Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
5
v.._ DEVELOPMENT Permit #: ELR2009 -00115
T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/17/2009
Parcel: 2S112BA05900
Jurisdiction: Tigard
Site address: 14058 SW MILTON CT
Subdivision: Lot: 0
Project: Westcon
Project Description: Install restricted energy for voice /data.
Owner: FEES
GOODHEAD, DAVID & JAN M Description Date Amount
9846 SW PEPPERTREE LN Restricted Energy Permit 04 /17/2009 $75.00
TIGARD, OR 97224 12% State Surcharge - Restricted Energy 04 /17/2009 $9.00
PHONE:
Contractor:
FIRE PROTECTION SERVICES
5573 SW ARTIC DR
BEAVERTON, OR 97005
PHONE: 503 - 590 -3732
FAX: 503 - 628 -6214
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Y Fire Alarm:
HVAC: Instrumentation: Total $84.00
Intercom/Paging: Landscape /Irrigation: Required Items and Reports (Conditions)
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other:
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 rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obt in a copy of the rules or direct questions to OUNC by calling 503 8699 or 1.800.33 .2344.
Issued By: V talk J� Q '��1'� J. Perm ittee Signature: l( `"n� p fl
� 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 603.639.4175 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.
• Ppr 14 2009 2:21PM Fire Protection Services 503 628 -6214 p.1
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Electrical Permit Application 1 o oil It 1. t sC 1.1 "N I.1
City of Tigard APR 14 200' .0 t _ , Permit No.: 2 oft" • 4 • I S
• 13125 SW Hall Blvd., Tigard, OR 97223 plan Review - Other Permit:
Phone: 501639.4171 Fax:
Line: 503 639.417503.598.1960 G'I`Iy OF TIf� p 1 � 1i � B Y lair. ® See Page 2 for
T i G :, I: D Internet: www.tigard- or.gov BOIL DING DIVISII 'I o: TI . Supplemental Information
E x ., - T-n !S t t1 p 5 rc�a^inr b : i ' tuz 7i 6 1V . t 1 . 2 i :atop t ]T .Ri - t t ..•r ,v ; yea, : � ,,:c% _ ,-
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i sib?,. t ,rJ t d .I li ,, m_�r.: i� -.rt„ rdu;wz. ��•
❑ New construction - ® Addition/alteration/replacement
Ple cock all that apply (submit 3 sem of plans who= checked below):
❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more ❑ Building over three stones.
where the available Omit current ❑ Marinas and boatymds•
_5iii0211ii111fEll 'i el: y !1',.. , f �, i. 7 ,„`. exceeds 10.000 amps et 150 volts or ❑ Floating buildings.
� ` = ,th - ":v; 4 •a a;_ _ lit tS�a y _` - - less to ground, or eueeds 14,000 ❑ Commercial - use agricultural
❑ 1 - and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installation: buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump ❑ Installation of 75 KVA
Ll , i -'�s... , ',.; m.,-,: rats dill t ` if i , , B l c x rtS i ❑ Emergency system. larger separately derived system.
i z , - ,,, _ -_ em ^., r.rili:s4 , _ - ' .t a,,.it.>.ruaiitier imaT..,ii t e u: = ❑Addition of n w motor load of El "A', E , "1-2". 1.3
Job no.: 2595 Job site address: 14058 SW MILTON CT. looHP cc more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: PORTLAND, OR ❑ Hmlth -care facilities. ❑ Supply voltage for more than
['Hazardous locations. 600 volts nominal
Suite/bldg /apt. no.: Project name: WESTCON REMODEL f atal •
,, service or feeder - der 600 amps or more. pp
. inn. iw'.-4i,AF3� i - a I KL'r •'V y
Cross street/directions to job site: r ro,,,,
Qty. teL 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. 0. or portion 33.40 1
Tax reap /parcel no.: Limited energy, residential
.
i it i<�__ ,, ,,M7f - I: x - 9 t il11l1ilti '!!f�1 (with above sq. It.) 75.00 2
w - ,e.it i illlt lie t r .,. . � ':: a 6 ` :i iiitli,I �n .0 ..r..:. . i. a_t
t F:
_ Limited energy, multi- family
LE - ADD PHONE/DATA CABLE RUNS 75.00 2
residential (with above sq. ft.)
Services or feeders Installatloa,aite ation, and/or relocation
r 200 amps or less 80.30 2
r
31 ±fi r a rc_- •� " .3- `---' w :. '4 % ." �` ' i l 1 201 amps to 400 a mps
-r a b,.r ... rra` -='- :., , 41 a : r.� :,, 0' '11. _ . . .: . 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 10030 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
= ., 3171 !tirI-P, -•• �__. ' ' ' - ' l0 c u c i I Fee f circuits
e service or feeder fee,
e
�.,�. lw t ,, a _ �:�__ =� �i lu't�t re '� `^" ' r'r've'y"` � tilN} above . r- -- =r.: - = a, l,icreod ... � a2'� ri, ?!_5t ,n.t.ednrt i:rire.,..,_ .?Lunn' -. .._ _ 665 2
tech brunch circuit
Business name: FIRE PROTECTION SERVICES, INC. B. Fee for branch circuits
Contact name: DAVID M. PHIPPS without service or leader fee, 46.85 2
first branch circuit
Address: 5573 SW ARCTIC DRIVE Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not Included)
City /State/ZIP: BEAVERTON, OR 97005 Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: (503) 590 -3732 Fax: : (503) 628 -6214 Reconnect only 66.85 2
' E - mail: phi pps@fpsnw.com __ �i �__ . Pump or irrigation circle 53.40 2
ig it itfAr"`.- - 4. ..��7 11�' _�„``•r IRtir.a. - .2:1'jb ' : Sign or outline lighting 53.40 2
Business name: FIRE PROTECTION SERVICES, INC. Signal circuit(s) or limited -
energy panel, alteration, or
Address: 5573 SW ARCTIC DRIVE extension. Describe: I Page 2 75.00 2
City / State/ZIP: BEAVERTON, OR 97005 Each additional inspection over allowable In a of the above
Per inspection 62.50
Phone: (503) 590 - 3732 Fax: 503) 628-6214 Investigation per hour (1 hr min) 62.50
CCB Lic.: I . 3 Electrical Lie.: 3' 88 " Suprv. Lie.: 4120LEA Industrial Diem per hour 73.75
Suprv. Electrician s gnu ,required � � r . i d .0.Ny�,i)Er , 1 r t , ,v , +r r - ^ - .�,
- ..?..?_.,f - :1,...e Subtotal: 76 ^ ^. C'D
Print name: DAVID M. PHIPPS Date: - _. 4M Plan review (25% of permit fee): 0.00
State surcharge (12% of permit fee): C I • CO
Authorized signature :i TOTAL PERMIT FEE: 8 q . CT 0
4c-0.- - „O This permit application expires If a permit Is not obtained within 1110
Print name: DAVID M. PHIPPS Date: y / dads after it has been accepted as completes
I: lDwldin�Permir s'Fi.C- F'ermizApp.doo os/23 6 440- 4615T(1 UMiCObtlwt� a Number of inspections allowed per permit.
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