Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 00065
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/11 /2012
Parcel: 25101 BC01000
Jurisdiction: Tigard
Site address: 12291 SW KNOLL DR
Project: The Knoll at Tigard Subdivision: KNOLL ACRES Lot: 5
Project Description: Security System.
Contractor: AZIMUTH COMMUNICATIONS INC Owner: KNOLL AT TIGARD APARTMENTS LP,TH
PO BOX 508 BY COMMUNITY PARTNERS FOR
WILSONVILLE, OR 97070 AFFORDABLE HOUSING
6380 SW CAPITOL HWY #151
PORTLAND, OR 97239
PHONE: 503 -639 -0110 PHONE:
FAX: 503 - 639 -0115
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 04/11 /2012 $75.00
12% State Surcharge - Electrical 04/11/2012 $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: N 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: Y 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 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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ■
/ 1
Issued By: J�����' i _ _ �i' == •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 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.
APR -09 -2012 MON 03 :55 PM AZIMUTH COMMUNICATIONS FAX NO. 5036390115 P. 02
Electrical Pet_ mit Appl CEIVED L'OI( OFFICE 1151 ONLY
Received P ermit No.:
• 1 13 3 , 125 S W Haal lasd.. Ti5urd,OR � 1 0 2012 Plan
Dam/By: ill 1)- der,- ,�(� l). _vc�r;S -
Phone: 503.639.4171 Fax: 503.598.1960 . - Date/By: Other Permit.
Inspection Line: 503.639.4175 Date Ready/By: Lurie: 0 See Page 2 far
t ` :1 Internet: www.tigard- or.gov CITY OF TIGARD Notitied/Method: l V Supplemental Information
RI HIDING DIVLS10N PLAN REVTIaVV
• , of WORK
•
Please chock all that Thal apply (submit 1 seta of plans wlitems ul>m teed below):
❑New construction Addition/alteration/replacement ❑service or feeder 400 amps or mom El Building over three stories.
❑ Demolition ❑ 0th : where the available fault current ❑ Marines and boatyards.
• CATEG t • If OF CONSTRUCTION excec 10,000 amps at 150 volts or ❑ Floating buildings.
_ lass to ground, or exceeds 14,000 ❑ Commcreial -use agricultural
❑ 1- and 2- family dwelling IC Commercial /industrial ❑ Accessory building amps for all other irutallations. buildings.
❑ Multi- family 0 Master builder
❑ O ther: ❑ Fire pump. 0 Installation of 75 KVA or
0 Emergency ayuyan lager separately derived system. •
' JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A" "8" "1.2" "1.3 ",
I I 0011P o mom, Recreation
Job no.: Job site address: i1 `• t l
0 Six or more re residential units, ❑Recreational vehicle perks.
' ❑ Health -care facilities. ❑ SuPply voltage far more than
City/State/ZIP: F �, 0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Illa _ M ❑ Service or feeder 600 amps or more.
. • FEE SCHEDULE
Cross street/directions to job site: 13e.erona I Qtv I pee. I Tsui J •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 r 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: • Limited energy. residential ' 75.00 2
• . . • DESCRIPTION OF WORK .. (with above u ft )
1 Limited energy, multi - family 75.00 2
SP-4 , ' th i \, 11 , residential (with above sy. 8.) _
�t I W 11X Services or feeders inatallatioa and/or relocatio
200 amps or less 80.30 2
El PROPERTY OWNER .:. • I • ❑ 'TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: _ 601 amps to 1,000 amps 240.60 2 _
Address: Over 1,000 amps or volts 454.65 r 2
City/Statc/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Owner installation: This installation is bcing made on property that I own which is not 401 amps to 599 amps 133.75 2
intended for salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT • . 1: CONTACT PERSON • . • above service or feeder fee, 6.65 2
• each brunch circuit
Business name: k , 1 y 1 ti I I ( 13. Fee for branch circuits
1
n without service or feeder fee, 46.85 2
Contact name: 6t r g first branch circuit
Each add'I branch circuit 6.6 _ 2
Address: f' _a@ L . _I lf Maecellataeous (serv or feeder not included)
1n t∎ 9 L / Each manufacuircd or modular 90.90 2
�V�1lf�.�piu. f O _ dwellin . service and/or feeder
Phone: hone: tlJ/ ��0110 % �y l� Reconnect only 66.85 2
__ ay�i!�ll�rl rLT MMI iri�I.W...1 • -G Pum porirrigationcircle 53.40 2
.. CONTRACTOR . • . Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: 1 1 1 1M i 1 1 M. 1 OW' energy panel, alteration, or
� S 67 hit/ d lla • extension. Describe: � Page2 75 . j 2
Address: wooFes'
City/State/ZIP: : k ' ji A 01)._ ' 1 #2., Each additional inspection over allowable in an of the above
A.M. 1 Per inspection 62.50
• hone: ! ') • , lit u Fax: i A. i . OW � . Investigation per haul( 1 hr min) 62.50
p2 �j J Su rv. Lic.: In dus trial plant per hour r , 73.75
r �/ D L.0 Electrical Lic.� l p� �� • ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: I /0 / / Subtotal: ,1•___
I Plan review (25% of permit fee): . ' '
Print name: •�� Date: State surcharge (12% of permit fee): VII
Authorized signature: » -. TOTAL PERMIT FEE: I "� 00
, r' , `^ This penult Application expires ifs permit Is not obtained within ISO
!
Date: I L days after it has beet accepted as complete.
r.. �.
• Number of inspections allowed per permit.
1:\ 0uitdinxWernrits \m.0•PermhIApp,dac 05/23,• 445- 4411'((IIIOSICOM/WF11