Permit . - CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR2010 -00149
T i G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/10/2010
Parcel: 2S101 DB00103
Jurisdiction: Tigard
Site address: 7360 SW HUNZIKER RD 206
Subdivision: Lot: 0
Project: Goodman Networks
Project Description: Low voltage for data
Owner: FEES
ROBINSON FAMILY TRUST Description Date Amount
21360 NW AMBERWOOD DR Restricted Energy Permit 08/10/2010 $75.00
HILLSBORO, OR 97124 12% State Surcharge - Electrical 08/10/2010 $9.00
PHONE: 503 - 645 -8531
Contractor:
AF TECHNOLOGIES
1418 HEMLOCK ST. NW
SALEM, OR 97304
PHONE: 503 - 362 -2364
FAX: 503- 362 -2382
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 ' -._. • b'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance wi - .proved •tans. This permit will expire if work is not started within 180 days of issuance, or if wo . is suspended for , • r e 180
days. • ENTION: Oregon la• -quir s you to follow the rules adopted by the Oregon Utility Notification Center. ''r ose rul= are s_ R
952 -00 -0010 through OAR 952-0. -0100. o , y obtain a copy of the rules or direct questions to OUNC by calling 503.246.6.1.800.3 3: ,_----
Iss d By: / dIP Permittee Signature. .L .4 ._
...--/ 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 Application <40,R-01. ERA.. E) °�yl'
lii City of Tigard RECEIVED Received iv/
`. 7 g DateB to d _ Permit No.: g / D rC.V • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960. ,, , f Date : Other Permit
B
I I :,� it l Inspection Line: 503.639.4175 i ®� -J 0 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
CITY OF TIC /'.RD
TYPE E ff[YYP f, )Ay Ci N , 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
❑ 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
JOB SITE INFORMATION AND •LOCATION. ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: ` J IOOHP or more. occupancy.
1 • / 3 � /'T /l) -2..,K.*: e ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: `y---' Z 6 �� / 1 R - ❑ Health -care facilities. ❑ Supply voltage for more than
iP ❑ Hazardous locations. 600 volts nominal.
t2 3,6%.„.&04
Suite/bldg. /apt. no.: 9 6 Project name: �j t ❑ Service or feeder 600 amps or more.
4 „.1) 0
FEE SCHEDULE
Cross street/directions to job site: 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 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 ' 1
Tax map /parcel no.: Limited energy, residential
(with above sq. ft. 75.00 2
DESCRIPTION OF WORK. ( 4 )
Limited energy, multi - family 75.00 2
11/91GAS f 1) ‘5 l Al4ra I( residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or Tess 100.70 2
. ❑ PROPERTY OWNER ` ' ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1 68.54 2
Branch circuits - new, alteration, or extension, er panel _
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ 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, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: /State /ZIP: Each manufactured or modular 67.84 2
t3 dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
• CONTRACTOR • _ Signal circuit(s) or limited- energy
/� / panel, alteration, or extension. i' Page 2 2
/7
Business name: - 'T Cyr N L , e , ` cs' Each additional inspection over allowable in any of the above
Address: / (a / / r y2 / L /< t j/) Additional inspection (1 hr min) 66.25/ hr
- Qn I / n /� Investigation (1 hr min) 66.25/ hr
City /State /ZIP:
.�•!, " . i ! /� % � � Industrial plant (1 hr min) 78.18/ hr
Phone: (619 /cp. — P 3 6 (/ Fax: 4 .- - e Inspections for which no fee is 90.00/ hr
!a r specifically listed (Y: hr min)
CCB Lic.: 47694/ / Electrical Lic.:0 _ r0 Supry ic.: c p 44 - ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
• o Subtotal: 75 •
—
���� Plan review (25% of permit fee):
Print name: /7 f ,/ 6_ R / g /iov5 Date: g 0 —P _ State surcharge (12% of permit fee): $ • CCU
�� TOTAL PERMIT FEE: 8
Authorized signature: �j�! This permit application expires if a permit t is not obtained within 180
days after it has been accepted as complete.
Print name: d /� P® /gCSt./5 Date: 6 11)
— ( • Number of inspections allowed per permit. ,
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•
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
n 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- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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