Permit UPI CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' .. COMMUNITY DEVELOPMENT Perm #: ELR2011 00078
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2011
Parcel: 25101 BC00100
Jurisdiction: Tigard
Site address: 8185 SW HUNZIKER RD C
Project: Knez Subdivision: Lot: 0
Project Description: Conversion of Unimode panel (security system)
Contractor: ADT SECURITY SERVICES INC Owner: KNEZ, JOHN S SR & JEANNE M
2815 SW 153RD DR 12301 SW HWY 212
BEAVERTON, OR 97006 CLACKAMAS, OR 97015
PHONE: 503 - 469 -7212 PHONE: 503 - 620 -6142
FAX: 503 - 469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/30/2011 $75.00
12% State Surcharge - Electrical 03/30/2011 $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: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: Y 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 ccordance approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for re the 180
days. A ENTION: Oregon a e'uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set rth in OAR
952 -001 0010 through OAR 95 m 01 -014 o may obtain a copy of the rules or direct questions to OUNC by calling 503.21987 or 1.800.332.23444.
♦
Issu y: _ ft / Permittee Signature: / /�.l �. 6 , / i - vx
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.
P/e E ��K dopyof
Electrtca�rmit Application j • FOR OFFICE USE ONLY
nq
City of Tigard � -7-Z' Dateivea �` Permit No 1412DA'/ Ge 7g
- • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639 �� / _ //� Date Ready/By: Boris: ® See Page 2 for
Internet: www.tigard or.gov / Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
[1] 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.
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
❑ Emergency system. larger separately derived system.
JOB SiTE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E ", "1- 2 ", "I -3",
Job no.: 61 y Job site address: gyis" S6f #04, z /,(/e-/L S j I OOHP or more occupancy.
R p
❑ Six or more residential units, ❑ ecreational vehicle arks.
City /State/ZIP: •7 4 -, -1 0/2 q 7.2,07 3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations, 600 volts nominal.
Suite/bldg. /apt. no.: if �� 'C Project name: kNe - 3/c/6` ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job • Description I Qty. ] Fee. I 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'I 500 sq. ft or portion 33.92 I
Tax map /parcel no.: _
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
//�� Q Limited energy, multi- family 75.00 2
(�O/f/ ye/ZSA/ %o D d/ / /.modC'/ ' ,,0e--Z residential (with above sq. fl.)
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
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2°` a
Address: Over 1,000 amps or volts 552.26 2' ..
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation Iv t
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2 .
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT V( CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
. / service or feeder fee, first 56.18 2
Contact name: „r0/14) 7C ./C a branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY / dwelling, service and/or feeder
Phone: 450 3) , -2O - (p fl?‘ Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy r�
n panel, alteration, or extension. Page 2 /� 2
Business name: n b r SE6 ( ry Each additional inspection over allowable in any of the above
Address: ,,,,Zg /s s( ,s, Zo s b2 Additional inspection (I hr min) 66.25/hr
City/ State/ZIP: Q Investigation (I hr min) 66.25/ hr
�« `L n � � �� r �� Industrial plant (1 hr min) 78.18/ hr
Phone: (5D3) 9f o y- 7 lobs Fax: ( 3 ) -1/6 9- 7// Inspections for which no fee is 90.00 / hr
. specifically listed ('h hr min)
CCB Lic.: , 9 91/5! Electrical Lic.:2G • 0 9 CAE Suprv. Lic.: 31 9ZS/9 ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: /"A /A Plan review (25% of permit fee):
Print name: e v . le Date: z s p State surcharge (12% of permit fee): g. (1 0
t TOTAL PERMIT FEE: k3,4 00
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
h Building Termits ELC-Perm it App.doe 07 10 440- 4615T(I1,05 /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:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
L Audio and Stereo Systems
in Boiler Controls
L Clock Systems
n Data Telecommunication Installation
I I Fire Alarm Installation
I I HVAC
I I Instrumentation
I Intercom and Paging Systems
Li Landscape Irrigation Control*
n Medical
I I Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
•I Other /02/ %C/J` Z /VC- 2 y -SCG 0/Ii T/ / s E/V
Total number of commercial systems: /
*No licenses are required. Licenses are required
for all other installations
I:` Buildin Termits'ELC- PermitApp.doc 07 10