeder not included)
Print name: Date:
I:\ Building \Permits\E1.C- PermitApp.doc 10/01/09 440 -4615T(t t/05 /COM/WEB
Each mantffactured of modular 67.84 2
dwelling, service and /or feeder
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
energy panel, alteration, or
extension. Describe: 1 Page 2 2
Each additional inspection over allowable in any of the above
Per inspection 66.25
Investigation per hour (I hr min) 66.25
Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Subtotal: � &`N
Plan review (25% of permit fee):
State surcharge (12% of permit fee): F 1"
TOTAL PERMIT FEE: —
This permit application expires if a permit is not obtained within 180 days after it has been accepted as
complete.
• Number of inspections allowed per permit.
I.\ Building ■Pennits■ELC- PermitApp.doc 10/01
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for a ll residential systems combined $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ 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
❑ 1-IVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 0 1
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\E1.C- PermitApp.doc 10/01/09