Permit a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Q - • COMMUNITY DEVELOPMENT Permit#: ELR2012 -00110
T iGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2012
Parcel: 1 S135CA02600
Jurisdiction: Tigard
Site address: 11130 SW GREENBURG RD
Project: Good Neighbor Center Subdivision::HERS ADDITION TO GREENBURG HE Lot: 3
Project Description: Fire alarm.
Contractor: UNITED FIRE HEALTH & SAFETY EQUIPMENT CO IN Owner: EAST WASHINGTON COUNTY SHELTER
4611 NE MARTIN LUTHER KING JR BLVD PARTNERSHIP COUNCIL
PORTLAND, OR 97211 DBA GOOD NEIGHBOR CENTER
11130 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503 - 249 -0771 PHONE:
FAX: 503 - 249 -0572
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 06/27/2012 $75.00
12% State Surcharge - Electrical 06 /27/2012 $9.00
Type of Use: COM
Class of Work: FPS
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: Y
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 $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. ATTENT Ore: • n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 + rough OAR 2 -' • 1 -' • 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. 7 or 1.800.332.2344.
Issued B / I u �� Permittee Signature: i&eCe7
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.
Electrical Permit Application RECEIVED 2 1 K 0,:i.,(-I: 1 s i•: ()\L
City of Tigard Q Perm . -oO f/ )
t: 13125 SW Hall Blvd., Tigard, OR 97223 JUN 0 6 2012 Plan R t>�� /..7 _ / ,
Phone: 503.7182439 Fax: 503.598.1960 Dates :
T I G A K D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: lure: el See Page 2 for
Internet www.tigard -or.gov
131111 DING DIVISION NotNotified/Method: Notified/Method: 77& 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 ❑ 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 Commercial industrial Accessory building amps to ground,
other a exceeds 1 n ❑ Commercial-use agricultural
El y g ® ❑ rY g amps for all other installations. . buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Addition �� separately derderived " system.
❑ Additioo o n of new motor load of ❑ "A ", "E", "1 -2 "", , "1 -3",
Job no.: 45380 I Job site address: 11130 SW Greenburg Road 100H or more res ° lion
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Good Neighbor Center ❑ 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. R or less 168.54 4
Ea. add'l 500 sq. ft or portion 33.92 I
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Replace faulty Fire Alarm Panel Limi
residential l( ( (with above sq It) 75.00 2
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
Name: Good Neighbor Center 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 11130 SW Greenburg Road Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State/ZIP: Tigard, OR 97223 relocation
Phone: (503)443 -6084 I Fax: (503 - )443 -3745 200 amps or less 5936 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, P er panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ® CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: United Fire and Safety B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Ed Wallace branch circuit
Each add'l branch circuit 7.42 2
Address: 4611 NE M.L.K. Jr. Blvd Miscellaneous (service or feeder not included)
City/State/ZIP: Portland, OR 97211 Each manufactured c or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 249-0771 Fax: : (503) 249-0572 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: ed@unitedfireandsafety.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy X
Business name: United Fire and Safety UN/ irEb j/ I panel, alteration, or extension. Page 2 - 2
l�f1f S Each additional inspection over allowable in any of the above
Address: 4611 NE M.L.K. Jr. Blvd. 5,9-fET4 E ip ib r c1/ m Additional inspection (1 hr min) 6625/ hr
City/ State/ZIP: Portland, OR 97211 // Investigation (1 hr mm) 6625/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 249-0771 Fax: (503) 249 -0572 Inspections for which no fee is 90.00/ hr
specifically listed (fs hr min)
CCB Lic.: 65290 7 // Electrical Lic.: CLE186 7 /i prv. Lic.: • I , LEA ELECTRICAL PERMIT FEES
—
d: 10 0� Subtotal:
Suprv. Electrician signature, require
�// / �ii %6 Plan review (25% of permit fee):
Print name: Mike Brooks Alb — Date: , / — State surcharge (12% of permit fee):
Authorized signature: / �j'r'� TOTAL PERMIT FEE: 8y. 4 0 - 0
��„ di_ This permit application expires if a permit is not obtained within 180
Print name: Ed Wallace Date: • /51 days after it has been accepted as rnmplete
�lf Number of inspections allowed per permit. .
I: Buil .doc 07101/10 440- 4615T(l l /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 $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: 1
*No licenses are required. Licenses are required
for all other installations
e�di .c- .aa 07/01 /10