Permit 14 q CITY OF T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00102
'.`�. DATE ISSUED: 4/28/2008
TWA' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 DB -00100
SITE ADDRESS: 07320 SW HUNZIKER RD 106 ZONING: C -P
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: WOODEN SHOE DELI
Project Description: Installing (1) data low voltage system. .
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
ROBINSON DEVELOPMENT AF TECHNOLOGIES
21360 NE AMBERWOOD DR. 1418 HEMLOCK ST. NW
HILLSBORO, OR 97124 SALEM, OR 97304
Phone: 503- 645 -8531 Contact #: PRI 503- 362 -2364
FAX 503- 362 -2382
FEES Reg #: ELE CLE10
LIC 167061
Description Date Amount
[ELPRMT] ELR Permit 4/28/2008 $75.00
[TAX] 12 State Surch 4/28/2008 $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`x / ----g
Issued By.�� "
- . Permittee Signature: i `/ _ `
_ '�
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 Application Received
FOR OFFIC USE ONLY
City of Tigard s\lell � R eceiv y J � d/i ♦ fj /I . ermit No.: , .- -C)� /--
' 13125 SW Hall Blvd., Tigard, OR 9, e `� Plan Review
'. Phone: 503.639.4171 Fax: 503.59:t''p t O% Date/B : Other Permit: P 't — od
T t GA R D Inspection Line: 503.639.4175 Z� Date Ready /By: Juris: ® See Page '2 for
Internet: www.tigard- or.gov le I Notified/Method: Supplemental Information
TYPE - ,OF WORK i � - a a n t ' C - PLAN; REVIEW
❑ New construction Addition /alteratlo � mBntD Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other; �j t ` J ❑ Service or feeder 400 amps or more ❑ Building over three stories.
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 1 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 0 Emergency system. larger separately derived system.
/ / El Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address:V3� ?Liz �p /� ❑ Six or tires. residential units. ❑ Recreational ` /C Six o or r more onal vehicle parks.
City /State /ZIP: / ❑ Health -care facilities. ❑ Supply voltage for more than
,_,,--t
❑ Hazardous locations. 600 volts nominal.
e
Suite /bldg. /apt. no.: 4: Project name: ' L ( { ❑ Service or feeder 600 amps or more.
FEE SCHEDUI:E • '
Cross street/directions to job site: �c7 A f c a N z, 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 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK. . (with above sq ft.)
,) Limited energy, multi - family
v ® G, �' +b .I ( t■) • (/ / residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' ❑ PROPERTY' OWNER 0' 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:
` i4 /1/,7Z - , e7 f .5 energy panel, alteration, or
Address: / Y/6 /29/De-/Z �� extension. Describe: Page 2 2
City /State /ZIP: ��/i1� Each additional inspection over allowable in any of the above
2 � Per inspection 62.50
Phone: ( 3 q3, 2 -6. Fax: 3 .O. Z Investigation per hour (1 hr min) 62.50
CCB Lic.: /e70 1 Electrical Lic.: C i i a- Suprv. Lie.: Industrial plant per hour 73.75 •
Suprv. �� ELECTRICAL PERMIT FEES • rv. Electrician signature, required: —
P g q lj Subtotal ����
Print name: (1....# N/ �' �® //i.) Date: I/ Ze� Plan review (25% of permit fee):
V/„ tYi� �� • State surcharge (12% of permit fee): 9( F�
Authorized signature: TOTAL PERMIT FEE: �{f
This permit application expires if a permit is not obtainc+d within 180
Print name: / '�� / . Date: Z days after it has been accepted as complete.
t� ®� � �I/ !S * Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp doe 05/23/06 440- 4615T(1,1/05/COM/WEB
Electrical Permit Application - City of Tigard .
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RE { gIDENTIAL WORK ONLY: -- ___ -__ _7 `,
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:, r
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
TA \ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
n Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
El 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
•
CITY OF TIGARD
BUILDING DIVISION
A PERMIT #: EL.R2M3-e0102
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4i003
Phone: (503) 639-4171 4:101A0
Inspection Requests (24 Hrs.): (503) 639-4175
0...,,,... .,=...
INSPECTION WORKSHEET FOR DATE: 4130/2008 TIME: 7:06AM PAGE: 35
SITE ADDRESS: 0i20 Sw HUNL'ip.:ER RD 10i3 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WOODEN 5 :;i - I0E OF-1-1
DESCRIPTION: Int.. data low vae 1 - 1':lein-
OWNER: ROBINSON DF PHONE #: 6n6-4
CONTRACTOR: AF 'rECHNOLOGIE.::.i PHONE #: :=:111:32.-2364
Inspection Request Scheduled For: Date: elar:OCE Pour Time:
Code # Inspection Descri tion Confirm # Contact # Nssage
1:.0 FIN:irk:4 fin4 069044 01 'q?. 20%655
Corrections /Comments / Instructions:
'O....4.- o I
siscx„—,k_
. •
PASS PARTIAL APPROVAL [ CANCEL fl NO ACCESS
0 FAIL fl CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G 0661...6 Date: 1 .43let. Phone #: (503) 718_141-N