Permit •
111111 "'�b q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° .. COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00406
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/5/2007
PARCEL: 2S 102 DA -00401
SITE ADDRESS: 13125 SW HALL BLVD TIDEMARK ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: TOWN HALL
Project Description: Add camera, upgrade existing equipment.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: 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: CAMERA X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD, CITY OF PROFESSIONAL VIDEO & TAPE
13125 SW HALL 10110 SW NIMBUS STE B11
TIGARD, OR 97223 TIGARD, OR 97223
Phone: Contact #: PRI 598 - 9142
FAX 503 -598 -9172
Reg #: ELE 34- 568CLE
FEES LIC 143031
Description Date Amount
[ELPRMT] ELR Permit 11/5/2007 $75.00
[TAX] 8% State Surcha 11/5/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questio s to OUNC at 503.246.6699 or 1.800.332.2344.
i
Issued By: `` , / Permittee Signature:
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.
'Electrical Permit Applicat FOR;O "'USE ONLY '
City of Tigard CEIVED Date/By: I I ti o 7 s Permit N �e ,,001 fg.
III
. ° 13125 SW Hall Blvd., Tigard, OR 97Z2A`, Plan Review/
Phone: 503.639.4171 Fax: 503.598. Q — ‘LOO7 Date /By: Other Permit:
T I G A K D Inspection Line: 503.639 /�l G [�Q Date Ready/By: Jsris: - J ® See Page 2 for
Internet: www.tigard- or.gov 4 � / � i � 1 � �r 0 f Notified/Method: 1 Supplemental Information
TYPE o Vlt'OJ A� ISIO PLAN REVIEW
❑ New construction 13, Addition /alteration /replacement Please check all that apply (submit 2 sets of plans se /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 ", "l -2 ", "1 -3 ",
�
^ 100HP or more. occupancy.
Job no.: Job site address: 3 I a 5 S (,(� / ! �L
O or more residential units. ❑ Recreational vehicle parks. •
City/State/ZIP: 7 \ q � 3 ❑ Health -care facilities.
❑ Hazardous locations.
CI voltage for more than
/ 600 volts nominal.
Suite /bldg. /apt. no.: Project name�� ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Tv Yv N\ _ 1 Description 1 Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: '
Limited energy, residential 75.00 2
. DESCRIPTION OF WORK (with above sq. ft.)
^ /� Limited energy, multi- family 75.00 2
/.tom r f 4 p”, e“ ✓'Q z ap e- Gti 1.Lr® yne+ N residential (with above sq. ft.)
C Services or feeders installation, alteration, and/or relocation
e-iorrt 4 i 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, Qer panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
• each branch circuit
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 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
1' 9 _/ T' 7— Signal panel, or limited -
Business name:
p/, O fm 4 / a �7 /_ ( ti G energy panel, alteration, or
' n AA// / 4 extensio Describe: Page 2 2
Address: b� y� S� /`�'k1 `o�GS '"f`e // 044./AuciA r,P,m.t �
City/State /ZIP: J 1,5 csf 972-2-3 Each additional inspection over allowable in any of the above
e f� Per inspection 62.50
Phone: (5 3) 5 N / 2- Fa x: (5- ) 5-5 — c," 7 2
7 / f / Investigation per hour (1 hr min) 62.50
41
CCB Lie.: lectrical Lic.: e Su rv. Lie.: Industrial plant per hour 73.75
ly3 0 3 / \1 3y r6�c � p /?-�1� e,�
Al' !c'L ELECTRICAL PERMIT FEES
Suprv. Electrician sigrnAre, required: L l Subtotal:
Plan review (25% of permit fee):
Print name: ��a 4e ��� Date: / /5` /0 7 State surcharge (8% of permit fee):
//�
Authorized signature: TOTAL PERMIT FEE: /
This permit application expires if a permit is not obtain thin 180
Print name: 0„,... / /gee h s4 " Date: ) �s _ /Q `] 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( I 1 /05 /COMM'EB
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*
❑ Vacuum Systems*
•
❑ Other:
COMMERCIAL WORK ONLY
Fee for each commercial $75.00
system
(SEE OAR 918 - 260 - 260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
•
•
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I .\Building\Permits\ELC- PermiApp doc 03/23/06