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Permit
J Y CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT II I ° COMMUNITY DEVELOPMENT Permit #: ELR2009 -00282 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/02/2009 Parcel: 1 S133AD16000 Jurisdiction: Tigard Site address: 12744 SW NORTH DAKOTA ST Subdivision: Lot: 0 Project: Key Bank Project Description: Installation of (3) low voltage systems: data, paging & security. Owner: FEES HALL DONALD W & GRACE L & Description Date Amount HALL, JOHN G ET AL, BY FIRST AMERICAN Restricted Energy Permit 09/02/2009 $225.00 REAL ESTATE TA, 8435 N STEMMONS 12% State Surcharge - Electrical 09/02/2009 $27.00 PHONE: Contractor: WEST COAST BUSINESS COMMUNICATIONS INC 11134 NE HALSEY ST PHONE: 502 - 465 -9222 FAX: 503 - 257 -0028 Type of Use: COM Class of Work: ALT Total Number of Systems: 3 Audio & Stereo: N Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: Y Fire Alarm: N HVAC: N Instrumentation: N Total $252.00 Intercom/Paging: Y Landscape /Irrigation: N Required Items and Reports (Conditions) Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: Y Security Alarm: N Other: N 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 i rdance vVi Ith. 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. TENTION: Oregon aw r-. • . you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -0 -0010 through OAR 952-0: -0100 Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 1.800.332.2344. Issu 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 INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' 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. 1 `Electrical Permit Application FOR OFFICE USE ONLY City of Tigard RECEIVED Received 640/74,9 apn 0 'GC/ .. g M o Date/By: �, /, / ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review _ .7 IN C .. Phone: 503.639.4171 Fax: 503.598.1960_ D Date/B : Other Permit: T I G A It D Inspection Line: 503.639 J Ready/By: 0 See Page 2 for Internet: www.tigard Notified/Method: / Supplemental Information CI O P TICARD TYPE O PLAN REVIEW 1��, DIVISION Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction 1g Addition! t rep acement ❑ 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 ,] Commercialindustrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A °, ' E ", "1 - ", "1 - 3", M , 100HP or more. occupancy. Job no.: Job site address: 2.7 y q 5 t� fib 12T 11 KdTA 9, ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: ' T Ci A �� , C) a Health -care facilities. ❑ Supply voltage for more than a , 9 1 2_2_3 Hazardous locations. 600 volts nominal. Suitt:/bldg. /apt. no.: Project name: C,I 3 4A31 , ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I 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 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) �/� Limited energy, multi - family 75.00 2 V o 1 ve--/ /2A I (' it9 /AI l 5 CC:J 2 ( T)/ residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ 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 1 Owner installation: This instal . n is being made on property that I own which is not 201 amps to 400 amp 100.30 2 intended for sale, lease, r 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 ❑ APPLICANT . ❑ CONTACT 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 frst 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 CONTRACTOR Sign or outline lighting 53.40 2 Signal circuit(s) or limited - Business name: UUe5"rC©ADT ( n+e�SS GC�M M -1— N L energy panel, alteration, or Address: 1 k 1 :St.,� NE 1- A1. 5 ST, extension. Describe: Page 2 225 2 City /State/ZIP: Pp0_- 4 _ 9 0 2 ( 1:7_00 Each additional inspection over allowable in any of the above l Per inspection 62.50 Phone: () 4 b5 c( 2ZZ Fax: ( �3j 2.57- Oo Investigation per hour (1 hr min) 62.50 CCB Lic.: 1 . 7 ' - i 50 Electrical Lic.: CLe g / Suprv. Lic.: 32% LEA Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: .Z25— Date: Plan review (25% of permit fee): Print name: STEt/E. / ) - � � �C° fG JS State surcharge (12% of permit fee): z7 "- Authorized signature: , TOTAL PERMIT FEE: 2_54 6 1? �+�-- ��^^''�� This permit application expires if a permit is not obtained within ISO Print name .TE✓E.✓ AG/L/ ✓S D y P p days after it has been accepted as complete. ... . - .. Ilectrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: i 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 ❑ Boiler Controls ❑ Clock Systems N I Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation NI Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: 3 *No licenses are required. Licenses are required for all other installations