Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
III a
a COMMUNITY DEVELOPMENT Permit#: ELR2009 -00159
T I C ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/11/2009
Parcel: 2S101AC00700
Jurisdiction:
Site address: 12700 SW 72ND AVE
Subdivision: BEVELAND NO. 2 Lot: 13
Project: PAULY & ROGERS
Project Description: Install resticted energy for data /telecommunication.
Owner: FEES
ROGERS, ROY R Description Date Amount
13690 SW TWELVE OAKS CT Restricted Energy Permit 06/11/2009 $75.00
TIGARD, OR 97224 12% State Surcharge - Electrical 06/11/2009 $9.00
PHONE:
Contractor:
MOUNTAIN F ENTERPRISES INC
25973 S MOEHNKE LN
BEAVERCREEK, OR 97004
PHONE: 503 - 313 -0761
FAX: 503 -632 -5521
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 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 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 th ugh R 952 - 001.0100. You may tain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: Oa Q/1 Permittee Signature: Q J nn � 4-02P
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 503.839.4175 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.
06/10/2009 0'3:04 503 - 632 -5521 ALAN FITCH ELECTRIC PAGE 02/03
i 1 t�
.. L 1ecfrical Permit Ap i 1 _' 1 . ) t )l 1 R t: 1 ' I.: tN i l City of Tigard , Received i; r ,
UN Dat
A 0 7-T 19 D fir••
13125 SW Hall Blvd., Tigard, OR 97223
Plan Review �G� •00 l
Phone: 50 3.639.4171 Fax: 503.598.1960 J " ' e/B . Ottler Pemnt: (� e
Inspection Line: 503.639.4175 C 1 ^ 1• ' G .1 4. 'I� �; Deo Ready/By: r- 0 See Page 2 for
Internet: www,ci.tigard,or.us v �t 1 Notified/Method (r Supplemental Information
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❑ New construction 1' Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other' ❑ m
Service over 225 amps, com'l ❑Hazardous location
r•10, r„ e : -: ••. ���,, El Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
, t; -,,, • r , : S V.4 1: .ud .:..M ::r 6ak aa�+xc I '14. si A • • 4 ; h∎l *. : .y,. of 1 and 2-family dwellings 4 or more new residential
0 1- and 2 family dwelling ■•• Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more
he'` +'• ' m s � 9 ^ n >w *. rr . i:�.r• Master ' '"(�t� i'' '"'''+� a r, DOccupant load over 99 persons ❑Manufactured structures or
NI I ' . 5 ; .j .. v )h•, �� .K 2 , `;- ,,Ave �5,= R s a a `t lrva .F tiska ilw �� 1 ...t ['1:gress/ii8htin8 plan RV pars`
a O / otiealth -care �cility ❑Other.
Job n0.: Job site address: /� yI! Iva 4 d Submit 2 sets of plans with any of the above.
City/State/ZIP: gAito ae aZ 5 The above are not applicable to temporary construction service.
/ I Project name: - (�� ' e f-S
M . v ff ' J 7r: an'�~ :l•m+,:•.' is k .r t o ... F , ''' L d,
Suitt /bldg /apt no.: ,
~ 4. i AacAptbis QV. FK. Tam
Cross street/directfons to job site: New residential single- or multi- family dwelling snit.
Includes attached garage.
REF Milf4 ? iAt ri '° L-C 2,e703 -- to Z7Z-. 1,000 sq. ft or less 145.15 4
Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential , 73.00 2
Tax map/parcel no.:
Limited energy, non- residential 75.00 2
..',.. } \ ,''s +t 3.•• ' 1 ° `Un ir�e•a°'M otv er�di' .: atila^ 4 «�V t .p -. Each manulacelred or modular
�
Y � - dwelling, service and/or feeder 90.90 2
%. /4 e e a mu , %A A t CA- I1)t& ■`ST A-tJ- Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
1 L '��7?,tfF,T w!pty +„4At traA i• M;' r' p:: n!•" Y
} q i i C psp C^ }, C i „ 7� 7t ,' 201 amps to 400 am 106.85 2
i6�".. b yy17 > PJ , J r r a } 46 i.� 1 E2
'w�� ;; `{`? { -v , I .YSVA!'Gi , .75 �N 7�•'i'�''1,�2.. d�• VaaP.'Ft+.Y1V1i.,��
,
401 amps to 600 amps 160.60 2
Name: _ 601 amps to 1,000 amps 240,60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City / State/ZIP: Temporary services or feeder's installation, aleeratiou, and/or
Phone: ( ) iFax: ( ) relocation
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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
4. '` ,,,; i '' ;�,,t ' rneLto iraror.7e .'tt4 a: * ikA A. Fee for branch circuits with
service or feeler fee, each 6,65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Mlseellaneons (service or feeder not included)
Pump or irrigation circle 33.40 2
Phone: ( ) Fax: : ( ) _ .,---
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
l' '':(b.""'''' la pWt zfT�er 'r""�'" g s anel
si9 . �. � - �, . r> �oTt+�e� y .. ..'. •� �.': �i�l: enBY P 0. or
Business name: extension. Describe: Page 2 ors 2
Ml o fx, . A_ A LA Lfn 041.0 /n„ xvs 7S; . -
Each additional inspection over allowable in any of the above
Address: 25q 1 " S. vv‘ U G jy.4... ( Per inspection 62.50
City/ State/ZIP: - t, v 09-, C q Investigation pa hour (1 hr min) 62.50
Phone: ( 2) 1 011 Fax ( ? vi ) . y Industrial plant per hour 73.75
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CCB Lic.: •' 1 E SL Electrical Lic.: 3 --.3 6 4.G Suprv. Lic.: �.1.Z,t.5 'ry "�: 1' L.. :F�a� #i ': �� > >u b „ o t all �lc � 7 ..: ''."+�':: �
fl Subtotal � O v
Suprv. Electrician signature, required: ,d�rt,s ._ , Plan review (23 %ofpermit fee)
Print mane: N A 0 .,..v.. `� I Date: ti -(0 - e, State suttdlarge (8% of permit fee) �r
F TOTAL PERMIT FEE 6 4; 0 0
Authorized signature: r 7bb wink appGtatiaa expires if a permit is riot obtained within 160
ih �l t days after it has been accepted as complete
Print name: F Da • Fee methodology sat by Tri- County Building industry Service Board
is Numberof inspections per permit allowed
oau001ngTennl El.c -Pam aass.4o I/O 7) 410.40 UT(10tU2 :OM/WEB