Permit 1
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
: COMMUNITY DEVELOPMENT Permit #: ELR2012 -00010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/18/2012
Parcel: 2S 102AA04201
Jurisdiction: Tigard
Site address: 8955 SW COMMERCIAL ST
Project: Essential Planning Group Subdivision: TIGARD HIGHWAY TRACTS Lot: 2
Project Description: Low voltage for voice & data.
Contractor: BRY -COM Owner: BUTTERFIELD, CHARLES W JR &
14244 SE BUSH MICHELLE S
PORTLAND, OR 97236 825 SW VIEWCREST DR
DUNDEE, OR 97115
PHONE: 503 - 761 -5156 PHONE:
FAX: 503 - 760 -7501
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/18/2012 $75.00
12% State Surcharge - Electrical 01/18/2012 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
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 ccordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended •r more the 180
days. AT NTION: Oregon law • -. ire you to follow the rules adopted by the Oregon Utility Notification Cente Those rules are - forth OAR
952 -001 -0 10 :AR 952.OYu may obtain a copy •f the rules or direct ::::::: 503.2.800.332. / f /w ��
lb 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 the next available inspection date.
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 ApplicatiTE FOR OFFICE USE ONLY
City of Tigard Date /B . PermitNo.: f �� /)
° 13125 SW Hall Blvd., Tigard, OR 97223': N 1 8 2012 Mr
Plan Review
14 C : Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T f GA R Inspection Line: 503.639 CITY OF TIGARD Date Ready /By: luris: 0 See Page 2 for
Internet: www.tigard- or.gov DIVISION
Supplemental Information
TYPE O1 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.
❑ Demolition Ei 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 to 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 - ", "1 - ",
1. C t // I OOHP or more. occupancy.
Job no.:
Job site address: rVI
i j ci+�V ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: /� , �f ❑ Health -care facilities. ❑ Supply voltage for more than
1 ///���� /� l� ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: , - - ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. tt.)
L - ` ta) , el h Q , 0 Li esi energy, mu dential (with a s q.
/ + D ' \ s L /N� "�`� 1(// G ` residential esi above am
ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59 36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 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 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included)
Cit /State /ZIP: Each manufactured or modular 67.84 2
y dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: 8 44 panel, alteration, or extension. P Page 2 2
I - � Each additional inspection over allowable in any of the above
Address: / S ci, g(/t.J Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: prZAO q()23/, Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (03 ) /� _ ' /...-S/ Fax: ( )1?40 . f) 33 q Inspections for which no fee is 90.00/ hr
specifically list (%F hr min)
CCB Lie.: /vv./ Electrical Lic.: 4,5 u�rv. L .F.: /3gy ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: � ,�. /����� - l Subtotal: 75. DO
0�' " Plan review (25% of permit fee):
Print namei1 S ,` / 6 : e: / � - rk State surcharge (12% of pennit fee): 9 ,00
lllllC.��J��J TOTAL PERMIT FEE: via)
Authorized signature:
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 07/01/10 440- 4615T(I1/05 /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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling .
n Other
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \Building \Permits\ELC - PermitApp.doc 07/01/10