Permit •
•
•
n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00012
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/9/2007
PARCEL: 2S 102A13
SITE ADDRESS: 12285 SW MAIN ST ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Voice /Data. Job #SFC2 - 7743.
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:
JOHNSON, WARREN W + BETTY TRS AN HENKELS & MCCOY INC
JOHNSON, REES C + MARYANNE G 5000 NE 148TH AVE
3112 SW SANTA MONICA ST PORTLAND, OR 97230
PORTLAND, OR 97201
Phone: Contact #: PRI 503- 205 -1720
FAX 503- 205 -1713
FEES Reg #: ELE 26- 895CLE
LIC 63699
Description Date Amount
[ELPRMT] ELR Permit 1/9/2007 $75.00
[TAX] 8% State Surcha 1/9/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
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 503.246.6699 or 1.800.332.2344.
Issued By: Permlttee Signature: f
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.
L .
Electrical Permit•Applicatl{ VIE: roll orhlcF, USE ciNLN'
City of Tigard // �� 11��II (� ry Date/B4 9 ., D ( 7 /D , Permit No. 1.40 l oad ��
° 13125 SW Hall Blvd., Tigard, OR 97223 J AN 9 7. 00 f 7 Plan Review
. ° . Phone: 503.639.4171 Fax: 503.598.1960 Date/By; Other Permit:
T I G A R D Inspection Line: 503.639.4175 11 , r.►1� Date Ready/By: luris: H See Page 2 for
Internet: www.ligard- or.gov c�l � 1 AJ+++�++Notified/Mcthod: Supplemental Informat
,;. _ ` P W ,.ms
_ - , - sue -._ _._..._.�..._,N4.-.„.. _ �_ , .,.Y
. .., - ...... :. -. - . .., ,.: -- ....,. _. ._ _ .._ . ............. _ ... -_ - > :s�• , �.. te=a;, _.: - ......,�:-
❑ 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 stones.
Demolition ❑ ❑ Other: where the available fault current ❑ Marinas and boatyards.
- : � , -- rc 1rfr : � - - - E : _ exceeds 10000 am at 150 volts or Floating buildings.
�����::,�r: ��..�,° CA3`EGQ 1'�;OE,COIVST'Itl) - = »���:: > .- :��a�:r�� �
less to ground, or exceeds 14,000 ❑ Commercial - use agicultural
❑ ` 1 - and 2- family dwelling l g. Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of75 KVA or
"4 =�_ -�,� „ ,�- - _ - , �, - _ : ,. _ ❑ Emergency system. larger separately derived system.
'"- < = ;. "- JO _ 'S T. "., FORMAT ONIAIVBrL' - • N nz _t w•�-, r r ..; �� ,�.�
_ _ �. s= -- <,�� �., 1 .. IN . �_ „_�,;,. � .- O. CATIO - . �, ❑ "A...,E...,I_Z....1_3..
.,._- ..... .._._ ..: :.,: _< -,._ , ,.- ....._.___ „_ __, -F - � ,,.,>_ ., _, M.. • -- � ,�:_;. „- . .:= T ea_ , ,, ° �, 0 of new motor load of
Job no.:5R2 11 g Job site address: (Z.2 f3 S 5 G� 0141 � 100HP or more. occupancy.
❑ Six or more residential units.
City /State /ZIP: a f \ / t ❑Recreational vehicle parks.
R ' e 2 Z 3 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: - ci (Project name: 5Del T t•-d iA ['Service or feeder 600 amps or more. g �
Cross street/directions to job site: nacripron i I Qty. I Fee. j 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 Limited energy, residential
Tax mno.:
: map/parcel n ; ,1, -_ - 75.00 2
*r - rw E T P_NAO '`.W,OR ` - `' "' (with above s 8.
Limited energy, multi - family 75,00 2
(J b l 4 QG c}‹-- EC b ( residential (with above sq. ti.) -
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
_
1 =?< .__ •�
=t<._. _ _ti �, c, s _� 10.
®wPR'OP�itT<Y - OWNER >��iY _ - - '' =�'ENANT;� : �.: 201 amps to 400 amps 6 8 5 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: ( ) 1 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
=._ _�-- _ above service or feeder fee
<A EliICA :. COIVTA('f' P R5U1Vr x
-. '' � 6.65
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: first branch circuit
Address: Each add'I 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
f : " - - 53.40
r v Sign outline lighting .._..,., _ -:. - 5 GCO .. _.. 1 , ." _. Signal circuit(s) or limited -
Business name: [ 5 (,h t� / �Ht� , energy panel, alteration, or
Address: 5 vo° N C f (. f a �.� • extension. Describe: Page 2 (, 2
City /State /ZIP: et, 4--1 G, 0 j,, q 72,3 6 Each additional inspection over allowable in any of the above
Phone: (5b2.,) 1c" ' 1, Z . / Fax: ( 0 3) Z � - 71Z 62.50
Per inspection 62.50
S Investigation per hour (I hr min)
CCB Lic.: 7%Cl 5 Electrical Lic. 36- S `' Suprv. Lic.:563 L E8 Industrial plant per hour 73,75 h
� ! s0'z.: ?ELECrgIGAI _P R WT,'1FE ;:>:�:, 7-�_.::-- ,V
Suprv. Electrician signature, required: l � Subtotal: -15
Print name: C.�v L. / kl d S p� Date: / •'$ D 7 Plan review {25 %of permit fee): vv
State surcharge (8% of permit fee): (•...-----
Authorized signature: / // TOTAL PERMIT FEE: 6 1.E
D ate: 1 _ This p ermit application expires if a permit is not obi rned within 180
Print name:
fad 4, M ; go n 1 ~ C ' days after it has been accepted as complete.
• Number of inspections allowed per permit.
I'U 3uitdin gTermits\ELC- PcrmitApp.doc 05/23/06 4404615T(I I/05 /COM/WEB