Permit ELECTRICAL
C ITY OF TIGARD
RESTRICTED ENERGY
ar,14 13125 , I 4 ' DEVELOPMENT H PMENa Tigard, (503) 639 -4171 DATE ISSUED: 4% R 2004
SITE ADDRESS: 11491 SW 90TH AVE PARCEL: 1 S135DB 12900
SUBDIVISION: HOFFMAN PART /MLP2003 -00015 ZONING: R -4.5
BLOCK: LOT: 002 JURISDICTION: TIG
Project Description: Low voltage: All encompassing.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
HOFFMAN, MICHAEL J PHILLIPS ELECTRONICS
1223 NW 24TH #5 (DBA FOR MASTER ALARM L.L.C.)
PORTLAND, OR 97210 1110 NW FLANDERS
PORTLAND, OR 97209
Phone: Phone: (ROBERT)
Reg #: L/C2- 508325364
ELE 26- 213CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 4/21 /2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 4/21/2004 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 -'11 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by ' 410 Permittee Signature wAr , i / _
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'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Y Electrical Permit Application
Date received: 4, pi/ , j Permit no. i.' is -Dbio
A ' x 14 1' City of Tigard �: Y b Project /appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date.issued: B
Phone: (503) 639 -4171 By: • Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type: - -
Land use approval: ' . - 1'1
TYPE OF PERMIT
•
p 1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction 0 Addition/alteration /replacement 0 Other: ❑ Partial
JOB SITE INFORMATION
Job address: 1 /491 c ( 901± i - Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: w t6v I Description and location of work on premises: Scj ,kpy A( %r t Jim wG.� ( 44
Estimated_ date of completion/inspection:
. .._ . _,CO, 1TR AJCIOR.AP...PLLCATLON,._..._., . -- - . FEE S,(✓(I 41IILE
Job no: • Fee Max
Business name:/4 Gf r�v
,,, Description Qty. (ea.) Total no. insp
- 4 r ,/
New residential - single or multi - family per
Address: 00 /V' (I, ni F- dwelling unit. Includes attacliel garage.
City cpy I State: 6,, I ZIP:' 7 .or Serviceincluded:
Phone: �2S I Fax:22.'P c9•7-z_ I E -mail: 1000 sq. ft. or less • 4
Each additional 500 sq. ft. or portion thereof
CCB no.: /.s of I Elec. bus. lic. no: _26 - 2(2 - C i✓ f
Limited energy, residential 2
City /metro lic. n•.: 3003
Limited energy, non - residential 2
ile
- / , Zip • AI/ 1(./124 Each manufactured home or modular dwelling
Si:tf to I- if supervising electrician (required) Date Service and/or feeder 2
elect. name (print): Services or feeders — installation, .
Sup. (p ) J e-cc S" cp-t-� L icense no: v 3`•� �{ alteration or relocation:
.. . . PROPERTY OWNER . . • . 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps • 2
Mailing address: 601 amps to 1000 amps . 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only t
Owner installation: The installation is being made on property I own Temporary services or feeders - -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
. ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: _ A. .Fee for branch circuits with purchase of
• Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase -
of service or feeder fee, first branch circuit: 2
Phone: Fax: E Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* '
7S 7 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan 0 Other: Per inspection
Submit sets of plans with any of the above. . Investigation fee '
— - The above are not applicable to temporary construction service. Other
Permit fee
$ 7S `""
_ Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
0 Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 6
oo
Expires accepted as complete. TOTAL $ /
. Name of cardholder as shown on credit card..
$
Cardholder signature Amount
440 -4615 (6/00 /COM)
•
Electrical Permit Fees: Limited Energy Fees: .
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 1
Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular n Garage Door Opener*
Dwelling Service or Feeder $90.90 2
Services or Feeders . Heating, Ventilation and Air Conditioning System*
Installation, alteration, or r
200 amps or less $80.30 2 El ,
201 amps to 400 amps $106.85 2 Vacuum Systems
401 amps to 600 amps $160.60 2 — •
601 amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $454.65 2
Reconnect only, . $66.85 _ 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation
200 amps or less $66.85 . 2 Fee for each system $75.00
201 amps to 400 amps $100.30 2 . (SEE OAR 918 - 260 - 260)
401 amps to 600 amps $133.75 2
• Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above.
Branch Circuits ❑ Audio and Stereo Systems
New, alteration or extension per panel
a) The fee for branch circuits in Boiler Controls
with purchase of service or
feeder fee. n Clock Systems •
• Each branch circuit $6.65 2 _
b) The fee for branch circuits n Data Telecommunication Installation
without purchase of service
or feeder fee. n Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 n
HVAC
Miscellaneous
(Service or feeder not included) n Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting • $53.40 - •
Signal circuit(s) or a limited energy ❑ Intercom and Paging Systems
panel, alteration or extension $75.00
Minor Labels (10) $125.00 I Landscape Irrigation Control
Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50
Per hour - ' • • • _ - $62.50 _ L I Nurse Calls
In Plant $73.75
n Outdoor Landscape Lighting* .
Fees;
n Protective Signaling
Enter total of above fees $
n Other
8% State Surcharge $
25% Plan Review Fee Number of Systems
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
•
Total Balance Due $ Fees:
0 Trust Account # Enter total of above fees $
8% State Surcharge $
• Total Balance Due $
•
•
is \dsts \forms \elc- fees.doc 10/09/00