Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
"�! 2 ,, COMMUNITY DEVELOPMENT Permit #: ELR2009 -00110
TIG ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/15/2009
Parcel: 2S102DA00401
Jurisdiction: Tigard
Site address: 13125 SW HALL BLVD PERMITS
Subdivision: Lot: 0
Project: Permits
Project Description: Install restricted energy for fire alarms.
Owner: FEES
TIGARD, CITY OF Description Date Amount
13125 SW HALL BLVD Restricted Energy Permit 04/15/2009 $75.00
TIGARD, OR 97223 12% State Surcharge - Restricted Energy 04/15/2009 $9.00
PHONE:
Contractor:
METRO SAFETY & FIRE INC
PO BOX 33650
PORTLAND, OR 97068
PHONE: 503 - 231 -2999
FAX: 503 - 256 -4691
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Fire Alarm: Y
HVAC: Instrumentation: Total $84.00
Intercom /Paging: Landscape /Irrigation: Required Items and Reports (Conditions)
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other:
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 i suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notific on /. enter. Those rul a - set forth in OAR
952- 001 -0010 through R 952- 00 -01 X 000. Q You may ob in ( a� c�o of the rules or direct questions to OUNC by calling 50 246,6.9" or 1.800.332 3.4.
/
Issued By: �\ \'A,� v v )7�X � Y/ `�L1 Permittee Signature: I
7 / 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.
Thls 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 ApplicationRECEl V ED • FOR OFFICE USE ONLY
Cl of Ti and Received I
Ty g APR 15 7009 Date/By: , I f-.2)' q Permit No.:�' 2 �' - , � r I 0
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review !
: Phone: 503.639.4171 Fax: 503.598. Date/By: Other Permit:
T 1 GA R D Inspection Line: 503.639.4175 I ¢ I a Y OF TIGARD Date Ready /By: Juris: ® See Page 2 for
• Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: < 1(2 Supplemental Information
TYPE OF WORK 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 ❑ 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 )41 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 - ", `'I - ",
IOOHP or more. occupancy.
Job no.: Job site address:
13 ' ZJ (() l ` (/ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: D Q Z 23 ❑ Health -care facilities.
El Hazardous locations.
El voltage for more than
Tl y /�"121� I n 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ® FPi -1/ Q ❑ 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'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK . (with above sq. ft.)
�� /� Limited energy, multi - family
�
ke, Li X4 S c4- • _1 ,,, s4+1( residential (with above sq. ft ) 75.00 2
/� I " �� Services or feeders installation, alteration, and/or relocation
Y " 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
IA APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: l er 4.1 Q -. 4._ F t l rr • B. Fee for branch circuits
�' without service or feeder fee,
m /}
Contact name: Qt_ CA-5 jn / first branch circuit 46.85 2
Address: 1 C �+� �C ��� Each add'l branch circuit 6.65 2
` 7 C Miscellaneous (service or feeder not included)
City/State /ZIP: ft.. (2L+ ,., b n 9 7 a33 Each manufactured or modular 90.90 2
/ dwelling, service and /or feeder
Phone:
( ) c 1 - Zci 5 S Fax: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
energy panel, alteration, or
Address: extension. Describe: I Page 2 2
City/State /Z1P: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.: � /�.5I Electrical Lic.: 3 3IL -12 h Suprv. Lie.: Industrial plant per hour 73.75
// / / I ELECTRICAL PERMIT FEES -
Suprv. Electrician signature, required: /J / - " Subtotal:
Print name: cy)44 �,� ` D, • • Plan review (25% of permit fee):
�/ State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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(1 I /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:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY: + •
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
n 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- PermitApp doc 03/23/06