Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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, = COMMUNITY DEVELOPMENT Permit #: ELR2010 -00103
TIGARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/04/2010
Parcel: 1 S 136DC04400
Jurisdiction: Tigard
Site address: 11945 SW 70TH AVE
Subdivision: DARTMOUTH SQUARE Lot: 30
Project: TVF &R Command Center
Project Description: Low voltage for control wiring
Owner: FEES
TUALATIN VALLEY FIRE & RESCUE Description Date Amount
20665 SW BLANTON ST Restricted Energy Permit 06/04/2010 $67.84
ALOHA, OR 97007 12% State Surcharge - Electrical 06/04/2010 $8.14
PHONE: 503 - 649 -8577
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON ST
PORTLAND, OR 97202
PHONE: 503 - 239 -4600
FAX: 503 - 239 -7038
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: N
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: Y
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 O. - 952-001-01$0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: / Permittee Signature: ,K�QC
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.
-- Permit Applicatio
R P t °.ti: c,lz�c�i <l Ic I usl ■iI Y
' City of Tigard `� Rec Rec , eeiv ved : (P 7/ r — Permit No. /O Oe /03
° 13125 SW Hall Blvd., Tigard, OR 9722 I'n�, /� Plan Review
• ' : ®''- Phone: 503.639.4171 Fax: 503.598,19 � 4 2010 Date1B : Other Pe`mitdu/ a 02 01V '9 0
T I V A I ' C ' Inspection Line: 503.639.4175 Date Ready/By: HI See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: J Supplemental Information
S r te" y » �; +! E"'b r a ,� i t. A J T� 1X'h I rat-. 'ct „ :4 ,t- x
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® 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.
�` �¢'' "'" �` [ ' '� ' ` It , 'V . r� ' y _ ,
.. C . ,( ,' ye, a.-. v „.. 1 ,rt t e 4 . 7' 1 . ' exceeds 10000 amps at 150 volts or X ❑ Floating
Cg buildings.
Agri "" 4 .58.'14 less to ground, ore exceeds 14,000 Commercial-use 'cultural
❑ 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
> r a x ❑ Emergency system. larger separately derived system.
li z � ?��r ;. �a” :ura �; ,;,,a. ,t • :' ,,,,-,',,,,4>41 ,,e- d e ;, ,aka., xs ❑ Addition of new motor load of ❑
Job no.: I Job site address: 11945 SW 70 Avenue 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, Oregon 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
/ n ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./ apt. no.: Project name: `-'0 (d cdi a V U I �,(, R,rt '4.44 ' / ❑ mice or feeder 600 amps or more
Cross street/directions to job site: �1 e aD Descrip � y � 3 Qty. Fee. Total
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'1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
J 3WA' W * - ? ", a§ < ' 0 e `its v , 01,: ; em (with above sq. ft)
67.84 2
Li energy, mu lti - f am il y 67.84 2
Low Voltage Control Wiring residential (with above sq. ft) ,
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
3 l a ' ,. r ' ` e E, r - .W A 201 amps to 400 amps 133.56 2
�,p O a at f ! ,,.. % s J
zs'' . .,. � skc �rar �s..r _ ,. . , ' - '7 ma ¢es ......::12
Name: 401 amps to 600 amps 200.34 2
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: ( ) 1 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
,t; lr ° , w c 4 Ir` t, , " , above service or feeder fee
b r . i I, � i e I € p . s • d 5 7.42 2
�;; ��_3,rd, •ms�saa'x�' .. , .. ...a .igimi each branch circuit
Business name: American Heating, Inc. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Brian Shea branch circuit
Each add'I branch circuit 7.42 ' 2
Address: 1339 SE Gideon Street Miscellaneous (service or feeder not included)
Each manufactured or modular
Ci / State/ZIP: Portion OR 97202 67 2
tY dwelling, service and/or feeder
Phone: (502) 239 -4600 I Fax: : (503) 239 -7038 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail
� ,� - �`�t4'�'r':;s1t�' Sign or outline lighting 67.84 2
.4, 1 + ri :'
�#S. .;�. �'r �.'`, '.,<„� �'' , "9 • ! q � - ' �3 0 �k,w:?�'>� -x�•�<F +��s °. + Signal circuit(s) or limited- energy
Business name: American Heating, inc. panel, alteration, or extension. 1 Pa 2 2
Each additional inspection over allowable in any of the above _
Address: 1339 SE Gideon Street Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Investigation (1 hr min) 66.25 / hr
ity/ State/ZIP: Portland, OR 97202
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 239 - 4600 Fax: (503) 239 - 7038 Inspections for which no fee is 90.00/ hr
ecificall listed (% hr mm
CCB Lic.: 33135 Electrical Lic.: 26993CRE Suprv. Lic.: 2640LEB t ,; ;a r J at ,' 3 a i a s" : ; ''' "`
Suprv. Electrician signature, required: / (25% Subtotal 4, 7
,
07 r W i . ,. Plan review (25% of permit fee):
Print name: T Steven Young ' s ate: X4 - State surcharge (12% of permit fee): ' p t j
y
it n n TOTAL PERMIT FEE: /,5 r 91 0
Authorized signature: A ' U e �-�- � V , This permit application expires if a permit Is not obtained within 180
Print name: Emma J Gordon Date: 5 -24 -10 i
days inspections allowed has been accepted as complete.
Number o inspections allowed d per permit.
I:\ Building \Pennits\ELC- PennitApp.doc 10/01/09 440-4615T01 /05 /COM/WEB
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