Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
F ° '!
• COMMUNITY DEVELOPMENT Permit #: ELR2011 -00225
13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 10/20/2011
TIGARD g Parcel: 1 S 136 DA00101
Jurisdiction: Tigard
Site address: 11410 SW 68TH PKWY
Project: OREGON Subdivision: PFAFFLE PLAZA CONDO Lot: GCE
Project Description: Fire alarm
Contractor: FIRETECH LLC Owner: OREGON, STATE OF PUBLIC
552 53RD PLAC EMPLOYEES' RETIREMENT FUND
SPRINGFIELD, OR 97478 11410 SW 68TH PKWY
TIGARD, OR 97223
PHONE: 541 - 689 -4629 PHONE.
FAX: 541 - 461 -0734
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/20/2011 $75 00
12% State Surcharge - Electrical 10/20/2011 $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 Y
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 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 -0090. You ma • • - • • • e rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344 c
Issued By: Permittee Signature: _ /_.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' 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.
10/19/2011 17:26 TEL 541 461 0734 U001/003
; Electrical Permit Applicatio roil Al : usi.: ON1.1
,
C1 of Tigard Date : Received F �
II > Permit No ,�, i 1 . 7
13125 25 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.196 \ D ate/By:
1' I Gil I: tl, Inspec Line: 503.639.4175 q Date Read Other Permit:
Y' ) tie: &I See Page 2 for
Internet: www.tigard- or.gov S ' \ \ % ']�(9 Supplemental NohfiedlMetho Iemen
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I - ti „i ti $ Y"ig� 7 �§ Er '. "aTli . �: t i . m r i, .tom °tea. z -,.#. tM I9t. _
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` Please check all that apply (submit 2 sets of plans w /items checked below).
❑ New construction A
VA d dition/alteration /replac a Q
��� ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: C\ _ ' G where the available fault current ❑ Marinas and boatyards.
t , l 21r e � € } 4 e xceeds 10,000 mps at ols or ❑ Fla
oting bng
le ce to ground, or a e xceeds 150 14,000 t ❑ Commercial - a gricultural
❑ 1- and 2 - family dwelling f// Commercial /industrial ❑ Accessory building amps for all other installations, buildings
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
3 " �a , =�° , a f.,;. -a � e,; sa t ❑ Emergency system. larger separa tely derived system.
.*,.. .. ),?, �c 16. ', . � s a ...t i y tlize :: :1,:::. .. :'�., .,.,. °� :";.#�,*: ❑ Addition of new motor load of ❑ A „ .. « 2 „ ..1 3
Job no.: Job site address' J 1 y 4 0 SO 10 Poi✓kuJa Six o or more ocpany. c
`'� ❑Six or mare residential units. ❑Recr vehicle parks.
City/State /ZIP: "rtetq,,rol a p o4ri2 23 } ❑ Health -care facilities. ❑ Supply voltage for more than
1 1 ❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: 'Yyt iz t I Project name: .QVS 3uA 1 ❑ Service or feeder 600 amps or more
"�.7° p 1 0 ' 5,010 A 3�FLYrq'Y :R� Fh.NTpx�
: dd3L "La3�Y. °ro � ,£'�i- . A .. 3a :�a� �i�.��' - �N'- "'�s:i
Cross street/directions to job site: lhacri Qty. Fee. Total •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq ft or less 168.54 4
Ea add'l 500 sq ft or portion 33 92 I
Tax map /parcel no Limited energy, residential
"'p >.t< ,xa- r m,.rxrr i .?" -� x " ';. (with above sq - 75 00 2
,.. si, >, i• k l+ ail( t 'vie r.Aiii - sWii�6 i�` ?t�i �..i; »licmv'isia?l . iWil€i':? >. - ( 4 ft )
Limited energy, multi -family 75.00 2
Lo of c, 9 - e +) residential (with above sq. ft.)
