Permit ti.
S ir
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 00177
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/07/2009
TiGAII� Parcel: 2S101 D600100
Jurisdiction: Tigard
Site address: 7320 SW HUNZIKER RD 203
Subdivision: Lot: 0
Project:
Project Description: Install restricted energy for voice /data.
FEES
Owner:
HILLTOP BUSINESS CENTER LLC & Description Date Amount
HUNZIKER LLC, 9430 NW KAISER RD Restricted Energy Permit 07/07/2009 $75.00
PORTLAND, OR 97231 12% State Surcharge - Electrical 07/07/2009 $9.00
PHONE:
Contractor:
AF TECHNOLOGIES
1418 HEMLOCK ST. NW
SALEM, OR 97304
PHONE: 503 - 932 -6657
FAX: 503 - 362 -2382
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: y Fire Alarm: N
HVAC: N 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 rul- -re set forth in OAR
952 - 001 -0010 through AR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.245 6 9 or 1.800.
Issued By: 61.P UrUi Permittee Signature: �1
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.
E4tctrical Permit Application RECEIVE E !I FOR OFFICE USE ONLY . ' .
City of Tigard Received Permit No.:
UL 0 7 2009 Date/By: VA F I ezooq- 00 ! 7 7
11 .
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
. Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I GA R D Inspection Line: 503.639 CITY OF TIGAR) Date ReadyBy' tu ns ® See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISI �lotified /Method. 'r L ' 1 Supplemental Information
... _ _ ... _. ' TYPE, $:.:WORK , .. - . . .,, .. ��'
- ' . : ,ePLAN} REVIEW , " -
.
❑ New construction J�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.
,''; .' ,. ,, . ;a _
,.. ., . °., a _' , ,- ; r =: � •_ : _ .- . CATEGOBY�bE;mLCONSTRUCTION. , - r� � .
� _ ,,,-7-,,, za 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
« " JO ON Emergency system.
larger separately derived system.
1 ed
m 4' , ,e " B'' SITE' ND'LOCA ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.: Job site address: ,f� 1 oot>P or more. occupancy.
7 �� 2 , d A ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: — 7 — t ! L ❑ Health -care facilities. ❑ Supply voltage for more than
rr ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 2,0 Project name: J C .� ❑ Service or feeder 600 amps or more.
t.���C►L EE/�Yl �/U N n ; - ..' :', _ :FEE.:CHEDULE't )' -, , S w' ' i ":F .,
� y.�x >< sue ...,. °:'e' °.
Cross street/directions to job site: 7f2 A„-,/ 9 fu 2: %r ` 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
� Li y 75.00 2
" ., , u. . - : : , - DESCRIPTION 13Fr WORK ,,, : ' , s " ' - (with above sq. ft.)
ti Ple- � ,b A[/ Limited energy, multi family residential 75.00 2
Services o r (with above installation, ti
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
" ' : 1 ; ' , O.,PROPERTY';OWNER,_ , :',, r , ' ' , ; , ` ; . ■ . T E N A N T S °: " '` r - I, 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
::'.,,, -
°❑ �,APP,I ICANT` "�� ❑ '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] 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: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
' _ _ , ; C ONTRACTI* ° t '' Sign or outline lighting 53.40 2
Business name: '� Signal circuit(s) or limite 7`/�
r� 3 - — / — energy panel, alteration, or / ''pp
Address: 4 /1-/C/f5 ° . ( � c � t� % Ai extension. Describe: 1 Page 2 2
City/State /ZIP: ��ll� g,,,.) C7 7 _ Each additional inspection over allowable in any of the above
/ Per inspection 62.50
(
Phone: s 3b 2 _ � j 1 � ° Fax: e7;3) 36 'Z � investigation per hour (1 hr min) 62.50
CCB Lie.: / 6704 Electrical Lic. C / Su rv. Lic.age� � Industrial plant per hour 73.75
ELECTRICAL =PERMIT FE -
Suprv. Electrician signature, required: �� / Subtotal: 76 /� :.
Print name: L Date: 7 r Plan review (25% of permit fee) / =-�f -� / State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: —I ,
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.
1 \Bw ]ding \Permits\ELC - PermitApp.doc 05/23/06 440- 46I5T( I 1 /05 /COM /WEB
Electrical Permit Application - City of Tigard 3
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
.RESIDENTIAL — – °y
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems* •
❑ Other:
l''C.O IMERCIAtiWORK,'QIN i ' 4
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
r 4_ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems: I_
*No licenses are required. Licenses are required
for all other installations'
I:\ Building \Permits \ELC- PermitApp.doc 03/23/06