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Permit • pri CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00025 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/29/2008 PARCEL: 2 S 102 DA -00401 SITE ADDRESS: 13125 SW HALL BLVD PD ZONING: CBD SUBDIVISION: LOT: JURISDICTION: TIG PROJECT: POLICE DEPT. Project Description: CCTV system 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: CCTV. TOTAL # OF SYSTEMS: 1 Owner: Contractor: TIGARD, CITY OF EYESTHERE, INC 13125 SW HALL 10725 SW BARBUR BLVD. TIGARD, OR 97223 PORTLAND, OR 97219 Phone: Contact #: PRI 503- 726 -3937 FAX 866 - 255 -0193 Reg #: ELE CLE83 FEES LIC 173533 Description Date Amount [ELPRMT] ELR Permit 1/29/2008 $75.00 [TAX] 12% State Surch 1/29/2008 $9.00 REQUIRED ITEMS AND REPORTS Total $84.00 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued By: _ Permittee Signature: - ,. I—_, --- T OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. .� R cr L 1 \ f �i Electrical Permit App i can FOR OFFICE USE ONLY • Cl of Tigard ! `' A Received G p 7 q - 13125 SW Hall Blvd., Tigard, OR `J ( � t� �ooU Date/By: /� I /Pi t$ Permit �..�0 i �5 Y7 Plan Review 'L 4 � , � Pho ne: 503.639.4171 R 5 3. 8. 9 Da[eBy Other Permit: Inspection Line 503.639I1 i � I` 1 IC U Ins TIGARD p .. 5 DateReadyBy• Juns: EI See Page 2 for Internet: www.ti . L DIN(y DI �/ T JSra Notified/Method. Supplemental Information TYPE OF WORK j PLAN REVIEW ['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 El Demolition ❑ Other: where the available fault current ❑ Mannas 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 R 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 - "l - ", t IOOHP or more occupancy. Job no.: Job site address: 1 ,--::,i.,_, l[ ` ( � c ` D ❑ Recreational vehicle parks ❑ Six or more residential units. City /State /ZIP: v ,. ... /-� C` ❑ Health -care facilities. ❑ Supply voltage for more than x f L J Z� — � a 0 Hazardous locations 600 volts nominal. Suite /bldg. /apt. no.: 1 . Project name: � ...,..! 1 e N 17 _ t ) ❑ Service or feeder 600 amps or more FEE SCHEDULE Cross street/directions to job site: Description I 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'I 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 ice- ",- r'�� -ti C---C-1 - 5 4-k �„- - ,,.. (2 i (._l �' • residential (with above sq. ft.) �L ( ' Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 2 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 v Name: a 401 amps to 600 amps 160.60 2 L cr. 1 Zc(Cb. <- 601 amps to 1,000 amps 240.60 2 Address: 1 7 . t 2_.c `_-•"_, l t -Lk 't ; it x) 1 Over 1,000 amps or volts 454.65 2 • Ci /State/ZIP: C,, • Temporary services or feeders installation, alteration, and /or �� —1 . I u '� } relocation Phone: (` z'3) S`i _ ‘...L( --4-( Fax: (5,.. 3 `7 , '- I C( c- u 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: •j,= (�� (LS r' t �f- c_ B. Fee for branch circuits Contact name: without service or feeder fee, <_.). L.- (' -4 first branch circuit 46.85 2 Address: 1 O •� 5 "� o , . - G Each add'I branch circuit 6.65 2 Z -� t C< 3� , ,. t J Miscellaneous (service or feeder not included) City /State /ZIP: Pc v ` L—c? et Lag. 9 1- c` Each manufactured or modular _ dwelling, service and/or feeder 90.90 2 Phone: (5,, -) -- 4_2 ..k.„ _ 3 -1,-3 1 Fax: : 0"<:•2L) 2 - - 7 - u / rj 3 Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: 5 Signal circuit(s) or limited - 4 .' t e_ energy panel, alteration, or Address: extension. Describe:. Page 2 2 City/State /ZIP: Each additional inspection over allowable in any of the above Phone: '021-03. y� Per inspection 62.50 ( ) / a Fax: ( ✓ ' 1 • , • Investigation per hour (1 hr min) 62.50 CCB Lic.: t 7 3 `- Electrical Lic.: (.L ,- ` j Suprv. Lic.: ` Industrial plant per hour 73.75 L -� ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: ( L_ , V�;i ,4-. Subtotal: F ` Plan review (25% of permit fee): Print name: ,\ L._ _ VA) c—( Date: >+ 1 L -t I Q �. , State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: id/. Qo 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 P\ BuddingWermits \ELC- PermitApp,doc 05/23 /06 440- 45t5T(11 /05 /COM/WEB