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Permit s -" F 14 y CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT g .,- COMMUNITY DEVELOPMENT Permit #: ELR2009 -00261 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/07/2009 Parcel: 2S 102 DA00401 Jurisdiction: Tigard ' Site address: 13125 SW HALL BLVD PD Subdivision: Lot: 0 Project: City of Tigard Project Description: Install restricted energy for thermostat. FEES Owner: TIGARD, CITY OF Description Date Amount 13125 SW HALL BLVD Restricted Energy Permit 08/07/2009 $75.00 TIGARD, OR 97223 12% State Surcharge - Electrical 08/07/2009 $9.00 PHONE: Contractor: RINU 19570 SW 90TH CT TUALATIN, OR 97062 PHONE: 503 - 603 -0205 FAX: 503 - 603 -0150 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: Y Instrumentation: N Total $84.00 Intercom /Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Required Items and Reports (Conditions) 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. 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: '\ 0 / � i 11 (� 1 n �v X 1 x � \� 4' S, 1�,�� Permittee Signature: X 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. RECEIVED FOR OFFICE USE ONLY Electrical Permit Applicati `J Tigard JUN 2 6 2009 Received e. y • , — 46, D Cl of T l and Date /B : Permit No.. • ( i 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review lK nnn - 1 'i Phone: 503.639.4171 Fax: 503.59 r OF TIGARD Date /B : Other Permit: I t " 2004. ` . 9 TIGARD Inspection Line: 503.639.4175 BU ILDING DIVISION Date Read /B 0 See Paget for Internet: www.tigard- or.gov Notified Method: Supplemental Information :.., -..; _. ,;�a;�cx' - , , ; „s,, cam. -,�� r; r, r,. -: :- C�, .TYPE•OF WORK *`' " .�.,.. " `: . ❑ ,.. - , 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. :' r =;' °�•" "'' ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings. t.;;;`,:.>, . C am ; "4' CATEGORY:.`O --' '' ' :, RU "' '"'' Ny '''''...;. _ ' ''''''t'''''"''''' a ' x _ .: - > ., ._ - > ,.- <. - -.:. s . , ; _ ' less to ground, or exceeds 14 0 0 Commercial -use ultural gn gr 0 ❑ >" < a c ❑ 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 ? FU <; r.W ;g a> 9,, ❑ Emergency system. larger separately derived system. �• „�� '' TOB :SITE INFO AND.; LOGATI(?N .- <.�� ” ^2 .�� � ea:,,, <a:• �,., . . .•, ����:: •�:e��<� >,...::. < � s t: .� : ❑ Addition of new motor load of ❑.. .. .. Ad/ l a.(( I IOOHP or more. occupancy. Job no.: Job site address: 1312,5 f 50 D lye/ ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: T - ,d 6 1 q72.2_ 3 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. e. ✓ -:, (N .. " MSCH ,04.:C �-�..\,._ > . a< ' -`", , 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 �,�'::� ytYr h t. �Y;j ss,, v:'; 41111„, : tia:} .; ;_ ; DESGRIPTTUN:Zr WORK %; 1' . (with above sq. ft.) : ' �;.'thi'- te JA''' 3y: N„ „v"�F- .- -- '' ->s 5a,.�,x .°''''.,,,, °'J.�'-',u>.'',.� - `' ' <�� . �. - - ' /� 1 - - Limited energy, multi- family 75.00 2 LOW VO a tit- / bte-r hlo.eet. f residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 "�'-, P'ROPERT;Y Ow", , ` -v 4,1•11 .' TEN ^t , w ` : ;.,, r : °: amps to 400 am ` °, ., � _. « ,.,. � . ,.�� �� ,...< , �_ ��.� . > � _ ,. , Nr�a�arx' fr - - -1 ;% „ %a�..ys,t 201 amps 106.85 2 P P Name: C t � a n d / 401 amps to 600 amps 160.60 2 - , /� 601 amps to 1,000 amps 240.60 2 Address: 13125 -5w �/1 Blvd Over 1,000 amps or volts 454.65 2 City/State /ZIP: Ti cu OR 9722-3 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 k „� > = APPL' '- - - T' �`' CO => ' ' '''' T. PERS - .. „ , % circuit 6.65 2 Business name: Re. I *»i is r, Meth cut l,,,,.l B. Fee for branch circuits Contact name: ' LIT- without service or feeder fee, n a r s first branch circuit 46.85 2 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: (Sp. )6o3_ C .c>5 Fax: : (503 )‘03 D Reconnect only 66.85 2 / 0 3 - O /S E- mail: r®, my % a r eA , 'l y yyl P r h ([ r1. to,,1 P ump or i rr i gat i on c 53.40 2 :'C ` NTRA - :,-Nay : Si or outl l ht 53.40 2 ,:,�`�:,. O CTOR: . � . >:. _ gn g g Re/ . / / Signal circuit(s) or limited - Business name: l� E! ! IY1 P,/e0^ /'�1 eG�Gtlgt G d ! energy panel, alteration, or Address: ) t.S 7D 5u) 9U Ctsur. extension. Describe: Page 2 2 City /State /ZIP: Tao, /a+los Oie. a a Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (.503 ) 4,3 _ O zo 5 Fax: (5,j3 ) t - O /SG Investigation per hour (1 hr min) 62.50 CCB Lie.: J5377a Electrical Lic.:3e f_`.i4 or Suprv. Lie.: II Lc 5 Industrial plant per hour 73.75 °; ELECTIMAI- :PEON', FEES°”; ; i .,, Suprv. Electrician signature, required: (L Subtotal: Print name: ['�+ ✓l � �"— Date: Plan review (25% of permit fee): -' 'a se �'1 State surcharge (12% of permit fee): Authorized signature: p. TOTAL PERMIT FEE: /� This permit application expires if a permit is not obtained within 180 A Print name: PjA) ?,,,�,,, Date: ‘72C/AC/4 days after it has been accepted as complete. 1 - 1 * Number of inspections allowed per permit. I:\ Building \Pemdts \ELC- PermitApp.doc 05/23 /06 440- 4615T(I1/05 /COM/WEB