Permit II CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELR2008 -00026
Date Issued: 01/29/2008
T IC;,fhRLI 13125 SW Hall Blvd., Tigard OR 97223 503.718.2 Parcel: 2S102DA00200
q I 1 Jurisdiction: TIG
Site address: 8720 SW BURNHAM ST
Project: NICHE Subdivision: Lot: 0
Project Description: CCTV low voltage 3/9/11, reprint to correct address from 13125 SW Hall.
Contractor: EYESTHERE, INC Owner: TIGARD, CITY OF
10725 SW BARBUR BLVD. 13125 SW HALL
PORTLAND, OR 97219 TIGARD, OR 97223
PHONE: 503 - 726 -3937 PHONE:
FAX: 866 - 255 -0193
FEES
Description Date Amount
Specifics: [ELPRMT] ELR Permit 01/29/2008 $75.00
[TAX] 12% State Surcharge 01/29/2008 $9.00
Type of Use: COM
Class of Work:
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
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 ccordancev0 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. A ENTION: OregorNjaw re•uires you to follow the rules adopted by the Oregon Utility Not cat'•• Center. Those rules are set forth in OAR
952 -001 0010 through OAR 952 - -•090. ou may obtain a copy of the rules or direct questions to OUNC by -. • • I 32.1987 or 1.800.332.2344.
t �
Issu By: / - !t " Permittee Signature: Fli
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.
r
- � CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00026
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/29/2008
PARCEL: 2S102DA - 00401
SITE ADDRESS: 13125 SW HALL BLVD ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: NICHE
Project Description: CCTV low voltage
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA /TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: • HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: CCTV. X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD, CITY OF EYESTHERE, INC
13125 SW HALL 10725 SW BARBUR BLVD.
TIGARD, OR 97223 PORTLAND, OR 97219
Phone: Contact #: PRI 503- 726 -3937
FAX 866- 255 -0193
Reg #: ELE CLE83
FEES LIC 173533
Description Date Amount
[ELPRMT] ELR Permit 1/29/2008 $75.00
[TAX] 12% State Surch 1/29/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued B y : r L.1 4s( Permittee Signature -
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit AppAg J ,I N" I,OR OFH( F 1 S1: OvI.1
- City of Tigard Received
�S 2008 Date/By: / P / 88 Permit No.: R �d 4
1114 q ijCAR
13125 SW Hall Blvd., Tigard, OR 9/24 2 i3 Plan Revie � -C•
Phone: 503.639.4171 Fax: 503.59$ X1960 Date/By: Other Permit:
TI G A R D Inspection Line: 503.639 41t r to . 1 i'J C Date Ready/By: 1uris:, Supplemental See Page 2 for
i
Internet: www.tigard -or.0 �� f'� � ^ � ] Notified/Method: Supplemental Information
jpO1 1 J vt°d PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction [ Addition/alteration/replacement
❑ 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 g 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 ", "l -2 ", "l -3 ",
Job no.: Job site address: s 7 ' .._ " .- 100HP or more. occupancy.
' - ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: - T - ', ��L�� U i' 9 } ❑ Health-care o c a t facilities. ❑ Supply volts nominal.
o voltage for more than
I J ❑ Hazardous locations. 600 v
Suite/bldg. /apt. no.: Project name: (- , T \j r i, ❑ Service or feeder 600 amps or more.
tV tL� 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 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Sj-/S *, C_�7C ' ,.. ` ,�,, c -h[ residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
NtC - 200 amps or less 80.30 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name:
a x �; t � 401 amps to 600 amps 160.60 2
"'l C 601 amps to 1,000 amps 240.60 2
Address: I '; t -ZS S\-.-. l{ i, - ;t.-Q0 Over 1,000 amps or volts 454.65 2
City/State /ZIP: \ d- , p fL 9 ZT 2 Temporary services or feeders installation, alteration, and/or
v relocation
Phone: (3 S) (c,-SCI _ %.__L( - ( Fax: ('63) 5 v _) ct 6 u 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 599 amps 133.75 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,
each branch circuit 6.65 2
Business name: C-YCS - tom 2v e t Tw L- B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
. L. . � ( A ..t first branch circuit
Address: I v - A- "LS . 0 ck..lou•..., 13k--00 5 . S Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: ?d V k -- .7c.23 at d r U (L_ 9 1- Z 1 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (5 - 4_2_ 6 _ 3 13 .4 Fax: : ( ( 2._S - U / ni 3 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 -
w4 energy panel, alteration 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.: 1 A's S-3 3 Electrical Lic.: 2 c3 Suprv. Lic.: 9 q 4 Lz,A Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: L. .. 1 ) C_A Subtotal: /5 DO
Plan review (25% of permit fee):
Print name: >�00.4 Date: t( 2..q I pc--', n
State surcharge (12% of permit fee): l atQ
Authorized signature: TOTAL PERMIT FEE: g / on
This 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(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*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
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
I:\ Building \Pertnits\ELC- PermitApp.doa 03/23/06