Permit fe
i ? 3 u CITY OF T I ELECTRICAL RESTRICTED ENERGY PERMIT
' ".' COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00097
1- 1_,G,-A.Rp.= 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/21/2008
PARCEL: 25101 BD -00103
SITE ADDRESS: 07875 SW HUNZIKER RD ZONING: I -L
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: TREK
Project Description: Installation of voice & data.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
H G M CO TELEDIGIT INC
BY NORRIS BEGGS + SIMPSON PO BOX 22287
ATTN: BLAKE HERING PORTLAND, OR 97269
PORTLAND, OR 97204
Phone: Contact #: PRI 503- 722 -8084
FAX 503 -722 -9914
FEES Reg #: ELE 3- 414CLE
LIC 116188
Description Date Amount
[ELPRMT] ELR Permit 4/21/2008 $75.00
[TAX] 12% State Surch 4/21/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 Notifi ter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or rect question o N 03.246.6699 or 1.800.332.2344.
Issued By: K ... .. ,,6 Permittee Signat
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.
III
Electrical Permit Application �� ], l oK orI lc F, u sF o�Y
Received r' qt )) Permit No.: 2, ,•io .• psi) g
DatefB : / O �"�
■ I, V 13125 SW Hall Blvd., Tigard, OR 97223 � R Plan Review Other Permit:
C City of Tigard Phone: 503.639.4171 Fax: 503.598.1 >
� Inspection Line: 503.639.4175 Ready /By: Date Read /B Vail Supplemental Information El See Page 2 for
P I GA:P D • a
Internet: www.tigard- or.gov Notified/Method:
TYPE OF WO t' ' � PLAN REVIEW
r ! l^, i11 ^y
❑ New construction 0 Addition /alteraait Weple e Please check all that apply (submit 2 sets of plans w /items checked below):
rt —,!r.,,1 1 .0
ctft j; sire; N
❑ Demolition ❑ Other: BU14- ❑ Service or feeder 400 amps or more ❑ Building over three stories.
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 ® Commerciallindustrial ❑ Accessory building amps for all other installations. buildings.
❑Multi - family ❑Master builder ❑ Other: Fire pump. ❑ Installation of 75 KVA o Other: l larger separately derived system.
❑ Emergency system. g P y y
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - 2 ", "1 - 3",
100HP or more occupancy.
Job no.: 1 Job site address: 7875 SW Hunziker Rd ❑ Six or more residential units. ❑ Recreational vehicle parks.
CI Health-care facilities.
❑ Supply voltage for more than
City/State/ZIP: Tigard, OR 97223 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Trek ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description 1 Qt 1 Fee. 1 Total
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'1 500 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
Voice & Data Cabling residential (with above sq. ft.)
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
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and/or
City /State /Z1P: relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 133.75 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT • • ❑ CONTACT PERSON abo ve service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: first branch circuit
Each add'l branch circuit 6.65 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Fax: I Phone: ( ) ( ) R econnect 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: Teledigit, Inc. energy panel, alteration, or 75.00
tension. Describe: 1 Page 2 2
Address: PO Box 22287 ex
City /State /ZIP: Portland, OR 99269 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 722 - 8084 t' q I ndustrial plant per hour 73.75
Fax: (503) 722 -9914 Investigation per hour (I hr min) 62.50
CCB Lic.: ]]6188 d f Electrical Lic.: 3 =141CLE Suprv. Lic.: 815LEA ELECTRICAL PERMIT FEES
Suprv. Electrician signature, require" - Subtotal: 75.00
Plan review (25% of permit fee):
Print name: Art Rosario Date: 4/21/08
State surcharge (12% of permit fee): 9.00
Authorized signat TOTAL PERMIT FEE: 84.00
' �~ This permit application expires if a permit is not obtained within 180
Print name: Art Rosario Date: 4/21/08 days after it has been accepted as cmnplrte,