Permit J • Y ,
t 4"� "'' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° t,;, COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00167
TI 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/5/2007
PARCEL: 2S 113B0 - 00600
SITE ADDRESS: 16580 SW 85TH AVE ZONING: I -P
SUBDIVISION: SEWER TREATMENT PLANT LOT: JURISDICTION: TIG
PROJECT: CLEAN WATER SERVICES
Project Description: Security and access control.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATAITELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
CLEAN WATER SERVICES SONITROL PACIFIC
2550 SW HILLSBORO HWY 8220 N. INTERSTATE AVE.
HILLSBORO, OR 97123 -9379 PORTLAND, OR 97217
Phone: 503 -681 -3600 Contact #: PRI 503- 223 -5822
FAX 503- 973 -7773
Reg #: ELE 26- 370CLE
FEES LIC 53535
Description Date Amount SUP 3567LEA
[ELPRMT] ELR Permit 6/5/2007 $75.00
[TAX] 8% State Surcha 6/5/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: 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'N: 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.
+ ' t+ s
• FOR OFFICE USE ONLY
l ectrcal Permit Applicatiot v .
City of Tigard Date /Be A
/� 7 Zp O no
r ' y c'/ /
II
13125 SW Hall Blvd., Tigard, OR 97223 6- Plan Revi w Permit No
Pho ne: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
Line: 503.639.4175 (' R f ( \ L't�' Date Ready /By: Jurist/ See Page 2 for
TIGARD �� � `i <rJSII Not i fied/Method: Su
Internet: www.tigard or.gov / Supplemental Information
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 ❑ Convnercial -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
❑ 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.: P070083 Job site address: 16580 SW 85th 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ H azardous locations.
y g 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Clean Water Services ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 1 Fee. 1 Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
Installation of Security and Access control system residential (with above sq. R.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 20) amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: Sonitrol Pacific
energy panel, alteration, or
Address: 8220 North Interstate Avenue extension. Describe: Page 2 2
City /State /ZIP: Portland, OR 97217 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 223 -5822 Fax: (503) 973 -7773 Investigation per hour (1 lir min) 62.50
CCB Lic.: 53535 Electrical Lic.: 26 -370 Suprv. Lic.: ye f 7( ,E1.7 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ��I� / Subtotal: 75
- t Plan review (25% of permit fee):
Print name oc k. /J 8 (0 ce f ,I Date: 6, - 1- G 7 State surcharge (8% of permit fee): 6
Authorized signature: TOTAL PERMIT FEE: 81
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1: \Building \Permits \ELC- PermitApp.doc 05/23/06 440- 4615T( I I/05 /COM/WEB