Permit 7 CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00303
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/24/2008
PARCEL: 25101 DB -00103
SITE ADDRESS: 07360 SW HUNZIKER RD 102 ZONING: C -P
SUBDIVISION: HILLTOP BUSINESS CENTER LOT: JURISDICTION: TIG
PROJECT: RGIS LLC
Project Description: Job No 8103 - voice & data
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 j
PO BOX 91305 / l N14/
PORTLAND, OR 97291 At. 411 £124 q - 73 O `t
Phone: Contact #:
FEES Reg #:
Description Date Amount
[ELPRMT] ELR Permit 10/24/200E $75.00
[TAX] 12% State Surch 10/24/200E $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 o. -in copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
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 INST.! TION ONLY
SIGNATURE OF SUPR. ELEC'N: i , / DATE: /2)
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.
Electric - al Permit Application _,FOR OFFICE USE ONLY
RECEDE I ..
n i`I' Received
.2,00? I
City of Tigard Permit No.'
� t g Date /Bv: l
f~ ," 1 3125 SW Hall Blvd , "heard, OR 97 OCT 2 4 2008 Plan Review a
Other Permit y pR� �� 6 � / 6 /
Phone' 503.639.4171 Fax. 503.598.1960 Date /By
,n-'^ GAR -' ' #' Inspection Line. 503 639.4175 Date Ready /By. tuns 0 See Page 2 for
v
TtI C' °r' -.3, Internet. ww'.tlgard- or.gov OFTIG r Notified/Method. Supplemental „
BUILDING DIVISION • TYPE ,WORK -. PL'N. REVIEW -, e
❑ New construction ❑ Addition /alteration /replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service of 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
❑ I - and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
e -- - - - ❑ Emergency system larger separately derived system
/� JOB 'SITE INFORMATION AND LOCATION`, '
r '" " ' ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: % VV3 .lob site address: 1. 3(QO Afl I y.e r ,,'a 1001 -1P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks
City /State /ZIP: 1 ' a� �4��" ❑ Health - care facilities. ❑ Supply voltage for more than
� 1 0 Hazardous locations. 600 volts nominal.
Suite /bldg./apt. no.: 1 Project name: g6-15 ❑ Service or feeder 600 amps or more.
- - .' .Fs�EE'CU
° 'SEDULE ,e `` _�' • ' -
Cross street/directions to job site: Description I Qty. [ ,. Fee. I Total
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
l 7 7/ !/' P {G Es t 12 G � residential (with above sq. It )
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER , : ®r: 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 I
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
l APPLICANT ' - '❑ 'CONV'TACT`•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'! branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/Z1 P: Each manufactured or modular 90.90 2
Phone: dwelling, service and /or feeder
( ) Fax: : ( ) Reconnect only 66.85 2
[ -mail Pump or irrigation circle 53.40 2
- - CONTRACTOR - ' ', . - , - , Sign or outline lighting 53.40 2
Business name: �j� r ����� �� ���- Sigma! panel, or limited -
���` energy panel, t re alteration, or
Describe: Address: 0 , 1.---00y., 1.---00y., (_0 extension. Describe / Page 2 2
City /State /ZIP: Fa O'� O - Q L Each additional inspection over allowable in any of the above
.` Per inspection 62.50
Phone' ✓3)q?,aL ., „, 5— Fa (503) 3C0a - a 3 O . " . Investigation per hour (I hr min) 62.50
CCl3 Lie :/7,,,,7 7 Electrical Lic.:C,Z -- lU St - v. Lie e9 Industrial plant per hour 73.75
f F' ELEC;1723C 1L 'PERMIT FOGS
Suprv. Electrician signature, required: ,...--.‘7.,.e„. ��, Subtotal. �� , UCH
1
Print name: (t / 2 , /g/A.5 Date: / / Z t/ Plan review (25% of permit tee):
State surcharge (12% of permit fee): '7.
Authorized signature: TOTAL PERMIT FEE: p , 0 0
This permit application expires if a permit is not obtained within 180
Print int name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I; AtiuddingVPermit,AELC- PermitApp doc 05/23/06 440 -46 t 5T(11/05/COM/WE3