Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
i . DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00176
��I DATE ISSUED: 7/24/2006
-- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 102BB -00827
SITE ADDRESS: 10495 SW JOHNSON CT ZONING: R -4.5
SUBDIVISION: BROOKSIDE PARK NO. 2 LOT: 003 JURISDICTION: TIG
Project Description: Door/Window annunciator.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
KAMMEYER, DALE R + CAROL M LIMITED ENERGY NW
10495 SW JOHNSON CT P.M.B. 190
TIGARD, OR 97223 3439 NE SANDY BLVD.
PORTLAND, OR 97232
Phone: Contact #: PRI 503 -810 -7331
FEES Reg #: ELE 26- 1012CLE
LIC 131668
Description Date Amount SUP 353LEA
[ELPRMT] ELR Permit 7/24/2006 $75.00
[TAX] 8% State Surcha 7/24/2006 $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.
Issued By: - %7��: � Permittee Signature: ../111
cr
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:
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.
.`EIe Permit A lication �p /6t ' ` 4 } '. : I( � Itt o 1 :F1C « ( iN R +.' jt ti, 4
PP ,R ECEI tl t�' n �iy {, j t ' f4u Y '' ' E , .
4 �y ..a. ` I Received
if '. ' City of Tigard Date/By- - s a ^ Permit No. �/L1 2 ,2i�� � / 7
' 9 ° 13125 SW Hall Blvd., Tigard, OR 97223 2 4 Vii' ., Plan Review
`l:= - i B Phone: 503.639.4171 Fax: 503.598.1960 JUL Date/By Other Permit:
PI G`n�R∎D
O&:x Inspection Line: 503.639.4175 CITY OF TIGAFi�t Date Ready/By: 3u�s /See Page 2 for
s,2i Internet: www.tigard- or.gov BUILDING DIVISIO �°ufied/Method /( �� ® 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 ❑ Commercial -use agricultural
D- <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 ", "1 -2", "1 -3 ",
Job no.: 1 z40 6 Job site address: 1(� 4I 9_5 sit) �o sts�v C I or more. Re c r ea ti on.
T ❑ Six o or r more residential units. ❑Receatonal vehicle parks.
City / State/ZIP: ; i 6. AR D / Q 2 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 6Lvacsij ITS � 3 _ C7 Description 1 Qty. 1 Fee. 1 Total 1 •
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
DESCRIPTION OF WORK (with above sq. ft.) i 75.00 2
Limited energy, multi - family 75.00 2
DdO RAN) /sv ,o LL,) ,AAJA) U A) C 1 A -ro 2_ residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
- ❑ PROPERTY OWNER I ❑ 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 Tess 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 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, p r panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT - 1 • • ❑ 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
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
' CONTRACTOR Sign or outline lighting 53.40 2
Business name: L , W, v rep C p0E-1 =may I iQzA TN L E T
Signal p a n ui, a er or t o n , or
/ energy panel, alteration, or
Address: P I� Q `el c 9 3 N 3 7 k) r &¢}Aff y '8( U o- extension. Describe: Page 2 2
City /State/ZIP: ?Oa -F A ,t.)) t Q c. 7 2 31 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5 ? i0 - -. 3 1 Fax: (.3.(t) �1i5/6 -- 37 2- g Investigation per hour (I hr min) 62.50
CCB Lic.: 13 1 66e Electrical Lic.: 26 - /D tzar Suprv. Lic.: 3 t? ILEA Industrial plant per hour 73.75
`p / / _ � ELECTRICAL PERMIT FEES
IQ, Suprv. Electrician signature, required: j �� -E � J f / ../� ... � Subtotal: $, �'
N i Print • name: �j lts.t4 ,Q .o 1 z u fl A 441 Date: 2 4.( c 1,3 L 66 Plan review (25% of permit fee):
State surcharge (8% of permit fee): 1.,?-2.
Authorized signature: n � L' TOTAL PERMIT FEE: / i"--2---
t r This permit application expires if a permit is not obtained within 180
Print name: Ed W 80 L ,J2-4 2
C +4 � Date: 11 c �'l �, days after it has been accepted as complete.
e_
• Number of inspections allowed per permit.
1:\ Buildin8 \Permits\ELC- PermitApp.doc 05t23/06 4404615T(11/05/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 ... $75.00
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 $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
• *No licenses are required. Licenses are required
for all other installations
1: \ Building \Pcmits\ELC- PermitApp.doc 03/23/06