Permit ' CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00023
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/28/2008
PARCEL: 2S 109AC - 06200
SITE ADDRESS: 13346 SW NICOLE LN ZONING: R -7
SUBDIVISION: WILSON RIDGE NO. 2 LOT: 030 JURISDICTION: TIG
PROJECT: WILSON RIDGE NO. 2
Project Description: Low voltage for vacuum system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPEIIRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
STONE BRIDGE HOMES Al SERVICE INSULATION LLC
16869 SW 65TH AVE. #505 PO BOX 3941
LAKE OSWEGO, OR 97035 HILLSBORO, OR 97123
Phone: 503- 387 -7577 Contact #: PRI 503- 984 -9542
Reg #: LIC 178229
FEES
Description Date Amount
[ELPRMT] ELR Permit 1/28/2008 $75.00
[TAX] 12% State Surch 1/28/2008 $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
issu- • - , . ' .rk is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Ut' y Notification .ter. T - - - r -s are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
ru es or direct question • •UN' :t ,03.246.6699 or 1.800.332.2344.
Iss -d By: Permittee Signature: . f /� 7/
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.
Electrical Permit Application ^
IN a Re 147 Q
O
City of Tigard Re e ive / D Q �/
n 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
C . Phone: 503.639.4171 Fax: 503.598.1960 DaDate/By: ive Permit No.: (1 nog 0;
Other / Other Permit:
1 G n R D Inspection Line: 503.639.4175 Date Ready/By: turi ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: 1 Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
El New construction ❑ Addition/alteration/replacement
❑ Service or 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
❑ 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: Tj �oollP or more. occupancy.
/ . 1 ,r ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: / ❑ Health -care facilities. ❑ Supply voltage for more than
ty r � 0 locations. 600 volts nominal.
Suite/bldg. /apt. no.: P roject name: / / ie �0 ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
] Description I Qty. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I 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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
�Q- i /c7 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑TENANT 201 amps to 400 amps 106.85 2
Name: Q 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: ( ) I 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
❑ APPLICANT I ❑ 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'l 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
CONTRACTOR Sign or outline lighting 53.40 2
Business name: 2 ° ;4, / ,o Signal circuit(s) or limited -
-� i� ���� �� �L— energy panel, alteration, or
Address: Q�� 3�l 7 elstansi an. -7e J � � Page 2 7, • 2
City /State /ZIP: if / t � s 171:2-- Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: - "p3 � 1 Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.: 170 1 El e c is Lie.: 1 Suprv. Lic.: Industrial plant per hour 73.75
a g /4 70/ p ELECTRICAL PERMIT FEES
Suprv. Electrician signature, req tre Subtotal: 7f5 .00
I Date: Plan review (25% of permit fee):
Print name:
�4 -- �� State surcharge (12% of permit fee): ?. co
t.
Authorized signature: �d j��• TOTAL PERMIT FEE: e / ?)d
Print name: Date: i--olit-r/57 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm .
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
Vacuum Systems*
Other:
I COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
•
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls .
❑ Outdoor Landscape Lighting* . -
E l Protective Signaling .
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06