Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2012 -00075
T [CARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2012
Parcel: 2S101AB00100
Jurisdiction: TIGARD
Site address: 12017 SW 70TH AVE
Project: Dr. Sepehri Subdivision: Lot:
Project Description: Audio and data telecommunications systems.
Contractor: DAVID KURAN Owner: RED ROCK BUSINESS ASSOCIATES LLC
5925 SW CHESTNUT AVE 23077 SW NEWLAND RD
BEAVERTON, OR 97005 WILSONVILLE, OR 97070
PHONE: 503 - 799 -6500 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04 /20/2012 $150.00
12% State Surcharge - Electrical 04 /20/2012 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: Y Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y 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: N Other: N Total $168.00
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.
Issued By: 1 — _ — 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 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 19 12 03:10p Craft Master Construction 503 - 997 -7172 p.1
Electrical Permit Application FOR OFFICE USE ONLY
NI City of Tigard Received Permit No.: 2— 0 75-- ° 13125 SW Hall Blvd., Tigard,OR ', dl Plan Review i
e ' Phone: 503.718.2439 Fax 503.` 11 .1 r 10- Date/13 . Other Permit: `. � // eta .
T I G n R D Inspection Line: 503.639.4175 ‘� Q Date Ready/By: See P age –
nitric for
Internet www.tigard -ongov 1 A`f � C ^z n , , ; oilfeld/ , 0 � Supplemental Information
TYPE OF WORK (fi � ��� \ �� PLAN REVIEW
,New construction ❑ Addition/alteration/ J1 Place check all dlat apply (submit 2 sets of plans w itans checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 Other: a���� where the available fault current ❑ Marinas ardboatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Fleeting buildings.
less to ground, or exceeds 14000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling tg Commercial/industrial ❑ 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', "I -2 ", "] •3 ",
Job no.: Job site address: 20I 7 SL.. 7 0 414 A IOOH cy P or more. occupan
❑ Six armory residential units. ❑ Recreational vehicle part*.
Cl 1 Cate /ZIP: 'j'� f� � C � ❑ Hezah -care facilities. ❑ Supply voltage for more than
S • 1 gar > 0f� ( 2� ■ T ❑Hamtdonslocati�ns. 600 volts nominal,
Suite/bldg. /apt. no.: Project name: D f, Se pe�ri ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: nacripiian 1 Qty. I Fee. I Total I •
• New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,0 sq. fl. or less 168.54 4
Ea. add'1 500 sq. ft or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
( with above sq R) 75.00 2
DESCRIPTION OF WORK ■
, l � /� �l Limited energy, multi- family 75.00 2
I o i 1„ �' rvidential (with above sq. f .)
� S, Iv1LsiCS Services or feeders Installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1.000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Teniporary services or feeders Installation, alteration, and/or
City /State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 1
201 amps to 400 amps 125.03 . 2
Owner installation: This installation is being made on property that 1 own which is not 401 amps to 599 amps 168.54 I 2
intended for sale, 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
EX APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
�) each branch circuit
Business name: Cr-0 4•• /24 45 0 Dee, on B. Fee for branch circuits without
service or feeder fee, first 56,18 2
Contact name: • B Qloo - 3 — c1/41,..104 r•-; branch circuit _
/- ``�� /J/ I y Each add'l branch circuit 7.42 _ 2
Address: &do Ca 3 $ ,8e, ✓t�TD••1 /74WiC �t K / . 220 Miscellaneous (service or feeder not included)
Ci /State/Z1P: � 4 4 ° �-7 2 Z S
Each manufactured se a or r modular 67.84 2
ty I�Or dwelling, sancta and/or feeder ,
Phone: (To3) 37 7/ 7L Fax:: (5' 3) 2,..ci2 —/177 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR _
Signal circuit's) or limited - energy e
r panel, dictation, or extension. 2 Paget _ 1 5C 2 2
Business name
.4 V 1 /:, f riJlzA ti Each additional inspection over allowable in any of the above
Address: 4-9.2.11. 41) Additional inspection (1 hr rein) 66.25/ hr •
�} r .t! L7 Investigation (I hr min) 66.25/ hr
City /State/ZIP: , €4✓EiETe
/� � o/C 9 7et6 Industrial plant() hr min) 78.18i hr
Phone: (S 79 v...‘ -oc. Fax: ( ) Inspections for which no fee is 90.00 hr
specifically listed OS hr min)
CCB Lic.: jyC 7yg'/4, Electrical Lic.:,�;.9 .4S3e;,Z£I Suprv. Lic.: y26 LEA ELECTRICAL PERMIT FEES w
Suprv. Electrician sijSaf (re, required: 7/f/Il 10 it f ivi Subtotal: / �,
Plan review (25% of permit fee):
Print name: Li 1.1) , I Date: �_/ - /2_ State surcharge (12% of permit fee):
f TOTAL PERMIT FEE: /C2 ' "
Authorized signature: f Ibis permit application expires if a permit is not obtained within 18D
/ 1 days after it has been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit.
LIBuilding '',Pcrmits'.ELC- PermitApp doe 07m1/le 440.4615T(11.05/CONS/WEB
Apr 19 12 03:10p Craft Master Construction 503- 997 -7172 p.2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
INBuildinglPemunU.C- Pmniulpp.ds 07101A0