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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT , • .-:._..., ., ` . c COMMUNITY DEVELOPMENT Permit #: ELR2010 -00128 TIGARD? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/22/2010 Parcel: 1 S127DD01200 Jurisdiction: Tigard Site address: 10031 SW CASCADE AVE Subdivision: LEVITZ BLDG Lot: 0 Project: Ultimate Electronics Project Description: Data /telecommunications FEES Owner: ULTIMATE ELECTRONICS Description Date Amount 321 W. 84TH AVE., STE. A Restricted Energy Permit 07/22/2010 $75.00 THORNTON, CO 80260 12% State Surcharge - Electrical 07/22/2010 $9.00 PHONE: 303 -412 -2500 Contractor: TICE ELECTRIC 5405 N. LAGOON AVE. PORTLAND, OR 97217 PHONE: 503 - 233 -8801 FAX: 503 - 872 -8290 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 $84.00 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 OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. / Issued By: / �� ' 2--/--Q. Permittee Signature: 0/V /97 -./ (f /d ' v 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 503.639.4176 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. REC }, ltlk PI' 1 I(1.0.',' l ()�1 1 Electrical Permit Applicati _ Received t � - / /0 �Q V /� i City of Tigard VL 2 0 ZOO R ete iv 2 BO .1gjAY PertmtNo . i 13125 SW Hall Blvd., Tigard, OR 972 Plan Review Other Permite& j 0 i Phone: 503.639.4171 Fax: 503.5 TIG ARD at : S8 See Page 2 for Inspection Line: 503,639.4175 �� Ante Ready/By: NM Supplemental Information "` '' Internet www.tigard-0r.gov ION BUILDING DIVISION Nottfie 7 PLAN REVIEW TYPE OF WORK Please check e1I that apply (submit 2. seta of plans w /items clucked below): ❑ New construction I7 Addition /alteration/replacemen 0 Service or feeder 400 amps or more ❑ Building over three stories. r 1 where the available fault current CI Ivied= boatyards. El Demolition W � aaa exceeds 10,000 amps at 150 volts of CI bloating bu0dipgs. CATE e ' Y OF CONSTRUCTION less to ground, or exceeds 14,000 ❑ Commercial -use agricultural `: 1 and 2 family dwelling i Commercial/industrial 0 Accessory building amps for all other installations. buildings. CI Fire per ❑ installation of 75 RSA or ❑ Master b uilder ❑ Other: larger separately derived system. ❑ Multi family ❑$mer ger P y JO18 SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑ "A" '"E ", "1 -2" "l -3 ", 100TdP or more. occupancy. Job no.: 5 , Job site a ddress:, 00 d Cif 5l.. tie ' ' .1, ❑ Six or more residential units, ❑ Recreational vehicle panes. — JO 03 © HealHt care facilities. ❑ supply voltage for more tbrm City /State /ZIP: 11 �//�� 1 7d. . ! ❑ Hardcar locutions. 600 volts nominal. f ❑ Service or feeder 600 amps or more. Suite/bldg. /apt no.: Project name: (7'l IEI�Gf u11C'S FEE SCHEDULE Cross street/directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. Lot no.: 1,000 sq. R. or less 168.54 4 - Subdivision: Ea add'I 500 sq. tt. or portion 33.92 1 Tax trap /parcel no Limited energy, residential 67.84 2 DESCRIPTION OF WORK (with above aq. fi.) Limited energy, multi - family 67.84 2 i 00 vo I T l residential (with above eq. ft.) . - Services or feeders installation, alteration, and/or relocation 200 amps or less 100,70 2 ErYROPERTY OWNER ❑ j___________TF,NANT 201 amps to 400 amps 133.56 2 , • 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amts 301.04 2 Address: Over 1,000 amps or volts 55226 2 Temporary services or feeders installation, alteration, and/or City /State/ZIP: relocation Fax ( ) 200 amps or less 59.36 1 Phone: ( ) i 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that 1 own which is not 2 01 amps to 599 amps 168.54 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: Iaate: A. Fee for branch circuits with ❑ APPLICANT r El CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: B. fee for branch circuits without service or feeder fee, 56.18 2 Contact name: first branch circuit Each add'I branch circuit 7.42 2 Address: Misceilaneouaserviee or feeder not included) City /State /ZIP' Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) I Fax.. ( ) Reconnect only 67.84 2 E- mail: Pump or irrigation circle - 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: Tice Electric Com 8 Y a n Signal circuit(s) or limited - energy panel, alteration, or extension. Describe: 1 Page 2 1;1 -q4 2 Address: 5405 N Lagoon Avenue IoW 1/0 I City/State /ZIP: Portland, Oregon 97217 Each additional inspection over allowable In any_of the above Per inspection 66.25 Phone: ( 5 03) 233-8801 Fax: (5 0 3) 872-8290 i nvestigation per hour (1 I v min) 66.25 — . CCB lac.: 166 Electrical Lic : 2 6 - 1 2 6 CJ Suprv. Lic.: 3651 S Industrial plant per hour 78.18 ELECTRICAL PERMIT FEES '7 t / Suprv. Electrician signature, required: S '�' Print name: Doug Johnson Date: 'Vigil 0 Plan review (25% of permit fee): / State surcharge (12% of permit fee): Authorized signature: amdop. i^`-"'— TOTAL PERMIT FEE: This permit application expires If a permit is not obtained within 180 Print name: Date: days after it boa been accepted as complet e Number of inspections allowed per permit. tl / t:iauadiaRtnamintSLC- FsrmttApp. 10/01/09 D mo.Jt6tsTlttros/conuwr?s V Electrical Permit Application - City of Tigard Page 2 - Supplemental I LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for ,aL1 residential systems combined $67.84 Check Type of Work Involved: ❑ Audio and Stereo Systems* [l Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Aix Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $67.84 s ysteU (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ C lock Systems ffi Data Telecommunication Installation ❑ F ire Alarm Installation ❑ HVAC ❑ Instrumentation [] Intercom and Paging Systems ❑ L andscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* El Protective Signaling ❑ Other Total number of commercial systems: T *No licenses are required. Licenses are required for all other installations I:\Building\Pamit$WZ C- pmnitApp.dO tQPo1/09