Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
51
o COMMUNITY DEVELOPMENT Permit #: ELR2010 -00153
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/31/2010
Parcel: 2S101 BC00900
Jurisdiction: Tigard
Site address: 12291 SW KNOLL DR
Subdivision: Lot: 0
Project: The Knoll at Tigard
Project Description: Low voltage systems for data, fire alarm & access controls. (3) hours charged for additional
inspections on multiple floors.
Owner:
FEES
THE KNOLL AT TIGARD Description Date Amount
PO BOX 23206 Restricted Energy Permit 08/25/2010 $225.00
TIGARD, OR 97281 -3206 Additional Inspection 08/25/2010 $198.75
PHONE: 503- 293 -4038 12% State Surcharge - Electrical 08/25/2010 $50.85
Contractor:
AZIMUTH COMMUNICATIONS INC
P.O. BOX 508
WILSONVILLE, OR 97070
PHONE: 503 - 639 -0110
FAX: 503 - 639 -0115
Type of Use: MF
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N Total $474.60
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 - plicable law. All work will
be done in acc• • - - ce wil . • •roved plans. This permit will expire if work is not started within 180 days of issuance, or if work • spended for more the 180
days. ATT ION: Oregon la requires -u to follow the rules adopted by the Oregon Utility Notification Center. Tho les are set forth in OAR
952- 001 -01 0 thro •h OAR 952 - 001 2 •'100. ou ay •A ' - -in a copy of the rules or direct questions to OUNC by calling 503.246.6• :9 or .80' '.2344.
Issued : — 4114-.Li ., Permittee Signature: A _ _ /I
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.
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.
Electrical Permit Application Received C Ft7ll t,rFl(� I: LI ST: ()NIX
CI of Tigard KhC b i�� � (5
`J g Date/B )( Permit No.: . / 0 —�
I N
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.�qS (- 6 Other Permit:
l;iv ! � � 0 2��0 D ateB :
T t I , i Inspection Line: 503.639.4175 Date Ready/By: ��� s ® See Page 2 for )
Internet: www.tigard -or.gov CITY OF TIGARD Notified/Method: / l (p Supplemental Information
TYPrs RiLlyPlig DIV ISION PLAN REVIEW
<ew construction ❑ Addition/alteration/replacement Please check all that apply (submit a 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.
�ulti- 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 - ", "I - ",
qq q 100HP or more. occupancy.
Job no.: Job site address:
�G Z ! / Sc'/c,1' ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 1 ( O Ue... ❑ Health-care a d facilities.
Supply voltage for more than
❑Hazrous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 7 /4. `le•7'. / ❑ Service or feeder 600 amps or more.
� ( FEE SCHEDULE
Cross street/directions to job site: � i / r C _ Description 1 (NT. 1 Fee. 1 Total 1 f l 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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
7 _ /, M A/ residential (with above sq. ft.) 75.00 2
/�, �• i` �tu4�✓ /tCw ♦ ACC S CO r • Services or feeders installation, alteration, and/or relocation
S 'e ri 4 / X`Y A/ q D p i . 200 amps or less 100.70 2
PRIDPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
/ / 401 amps to 600 amps 200.34 2
Name: 5 {0v G1/�,�� frfr"> 601 amps to 1,000 amps 301.04 2
Address: �o &AK Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: e • SrJla, t/ <Ye__ relocation
Phone: ( ) a �'_ 01 !U .4114-1S-1- Fax: ( 2 9 (€5 t — 0 I( S 200 amps or less 59.36 1
C' 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel _
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: / /� / B. Fee for branch circuits without
N ` G f/� / orc_ service or feeder fee, first 56.18 2
Contact name: / branch circuit
{�' v ✓ - �/Vj�f Ea ch add'I branch circuit 7.42 _ 2
Address: 9 ,4 L., �/ _� ,,� �et Miscellaneous (service or feeder not included)
CI /State /ZIP: ✓'Y Each manufactured or modular
tY �(,��� � Lj 7/) V � 7( dwelling, service and/or feeder 67.84 2
Phone: (, (. 51_ d / j _ ts '' Fax: : ,� ! - `� t Reconnect only 67.84 2
�.0 3 Pump or irrigation circle 67.84 2
E - mail: 5-feet. At 4 .s, Olt Le.msi v v_ . r- r
AL f �!/ rYL, Sign or outline lighting 67.84 2
CONTRACTOR • Signal circuit(s) or limited- energy /,r; AA S .°° 2
�+ panel, alteration, or extension. S- Page 2
Business name: 2
,,, . .Mt z....".4% C c-44 6.4 4-"t Each additional inspection over allowable in any of the above
Address: ( Additional inspection (1 hr min) 3 66.25/ hr /c72.75 �
City /State /ZIP:
( .t hQ .—t ) Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lic.:(ys82Y) Electrical Lic 'NC/ ,E Suprv. Lic.: ELECTRICAL PERMIT FEES' /
Suprv. Electrician signature, required: Subtotal: ok 5. /1
Plan review (25% of permit fee): C
Print name: 64 1 U /4�q Date: (i /D i State surcharge (12% of permit fee): 5Q.lb
. (r'�� ` TOTAL PERMIT FEE: //7 6 D
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um be r of inspections allowed per permit.
l:\Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I1/05 /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- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems • •
•
z gr Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls • • • •
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
7 0ther pf LeS 5 c U i2 (c
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \ Building \Permits\ELC- PermitApp.doc 07/01/10