Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 q
$ COMMUNITY DEVELOPMENT Permit #: ELR2012 -00083
T I GA R_D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/04!2012
Parcel: 2S101AB01606
Jurisdiction: Tigard
Site address: 7357 SW BEVELAND RD 200
Project: Beveland Wellness Center Subdivision: HERMOSO PARK Lot: 17
Project Description: Low voltage for (3) systems: a /v, data and security.
Contractor: INTEGRATED TECHNOLOGIES LLC Owner: CLARKE, THOMAS C & SUSAN L
1327 SE TACOMA ST #336 12439 SW 22ND AVE
PORTLAND, OR 97202 LAKE OSWEGO, OR 97035
PHONE: 503 - 808 -1277 PHONE:
FAX: 503 - 914 -0339
FEES
•
Description Date Amount
Specifics: Restricted Energy Permit 05/04/2012 $225.00
12% State Surcharge - Electrical 05/04/2012 $27.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 3
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: Y Other: N Total $252.00
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 a • - - - - 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. ATT• 'TION: Oreg• • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 ' 1 10 through OAR 9 • -' -0 ' • 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu By: I // C` %��`� 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 603.639.4175 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.
Electrical Permit Application FOR OFFICE USE ONLY
Received / Permit No
Ci of Tigard p � ,01,e,.._„„
I,
tY g / DateB : ` J �� : /
° 13125 SW Hall Blvd., Tigard, OR 9 ''' ; Plan Review
17 .: • Phone: 503.718.2439 Fax: 503.59:.1' : Date : Other Permit:
I 1 G A R D Inspection Line: 503.639 MAY Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard - or.gov - 4 2012 Notifred/Method: Supplemental Information
TYPE OF W F G A ^ PLAN REVIEW
" El New construction IS] Addition/altst ' ' / ll �� Please check all that apply (submit 2 sets of plans w /items checked below):
�&�
t F . tlCr� ❑ 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: 7357 SW Beveland St IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Portland OR 97223 ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations.
ty 600 volts nominal.
Suite/bldg. /apt. no.: p Project name: Jg )D W { SJs ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: C t i./2- Description I Qtr. 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 168.54 4
Ea. add'1500 sq. ft. or portion 33.92 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
Board Room AN System; Mechanical Shading; move some existing Data and residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
Phone Drops 200 amps or less 100.70 - 2
❑ PROPERTY OWNER • ❑ 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
City/State/ZIP: Temporary services or feeders installation, alteration, and /or ,. h relocation
Phone: ( )
Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 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
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first •
56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
• City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( )
Fax: : ( ) 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 3 L Q �
Business name: Integrated Technologies LLC panel, alteration, or extension. �.1 Page 2 2
Each additional inspection over allowable in any of the above
Address: 1327 SE Tacoma St. #336 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Portland OR 97202 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 8081277 Fax: (503) 9140339 Inspections for which no fee is 90.00/ hr
` specifically listed L hr min)
CCB Lic.: 172217 01\1 Electrical Lic.: CLE66 V\ Suprv. Lic.: R11775J ELECTRICAL PERMIT FEES
"IV Subtotal: AdtS
Suprv. Electrician signature, required: _.— Plan review (25% of permit fee): �"
Print name: Joe Dunn Date: 5/2/2012 State surcharge (12% of permit fee): a '7. 6 ' 0
TOTAL PERMIT FEE: A5, eDU
Authorized signature This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Gregg Gaido Date: 5/2/2012 • Number of inspections allowed per permit. .
I:\ Building \Permits\ELC- PernitApp.doc 07/01/10 440-46t5T(11 /05 /COM/WEB
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 system $75.00
(SEE OAR 918 - 309 -0000)
Check T pe of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls
❑ 5>cic Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
•
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
/ .0' ' Oth Q C
er s k-k- (
Total number of commercia stems:
Y
•
- ' *No licenses are required. Licenses are required
for all other installations
•
I: \ Building \Permits\ELC- PennitApp.doc 07/01/10 .