Permit Ft
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
r r COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00040
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/25/2008
PARCEL: 1 S 125DA -09500
SITE ADDRESS: 06560 SW ALFRED ST ZONING: R - 4.5
SUBDIVISION: PP1991 - 092 LOT: 002 JURISDICTION: TIG
PROJECT: RAWLINS
Project Description: Installation of low voltage for audio /stereo wiring.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X 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:
TOTAL # OF SYSTEMS:
Owner: Contractor:
JOHN & HEATHER RAWLINS OWNER
6560 SW ALFRED ST
TIGARD, OR 97223
Phone: 503- 245 -3742 Contact #:
FEES Reg #:
Description Date Amount
[ELPRMT] ELR Permit 2/25/2008 $75.00
[TAX] 12% State Surch 2/25/2008 $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 Notifi9etion Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or dirdc uestions to . S C at 503.246.6699 or 1.800.332.2344.
Issued By V � �� I' Permittee Signatures OAP '
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.
Electeical Permit Application
ipli City of Tigard ®� 5 0ived /J p �i.
, , �� @7 Date/By: ON /1 � Qb Permit No.: ,:,;(;),0 • 13125 SW hall Blvd.. Tig QR )2.5 Plan Review
Phone: 503.639.4171 Fa 98.1.960 $ Date /Ay, Other Permit;
. I ., \ 1 ,. 1 t Inspection .Lint: 503.639 4175 8 A S Z Date Ready/By: J.•l.. to Bee Pala 1 for
B Notified/Method hod
Internet. wtvw.tigtud- nr.gnv � N i Supplemental Iafarmados
tsn'
1 , 7 % r O WORK - C 1V` , c: tl�1N PLAN. REVIEW..:, .. :. :
❑ New construction dditidn nciatigaraefilac��r�'rent Plcaa check all that apply (submit Z seta of plans whtcme checked below).
n , 1 V tt El Service or feeder 400 Da or more 0 Building over three stories.
❑ Demolition ❑ Othcr v where the available fault current 0 Marinas and boatyards
CATEGORY OF CONSTRUCTION . • . • • . • exceeds 10.000 amps l at 50 vcdts of 0 Ftdating buildings.
less to ground, or exceeds 14.000 0 Commercial - use agricultural
1 - and 2- family dwelling 0 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: 0 Firc pump. ❑ Installation of 75 KVA or
• JOB SITE INFORMATION AND LOCATION .. ❑ Bmnegeney System, large separately derived sy.acm
❑ Addition anew motor load of 0 "A ". "E ". "1.2 ". "1.3 ",
Job no.: 1 Job site address: or more. oocttpaney.
/ S Ll/' r , I0
�^� n4PP
�' `A 0 /) 1 _ ❑ Six or more residential units. I:.Recreational vehicle parks,
City /Statc/Z1P:
— j--'`( - 7 ❑ Hcalth•caro facilities, O Snarls' wltn(m for more than
r �� ❑ Hnvxdona locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Yom' A 1 t i iJ-- O Service or feeder 600 amps or more.
Cross streeVdirections to, job site: FEE SC I Qty. I / nascri�tioe Qty. Foe. I Torah I .. �Cr - 6 Z ') 9 //-- / New residential single - or multi - Dimity dwelling unit.
� Inclades attached garage.
Subdivision, 1 Lot s iL1�
no,: 1,000 sq R. or less 145.15 4
Ea. add'I 500 sq. It. or ponion 33.40 1
Tax map /parcel no.. -
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
II Limited energy, multi - family 75.00 2
j `^� residential (with Above coq. 6 )
Services or feeders Installation alteration, and /or relocation
200 amps or less 80.30 ' 2
. Al PROPERTY OWNER ' 1 .. ❑ TENANT' ' • . • . 201 amps to 400 amps 10615 2
401 amps to 600 amps 160.60 2
Name: ��it,-. .vV iD n+ � '
001 amps to 1,000 amps 240.60 2
Address:
• Over 1.000 amps or volts 454.65 2
City/Stoic /7.i.P: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 00 amps or less 66.85 ' 1
Owner installation: T •s installation is being made on property that 1 own which is not 2 ]amps to 400 amps 100.30 2
intended for sale, I Ce•�
cnt, ( o a r cx .,, c. ac •rdi'rig to OR.S' 447, 449, 670 ' and 701. . 4 1 amps to 599 amps 133.75 2
Owner signature: e
lJ - � Date: , I ( (j ,) ranch circuity —new nitersrflon. or extension, per panel
t A. Fee for branch circuits with
: ' ❑' APPL . ' ' ❑ CONTACT PERSON' above service or feeder fcc, 6 65 2 •
etch branch circuit
Business name; B. Pee for branch circuits
without service or feeder fcc,
Contact name: first branch circuit 46 85 2
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
h Each manufactured or modular
dwelling, service and /or feeder 90 2
Phone: ( ) Fax:: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR . .. Sign or outline lighting 53.44 2
Signal circuit(s) or limitcd
Business name: . '
f�� _;....:;,/, 1 _r.• w J energy panel, alteration, or
Address: 307 g - -} /// extension scrib ; Poge 2 �� 2
� /mac' am ALM(0 Tinto
City /State/Z1P: ` r ` Each ad Mono! inspection over allowable to any of the above ,
`'"""� 1 Per inspection 62.50
Phone: ( ) 02 7 / -- z / /2 Fax: tsr ) 27/ --7j/ L__ Investigation per hour (t hr min) - 62.50
CCB Lie.: j -L--2 0 p-y Electrical Lit.: Svprv, Lie.: Tndusmal plant per hour 73.75
/ ELECTRICAL PERMIT FEES
Suprv. Electrician si ature, required: Subtotal: 15,E
Print name: /� , etc; Plan review (25% of permit fee):
/ State surcharge (12% of p cmt it fee): , OU
Authorized signature: TOTAL PERMIT FEE.. 8 y . e O
Print name; Date: Pits penult application eapirea if a permit Is not obtalned within ISO
days after It has been accepted as complete.
' Number of inspections allowed per permit.
I:t auitdineermIh \ELC.I'crmirapp,tlor 0583706 440.4617T(II/05/COMAW5S .
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information, •
LIMITED ENERGY PERMIT FEES:
• • . • •
Fec for all residential systems combined $75.00
Check Type of Work Involved:
• Audio and Stereo Systems*
O Burglar Alarm
0 Garage Door Opener*
D Heating, Ventilation and Air Conditioning System*
ED Vacuum Systems*
▪ Other:
COMMERCIAL, WORKQNLy: H '2 • • •
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
0 Audio and Stereo Systems
O Boiler Controls
Clock Systems
Data Telecommunication Installation
O .•
Fire Alarm Installation
n HVAC
D Itistrumentarion.
Intercom and Paging Systems
O Landscape Irrigation Control*
• Medical.
n Nurse Calls
Outdoor Landscape Lighting*
El Protective Signaling
P Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
Bauliang\PefmlimEl.c-rennilApp.doc 03/21/00