Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR2009 -00201
. T (G A R n 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/27/2009
Parcel: 2S101AC00700
Jurisdiction:
Site address: 12700 SW 72ND AVE
Subdivision: BEVELAND NO. 2 Lot: 13
Project: PAULY & ROGERS
Project Description: Low voltage for fire alarm extension for new addition.
Owner: FEES
ROY R ROGERS Description Date Amount
13690 SW TWELVE OAKS Restricted Energy Permit 07/27/2009 $75.00
TIGARD, OR 97224 12% State Surcharge - Electrical 07/27/2009 $9.00
PHONE: 503 - 620 -2632
Contractor:
ESDS CORPORATION
10700 BEAVERTON - HILLSDALE
BEAVERTON, OR 97005
PHONE: 503 - 641 -9170
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: N Fire Alarm: y
HVAC: N Instrumentation: N Total $84.00
Intercom/Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit ' : • ubject to the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes and all other applicable law. All work will
be do = in accordance wi approved c . ns. 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 I- . • uires you follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 001 -0010 thr•ugh OAR 952 -01 -0100. •u y btain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
I ued By: 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.
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 FO R ()Hi( 1 ; . is O,N . \,
City of Tigard Received 1 7/A7 D ' an Permit No.: . i ...• • r ,_..
° 13125 SW Hall Blvd., Tigard, OR 97223 pan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date43 : Other Permit:
TI GA RD Inspection Line: 503.639.4175 Date Ready/By: IMI El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please 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.
El 1 - and 2 dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
y g� 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 ❑ system. larger separately system
❑ Addition n o of new motor load of ❑ "A", "EE"", , " "11 -2"", , - 1-3",
Job no.: Job site address: IQ- 0 SN - To-- to � � 100 or more. occupancy.
o� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: — R ^Q 9 `� ❑ Health-care facilities. ❑ Supply voltage for more than
(,J za
❑ Hazardous locations. 600 volts nominal. or more.
Suite/bldg. /apt. no.: I Project name: QA t4 L. ,.... 1 t 1Zt�C� -R S f . Q ❑ Service or feeder 600 FE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Yea 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or Tess 145.15 4
Ea. add'I 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
E3{ 5 10—hi 01; EX isr »-iL7 tilt -(J 52.05 . residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
`❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
+pia kA L�/ , is C) ZaIZ S t 6O , 601 amps to 1,000 amps 240.60 2
Address: 1 7 7) 0 S 1-•1 -) 2 pre, ro Y6 Over 1,000 amps or volts 454.65 2
City/ State/ZIP: -. T- ) , Q �� 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 I 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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46 85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: D Signal circuit(s) or limited -
i s CDC 2 energy panel, alteration, or 1
Address: S to r 7L extension. Describe: Page 2 2
1071 St�l $ /,cFZJY rN) L_L . J)P ) - ►..t ,5',
% City/ State/ZIP: 4 0 7 .. c - oo S ( Each additional inspection over allowable in anxof the above
\`. aO � Per inspection 62.50
Phone:_5l G.+• - 9) -A � t 1 IA Fax: (5 ) 1,1 ) .. (,9 0( �j Investigation per hour (1 hr min) 62.50
CCB Lic.: _,cC c 3 I Electrical Lic .y 3 C uprv. Lic.: , Industrial plant per hour 73.75
rt ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: L j < < L Subtotal: 1 7s D O
Print name: itj i i /?j< /c Date: ?- �fi Plan review (25% of permit fee): .
State surcharge (12% of permit fee): 9 d o
Authorized Signatt TOTAL PERMIT FEE: (j2 L .00R
Date: This permit application expires if a permit is not obtained within 180
Print name:
1? I c — K e0 en S : 7�a.i • cot days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05 /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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Other T' U-r.) F E.X1s 11 r1 C7 __5(44_5 o jiz5
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
I1Building \Permits\ELC- PamitApp.doc 03/23/06