Permit x CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
3 _ COMMUNITY DEVELOPMENT Permit #: ELR2010 -00112
Date Issued: 06/16/2010
T t G fti RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S135BC00900
Jurisdiction: Tigard
Site address: 10855 SW CASCADE AVE
Subdivision: Lot: 0
Project: Right Angle
Project Description: Low voltage for data.
FEES
Owner:
PAULSON LIMITED LIABILITY CO Description Date Amount
BY RICHARD G PAULSON SR, 10855 SW Restricted Energy Permit 06/16/2010 $67.84
CASCADE BLVD 12% State Surcharge - Electrical 06/16/2010 $8.14
PHONE:
Contractor:
A BETTER ELECTRICAL COMPANY
16869 SW 65TH AVE STE 373
LAKE OSWEGO, OR 97035
PHONE: 503 - 753 -0836
FAX:
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: y 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: 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 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 OA 952-001-0100. You ma obtain a co• • le rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
g -ae Issued :� '� 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.
CaII 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.
Electrical Permit ApplicaRECEIVED FOI? OFFICE USE ONLY
City of Tigard I Received
114 r I� u ^A�I' , q Date/I3 / / 1 Permit No.: 1
° 1312 SW I lall OR � 6 � t0 ifI �� ..DIO Q� ll�
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /13y: Juris: ED See Page 2 for
Internet: www.tigard- oegov BUILDING DIVISION Notified /Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration /replacement i'lease check all than apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other: ❑ 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 dwclling OComniercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑Other: ❑Fire pump. ❑ Installation of 75 KVA or
nu n
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
['Addition of new motor load of ❑ "A" - 1 " "I.2' "I -3"
Job no.: Job site address: Q gJ S _ 1 ,(C Q 0 100111' or more. occupancy.
f - C LW ( .i .> ✓ ( r C i f I. ❑ Six or more residential units. ❑ Recreational vehicle parks.
Clay /Slate /ZI 1 ('�J /< `/ i r 0 e ❑ Health -care facilities. ❑ Supply voltage for more than
J 7 ! 7 j �
• , ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 4;i4 / �jt/ f'� 0 Service or feeder 600 amps or more.
C FEE SCHEDULE
Cross street/directions to job site: nescr;puuo 1 Qty. 1 Fee. I Taral
New residential single - or multi- family dwclling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 145.15 4
Ea. add'I 500 sq. II. or portion 33.40 I
Tax map /parcel no.: • Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. 11.)
® A imited energy, multi- liimily
/ Co Q i2//71 residential (with above sq. 0.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER SCTENANT 201 amps to 400 amps 106.85 2
Name: • 401 amps to 600 amps 160.60 2
Address: 601 amps to 1,000 amps 240.60 2
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 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee Tor branch circuits with
fif APPLICANT
1 ❑ CONTACT PERSON above service or feeder fee,
6.65 2
Business name: t rill
v /
each branch circuit
4 / 13. Pee for branch circuits
without service or feeder fee, 46.85 2
Contact name: ���i /�i�
�' first branch circuit
Address: Each add'l branch circuit 6.65 _ 2
/r, � 55 � SC E , / (� ; gip A f/ � Miscellaneous (service or feeder not included)
City /State /ZIP: 7-7 Fax (�j�) 6:�o 3 d / AIx 6 2 g722, 3 Each manufactured or modular
Phone: �/ ® G dwelling, service and /or feeder 71)'`)1) 2
Reconnect only
66.85 2
E - mail: CA v e, 0 AM2 e -4 N€T Pump or irrigation circle 53.40 2
NTRACTOR Sign or outline lighting 53.40 2
Business name:
MC/ f " G 4/6 /�oi2KS 1/1/c, eneral rgy panel,(a) alor ter lio , or
ene panel, alteration, or
Address: /‘861 ( C 60 / r74 A 7 3 extension. Describe: Page 2 2
City /State /ZIP: A1 y f/ Gl / �
e a C 9e e ) O 77435' ' Each additional inspection over allowable in any of the above
V �� �� / � 3 J �� O Per inspection 62.50
Phone Q3) 6Lls' ro 0 Fa x: D ) Z Investi per how• (1 hr min) 62.50
C Lic.: j 81/782 ectrical Lic.: C 1/52,• Suprv. Lic. 3S 5 Industrial plant per hour 73.75
/ NI � ELECTRICAL PERMIT FEES
Suprv. cct s required: / � '� ' '� ! �2%i.' Subtotal: v 7, S y
Print name: /yf /G / ge i1 � e / Date: G -/ 6 - Plan review (25 %orpermit 6.e):
♦i r '! �Q State surcharge (12% of permit Ice): %. `/
Authorized signature: TOTAL PERMIT PEE: 9 3 • 1 g
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.
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