Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00126
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/08/2009
Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 160
Subdivision: Lot: 0
Project: Biscuits
Project Description: Install restricted energy for POS and telephone.
Owner: FEES
SN PROPERTIES PARTNERSHIP Description Date Amount
1121 SW SALMON ST Restricted Energy Permit 05/08/2009 $150.00
PORTLAND, OR 97205 12% State Surcharge - Restricted Energy 05/08/2009 $18.00
PHONE:
Contractor:
DELSTAR ELECTRIC INC
PO BOX 1371
TUALATIN, OR 97062
PHONE: 503 - 692 -3219
FAX:
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Y Fire Alarm:
HVAC: Instrumentation: Total $168.00
Intercom/Paging: Landscape /Irrigation:
Landscape Lighting: Medical: Required Items and Reports (Conditions)
Nurse Calls: Protective Signal:
Security Alarm: Other: Y
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 in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if w• , suspended for more
the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility N. • • . •' ter. , ose , . set forth in OAR
952- 001 -0010 through AR 952 - 0944100. You may obtai a copy f the rules or direct questions to OUNC by callin. • 03.241 ;13 .
Issued By: n Permittee Signature: ( \W —■ ► _ •
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.
RECEIVE 1 £ LRa - 1 . r
Electrical Permit Application • FOR OFFICE Ii5F oNL.V-
MAY 0 8 2009 Received
II City of Tigard Permit No.:
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan R
C • Phone: 503.639.4171 Fax: 503.598.196Q, CITY OF TIG ` Il l Review Other Permit:
f, C, Ii D Inspection Line: 503.639.4175 BUILDING DIVISI a V . a Ready/By: luris: 65 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction ❑ Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ID Other:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - and 2 dwelling .& less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
y g ❑ A 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 ", "l- 2 ", "l -3 ",
Job no.: Job site address: i 1Q23o Sol R _tF-I[., 4 Y I or more. occupancy.
❑ Six x o or r more residential units. ❑ Recreational vehicle parks.
-- ❑ H -care fa
0 locations. ❑ Supply voltage for more than
City/ State/ZIP: I I � �
1 600 volts nominal.
Suite/bldg. /apt, no.: dun Project name: L'S C../.3 ITS ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 1 ,.... 24) T Ouj s t Description I Oty.• 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'l 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
PO t�T OF SAME al Tr t t- '1.3- t Rwb, 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 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'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: T a . e t_e TIZtc- l 1 aJL energy panel, alteration, or
Address: ? r , X 13i l extension. Describe: p 0 ,S Page 2 2
City/State /ZIP: '''17 f,„LQ 1 bF 970C•7_ Each additional inspection over allowable in any of the. - above
Phone: ( - c ) - . q_%yq , ■ Fax: ( b3) Per inspection 62.50
[9 : � o /� Investigation per hour (l hr min) 62.50
CCB Lic.: Electrical �� . r v, ' 6 Industrial pl ant per hour 73.75
G. ii�a y p � IK c
■ , n — __ ELECTRICAL PERMIT FEES
Sup . - ectrician signature, required: 4 M . � .
�_P , Subtotal:
Date: Plan review (25% of permit fee):
Print name:
(--All S —. State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: t g , en
Print name: Date: 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.
1:\ Building \Pennils\ELC- PermitApp.doc 0523/06 440- 4615T(I1 /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*
El 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
VA • ata Telecommunication Installation
❑ Fire Alarm Installation
❑ FIVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: Building \Pamits'ELC- PermitApp.doc 03/23/06