Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
le COMMUNITY DEVELOPMENT Permit #: ELR2010 -00290
T i G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/29/2010
Parcel: 1 S135CA90125
Jurisdiction: Tigard
Site address: 11046 SW GREENBURG RD 125
Project: Ash Creek Condominiums Subdivision: ASH CREEK CONDOMINIUMS Lot: 0
Project Description: Low voltage for fire alarm.
Contractor: WESTERN STATES FIRE PROTECTION Owner: PHIL- ALEXANDER, LORRAINE
13896 FIR ST STE B 11046 SW GREENBURG RD #125
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 657 -5155 PHONE:
FAX: 503 - 657 -5182
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/29/2010 $75.00
12% State Surcharge - Electrical 12/29/2010 $9.00
Type of Use: MF
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
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 i = cordance •• 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. • ENTION: Oregon la •uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -01 -0010 through OAR 95 101 -00 • may obtain a copy of the rules or direct questions to OUNC b . 'I , 503.2 2.1987 or 1.800.332.2344.
Issued By: 1 1 =v .. i / Permittee Si. • .ture: ■• - !.l
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
City of Tigard ECEV t s�- Received Permit No
4J g 1' DateB A �� ��X pf0�� ��Q� <CJ
° 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
N., Phone: 503.718.2439 Fax: 503.598.1 6 Date/B : Other Permit:
7' I G A R D Inspection Line: 503.639.4175 DEC 2 9 2010 Date Ready/BY: curb: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WOW T" OF TIGARF) PLAN REVIEW
® New construction ❑ Addition/alteralMtBlinegiVISIoN 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 ", "I - ", "I - ",
Job no.: Job site address: 11046 SW Greenburg Rd. ooltP or more. occupancy.
gl S ix or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, Oregon ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Ash Creek Condominium Rep ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 99 w fG is ,-e_tGnhKr Description I Qty. I Fee. I Total I •
L Y / ' - C/• New residential single- or multi- family dwelling unit.
'5 : ( l S o W (Z.Ja (nab SJ o K�T
s4-., Includes attached garage.
Subdivision: l 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
DESCRIPTION OF WORK ( with above sq. ft.)
Limited energy, multi - family 75.00 2
alarm & detection - new install residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
A 401 amps to 600 amps 200.34 2
Name: A s A ( �A/ „ G k LD/'tICES /C#1 601 amps to 1,000 amps 301.04 2
Address: / (C S I) GI /`Ct,42 &i /' Rel . Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: 'Til 4 red , D, ar 5122:5 relocation
Phone: (5 4 221 5 Fax: ( ) 200 amps or less 59.36 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
® APPLICANT I ® CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Western States Fire Protection Co. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Bill Rogers branch circuit -
Each add'l branch circuit 7.42 2
Address: 13896 Fir Street, Suite B Miscellaneous (service or feeder not included)
City/State/ZIP: Oregon City, OR 97045 Each manufactured or modular 67.84 2
tY g ty� dwelling, service and/or feeder
Phone: (503) 657 - 5155 Fax: : (503) 657 - 5182 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: bill.rogers@wsfp.us
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
panel, alteration, or extension. I Page 2 2
Business name: Western States Fire Protection Co.
Each additional inspection over allowable in any of the above
Address: 13896 Fir Street, Suite B Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Oregon City, OR 97045 Investigation (i hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: 503 Fax: (503) 657 - 5182 Ins for which no fee is
Phone: ( 503) 657 - 5155 a x: ( ) 90.00 / hr
specifically listed ( hr min) •
CCB Lic.: 104570 Electrical Lic.: 96,/ Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal: 75; O D
Plan review (25 /o of permit fee):!
Print name: �r��I A.. i' . , Date: (Z �' It) State surcharge (12% of permit fee): /
TOTAL PERMIT FEE:
Authorized signature: � � �& This permit application expires If a permit Is not obtained within 180
days after It has been accepted as complete. 6,0
Print name: Date: • Number of inspections allowed per permit. /yV1 '
1: \ Building \Permits\EI.C- PermitApp.doc 07/01 /10 440- 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*
0 Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
•
Other: Fl AL, 1
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
Total number of commercial systems:
*No licenses are. required. Licenses are required
• for all other installations
•
l: \Building\Permits\ELC- PermitApp.doc 07/01/10