L �/�y Services or feeders installation, alteration, and/or relocation
200 amps or less 100 70 2
iY 1 d* i ``` a: i zt " "„ . "`�' '�:N `'"'' r , 201 amps to 400 amps 133 56 2
z . - ui.,xa s J.. Y a � f 3 ul�' °1� :s ue _ 401 amps to 600 amps 200.34 2
g;
� �- n1
Name: '- e.../if ( �d1-rv'� ja l (_ 4A ' e� f Z l 601 amps to 1,000 amps 301.04 2
5
Address: 1 1 . 4 0 c^ ( V Y 4 Over 1,000 amps or volts 552.26 2
City /State /ZIP: _1 Temporary services or feeders installation, alteration, and/or
! Ie o (Z_ q "7Z2 '3 J relocation
Phone: ( ) t I Fax: ( ) 200 amps or less 59.36 1
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: ., A. Fee for branch circuits with
"mss ' "' ' ' ' 5 "' ! e "' t .'il + n " ' a service or f ee d er f ee,
e " a? .;- sew1'r s' Ik eZPu,,ti . 742 2
a � s� 4.� each branch circuit
Business name: y �� I , L � � B Fee for branch circuits without
e<+ service or feeder fee, first 56,18 2
Contact name: ( AvicA r Nct branch circuit
� , Each add'I branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: dwelling, service and/or feeder 67.84 2
f
Phone: ($f( l059 —,l�O� Fax:: ( i() �� / ` 0?-7.3'1 Reconnect only 67.84 2
Pump or Irrigation circle 67.84 2
E
n t� 1... YI' Sign or outline lighting 67.84 2
all1 di i ' ,rla. " ` .3 "`•^ t �' °'" NI T A �i -:./ V . `
:��,��e,.t�s:a:ssr��.d ��.`�. � r „.:.ss;� ., " rl' .., a.o�. Signal ctrcuit(s) or limited �,.��7
Business name: F„r�.y��( ) t�/ panel, alteration, or extension, Page 2c7 2
i Each additional inspection over allowable in any of the above
Address: 1 6 �� nL d [ o Additional inspection (1 hr min) 66 25/ hr
City /State/ZIP: .e� x n _ j ,,,,( (D& g t f� g Industr p a ( min) 78 28/ hr
� �1x�" Industrial p lant (] 1 hr min) 78.18/ hr
Phone: (54 () L 20 1 Fax: (S',( ) cifF I - O"/3 Inspections for i s hr fee 90 00/ hr
CCB Lic.: l gip Cf Electrical Lic.: E ZLY) Suprv. Lic.: '` � Ex t i 7' =. as' I a Wit'
t `` i � .�i3i n�*mm*�t� un�, � .+..a< ::. 1- . wxrnnA,l�l f �1nc� -. �*vsa:�€� s .....�_ -...; =
Suprv. Electrician s1 tl e require 7f t ! �, Subtotal: fig; � "" Plan review (25% of permit fee):
Print name: .... yp p , ,�C1 Date: l oo(C[ / 2 o /� State surc h a rge (12% of permit fee). chop
r 1 TOTAL PERMIT FEE: r I,
Authorized signature: / '
Print name: 6 �, Da te: � dJ[ This permit application expires if a permit is not obtained within
/ days after it has been accepted as complete.
/
Cf /,O[� * Number ofinspecd
Pi Buiidiag \PermitaAELC- PermitAppEoc 07 /01/10 440-461 5 T(11 /OS/COM/WEB MTh
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10/19/2011 17:27 TEL 541 461 0734 ZI002 /003
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
ale, <,,.hxY'xax. ..�fi�r� � ,x;ucs;.i*�"aa.�..'�.es.:,:�.x .,:. •�si�K.�"d� _. .. .�����w�1a�t
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:
�"' •i n �°' _.* + �.� �`. �.x � � :..,..:, ` d �� '�wa.;:�?w�.;� ie�^7�.'4�, �. �`r; ���,
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: _L
*No licenses are required. Licenses are required
for all other installations
I:IBuilding\Permits \ELC•PermitApp doc 07/01/10