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Permit �� � CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT - ', ..- COMMUNITY DEVELOPMENT Permit #: ELR2010 -00271 11 ARD; 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/07/2010 Parcel: 2S102DA00600 Jurisdiction: Tigard Site address: 13500 SW HALL BLVD Project: Friends of the Tigard Library Subdivision: Lot: 0 Project Description: Low voltage for control wiring - HVAC Contractor: REITMEIER MECHANICAL Owner: CITY OF TIGARD 19570 SW 90TH CT 13125 SW HALL BLVD TUALATIN, OR 97062 TIGARD, OR 97223 PHONE: 503 - 603 -0205 PHONE: FAX: 503 - 603 -0150 FEES Description Date Amount Specifics: Restricted Energy Permit 12/07/2010 $75.00 12% State Surcharge - Electrical 12/07/2010 $9.00 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: N HVAC: Y Instrumentation: N Intercom /Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Total $84.00 Other Desc: Required Items and Reports (Conditions) 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. ATTEN egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001- 0 through OAR 9 -001 01 -' � . You may obtain a copy of the rules or direct questions to OUNC by calli 987 or 1.801.332.2344. I ued By: � i 4 ...._8_ 1 / Permittee Signati r — 4 i = 1 d." r�_— 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 the next available inspection date. 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 FOR OFFICE USE ONLY Received e - /f 4/4 � _ City of Tigard Date /By: l `J / p (k Permit No.: 14 q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date /By: Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information t vsy �Y I €t e M . P W i sa T fi YPE O F W O RK. t ', ,:;::41e.'"- a ., ` . r . . � , ❑ 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. r 8 CATEGORY OE @ONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. I- and 2-family d x Commercial/industrial ' ' ' t� °u� '' " ` less to ground, or exceeds 14,000 ❑ Commercial -use agricultural El ' y g cial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB ;SIT�E INFQRMPTION , AND�LOCATIONr Ka _ s�.. .,�, �.e,u. ,.,� ?...f ..,,,�,�,r , ..,����� ,,., , .. , , ,,,F ..eik ❑Addition of new motor load of ❑ ,. .. .. 3 „ Job no.: Job site address: /3506 SCt..) i .11 <B1L/ 100HP or more. occupancy. ❑ ❑ Six or more residential units. Recreational vehicle parks. City/State /ZIP: �� eL % 01172_2-3 ❑ Health -care facilities. ❑ Supply voltage for more than rid ❑ Hazardous locations 600 volts nominal ❑ Service or feeder 600 amps or more. Suite/bldg. /apt. no.: Project name: L / .r f . ).. FEESCHEDULE..`.'' . ',. Cross street/directions to job site: Description 1 Qry j Fee. 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'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no Limited energy, residential 75.00 2 )!,, , •, tE DE IP SCRTION FD O WORK y (with above sq. ft.) / " Limited energy, multi - family 75.00 2 Lao v olt caI d1'ro/ L'. /r /h9 ` i t residential (with above sq. ft.) / Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 PROPERTY :OWNER TENANT 9 i , , 201 amps to 400 amps 133.56 2 1 q 401 amps to 600 amps 200.34 2 Name: C,�v 6T / � ) Ct 1r� 601 amps to 1,000 amps 301.04 2 Address: 1 3/2.5 z5 .7 �/ w I blvd Over 1,000 amps or volts 552.26 2 1 Temporary services or feeders installation, alteration, and/or City/State /ZIP: 7 4 / op 972.2-3 relocation Phone: ( ) (� Fax: ( ) 200 amps or less 59.3 1 _ 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 above service or feeder fee 7 APP C I ANT ' ` ,. i r,. ❑ " C O NT AT PCER SON . .42 2 ,< .., _ _ � . "; ,. , ,r, . ,� � , n,. ®. ��.�.,�,., � . ' each branch circuit Business name: rE,t elipx, Meci ( I B. Fee for branch circuits without ( service or feeder fee, first Contact name: e_r_ branch circuit 56.18 2 Each add'l branch circuit 7.42 2 Address: JGf 7 s q C r t Miscellaneous (service or feeder not included) 'T - Each manufactured or modular City/State /ZIP: 67.84 e� 1 l� 0� 87(762 dwelling, service and/or feeder 7.84 2 / Phone: Fax: : cs Reconnect only 67.84 Pump or irrigation circle 67.84 2 2 (So3 ) 6o3� c�� a S (S 3 ) �l�d ,� 1 E mail /Yta`!l+ro n r S vet r me)ermec NGLIA/� 1 e� i Sign or outline lighting 67.84 2 . R" . , k E CONTRACTOR i.,., ,�.,.,- r : . •,% Signal circuit(s) or limited - energy y�1'Z { panel, alteration, or extension. Page 2 ( 2 Business name: e r iii e_fer �"iec_het i l (CGC- / Each additional inspection over allowable in any of the above Address: /6($77 ) Tali, 64.0 f Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: r ©p CM--)62. Investigation (1 hr min) 66.25/ hr �(/lCe I A- - tit / h Industrial plant (1 hr min) 78.18/hr Phone: ( ) 3 ) 5c>3 6� j - �s Fax: (jam 603 - Q Inspections for which no fee is specifically fisted (Y. hr mm) 90.00/ hr CCB Lic.: Electrical ' Suprv. Lic.: ,,, , ELECTRICAL PERMIT „ �FEES „, , 153770 : y - 6�s�C,«� p 1/L , ., .,,.... � .,�,,... �� �e Subtotal: 75 Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: f---- ,4 Date: I (_ V .— / ID State surcharge (12% of permit fee): CJ 0 p a d d '` TOTAL PERMIT FEE: D Authorized Sign: > This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: 'FT: : 1 S ' .c — 1 Date: 1 1 — Sc - ( 0 * Number of inspections allowed per permit. I:\ Bui lding \Pemvts \ELC- PermitApp.doc 07/01/10 440- 4615T(11/05 /COM/WEB