Permit il Y CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
l COMMUNITY DEVELOPMENT Permit #: ELR2009 00143
Date Issued: 05/29/2009
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 639.4171 Parcel: 2S101 BBO1400
Jurisdiction: TIGARD
Site address: X I2150 SW GARDEN PL, BLDG# 3_
Subdivision: PARK 217 Lot: 0
Project: Harris Worksystems
Project Description: TI - Low voltage for data
FEES
Owner:
WALTON CWOR PARK BC 8 LLC Description Date Amount
BY TTA/EPROPERTYTAX DEPT 325, PO BOX Restricted Energy Permit 05/29/2009 $75 00
4900 12% State Surcharge - Restricted Energy 05/29/2009 $9.00
PHONE:
Contractor:
REESE & SON ELECTRICAL INC
16310 SE RHONE
PORTLAND, OR 97236
PHONE: 503 - 969 -2191
FAX. 503- 760 -8903
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' Y Fire Alarm N
HVAC N Instrumentation_ N Total $84 00
Intercom /Paging N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting N Medical. N
Nurse Calls: N Protective Signal. N
Security Alarm' N Other: N
Other Desc.
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 ATT NTION. O ?egos` law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -001 010 through OAR 952` 0 00 Yo maay obtain a copy of the rules or direct questions to OUNC by calling 503 246 99 or 1 800 332 23 f ��� /�
Issued By: /........_ it ,2rX ��� Permittee Signature: �.'j / 1.� —
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 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.
ti
Electrical Permit Application FOR O.FFIcE USE ONLY
City of Tigard Date/By � € 9&I (k —h Permit No' E ar 1c3
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
ih
Phone' 503.639 4171 Fax. 503.598.1960 Date/By Other Permit
T:CGARD Inspection Line. 503 639 4175 Date Ready/By Juris H See Page 2 for
Internet. www tigard -or gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ' jkddition/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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 42/3o S k i /�G�iC� 10011P or more occupancy
i r '"` ! (° ❑ Six or more residential units ❑ Recreational vehicle parks
(((///
City/State /ZIP: ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: 4 f t r , , s . / �-1,( S f ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
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'l 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
A IVCO residential (with above sq ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts 454 65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 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 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6 65 2
Business name: B Fee for branch circuits
Contact name: without service or feeder fee, 46 85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90 90 2
Phone: ( ) Fax: : ( ) Reconnect only 66 85 2
E -mail: Pump or irrigation circle 53 40 2
CONTRACTOR Sign or outline lighting 53 40 2
Signal circuit(s) or limited -
Business name: A eye ,,,Ls �� - t c � G energy panel, alteration, or 0�
Address: /6 3 0 0 5 A h„, extension. Describe: Page 2 S 2
City/State /ZIP: �� r� 7. ? Each additional inspection over allowable in any of the above
/- n// / ' Per inspection 62 50
Phone: (c-63 ) 7 (� 9 _,2/ �+ / Fax: ( 0J ) 7 1(1 �9D Investigation per (1 )
D Investi anon er hou 1 hr mm 62 50
CCB Lic.: gl Electrical Lic.W S� Suprv. Lic. /� i�_ Industrial plant per hou 73 75
Suprv. Electrician signature, required: ELECTRICAL P FEES
Su
p g 9 / t �� �e Subtotal O�
Print na e: ae w /�� , Date: 2 ) Q Q Plan review (25% of permit fee) �J y
,.�tJ / State surcharge (12% of permit fee) 6) - v
Authorized signature: TOTAL PERMIT FEE ,g q. oo
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
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Bu ldmg\Permrts\ELC- PermitApp doe 03/23/06