Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
3 ' • COMMUNITY DEVELOPMENT Permit #: ELR2009 -00066
T [ G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/17/2009
Parcel: 1 S 136CB02500
Jurisdiction: Tigard
Site address: 11130 SW 82ND AVE
Subdivision: RANCH VALLEY Lot: 6
Project: Heath
Project Description: Install restricted energy for all encompassing low voltage.
Owner: FEES
HEATH, ROGER C & DIANNE S Description Date Amount
9373 SW PAST PL Restricted Energy Permit 07/17/2009 $75.00
TIGARD, OR 97223 12% State Surcharge - Electrical 07/17/2009 $9.00
PHONE:
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N Total $84.00
Vacuum System: N Required Items and Reports (Conditions)
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 through OAR 952 - 001 -0100. You may obtain a copy of rules or direc questions to OUNC by calling 503.2. •. • .... or 1.800.332.2344
Issued By: V ak d . 1 Permittee Signature: -.41
/
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.
:lectr`ical Permit Application RECEIVE
1:9
City of Tigard Date/By: Permit No.: 4' 1220()�'r , 000(o(
13125 SW Hall Blvd., Tigard,OR 97223 JUL 17 2009 Plan • Rev Received Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit:
® Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard- or.gov BUILDING ntviSlu P �' otified/Method: T( () Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Iddition/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
En_ 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 ", "1 -2 ", "1 -3 ",
d N P IOOHP or more. occupancy.
Job no.: Job site address:
J' J 3 lJ 'ry I c ❑ Six or more residential units. ❑ Recreational vehicle parks.
Ci /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
ty 9 le-1) O 9 Z 3 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Pro�ct name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
N g c.,.1 G 4 S L t lti E. I I■ S / D 4 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: e�j ' dif:/f 401 amps to 600 amps 160.60 2
°ye 601 amps to 1,000 amps 240.60 2
Address: 67; 7 -, s t.i fAt S 1 pl.- Over 1,000 amps or volts 454.65 2
City/State /ZIP: —{� A x p D � q 7 P Temporary services or feeders installation, alteration, and/or
t relocation
Phone: ( ) 7p I — .5s Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being r ade on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, leas- - o r exchange, ac . rding to • RS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: _ ��. „ _ ��. Date: ']/7 o q A. Fee for branch circuits with
❑ APPLIC • 'T I ❑ 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: ( ) 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: Signal circuit(s) or limited -
Le__) e_J N fi � energy panel, alteratiork or
Address: extension. Describe:' Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: (,-I • 00
Th permit application expires if a permit is not obtained within 180
Print name: Date: 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(1 t /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:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
,] Other:7 \\_'_Q COM Pic( 1Y1C71
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
•
*No licenses are required. Licenses are required
for all other installations
I: \Building\Permits\ELC- PermitApp.doc 03/23/06