Permit I I I o CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I: COMMUNITY DEVELOPMENT Permit #: ELR2012 -00133
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/16/2012
Parcel: 2S 101 DCO5000
Jurisdiction: Tigard
Site address: 13410 SW 76TH AVE
Project: Albertina Kerr Centers Subdivision: PACIFIC RIDGE Lot: 2
Project Description: (3) signal circuits
Contractor: LIMITED ENERGY NW Owner: ALBERTINA KERR CENTERS
P.M.B. 190 ATTN: JERALD A HOFFERT
3439 NE SANDY BLVD. 424 NE 22ND
PORTLAND, OR 97232 PORTLAND, OR 97232
PHONE: 503 - 810 -7331 PHONE: 503 - 239 -8101
FAX:
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: SF
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: N
Security Alarm: Y
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: Y
Other Desc: Total $84.00
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 if work is suspended for more the 180
days. A ION: Ore. law - quires you to follow the rules adopted by the Oregon Utility Notification nter. ose rules are set forth in OAR
952 -001 010 through OAR 95 = r 1 -r 1 9 g You may obtain a copy of the rules or direct questions to OUNC by calling 503.23 .1987 ,800.332
Issu By: % -' !l -A ' PermitteeSignature: )('` Z/e.e....5,....17
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 Foli ol.I tci: usi ONI.,
•
Cl of Tigard Received �f / n /A g l.
• Permit No .t.
City g EC,OVED DateB lO OI eZ -. 001.
q
13125 SW Hall Blvd., Tigard, OR 972 Plan Review
III Phone: 503.718.2439 Fax: 503.598.19 Date/By: Other Permit: F P5 �I a ' 00059
f I G A IZ D Inspection Line: 503.639.4175 JUN 2 6 2012 Date Ready/By: Juds: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Tic Supplemental Information
17 OF 1 :10f 4 .FT
YPE OF WTtl . 1 ` I� `- 711`', at' PLAN REVIEW
❑ New construction A ldition/alteratto repp la ' ce m ent 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.
• less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
! •1 and 2- family dwellin ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
i4 16 ❑ Master builder ❑ Other: 0 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 ", "I -2 ", "l -3 ",
Job no.: Job site address: 13 t.,' (C) S id 7 T!1 / Q oe 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 4 L 0 ❑ Health-care facilities. ❑ Supply voltage for more than
I ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ 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. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
h(-57A 1- 'R F' A LA/ /H- c ox ? }/ �C S-First4-S residential (with above sq. ft.)
J / 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
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
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
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, per 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: • 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)
Each manufactured or modular 67.84 2
City/State /ZIP: 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 Q •��U�
Business name: L,rk Cl F � A)Eze 16 t4 tzr S -j- panel, alteration, or extension. Page 2 _ /.7 2
Each additional inspection over allowable in any of the above
Address: 4 ilk ? I f(Q 3C,/3 /i ...5 9y 8,%'/ Additional inspection (1 hr min) 66.25/ hr
// . Investigation (I hr min) 66.25/ hr
City/State /ZIP: ?c, g_rl' LA t ..) 6 A ? 72 3 Industrial plant (1 hr min) 78.18 / hr
Phone: c5 g/O _ 3j / Fax: (J ) ,c;(6, 7 37 2 Inspections for which no fee is
37 specifically list (Vs hr min) 90.00 / hr
CCB Lic.: /3i 6 6 3 Electrical Lill` �4 _/d /2 c Suprv. Lic.: F4 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Z � ,A s /(.,,....,0 lq�` l� Subtotal: 4-7/6—. CU
o
Plan review (25% of permit fee):
Print name: GA t o el k-o L . 43 / j,4,z o Date: �j & J,, N E fr 2 State surcharge (12% of permit fee): 9' O°
Authorized signature:
/.49 / TOTAL PERMIT FEE: s (. evil'
� f " This permit application expires if a permit is not obtained within 180
r jei7-17:4_4-)
/ day s after it has been accepted as complete.
Print name: C a 1 (, /rl 4. /) `, „ �O y J /IA Dat e: 2 /a ctv-s 26/1 • Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10 4404615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information •
LIMITED ENERGY PERMIT FEES:
r 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*
► °� er:
4-ce Es s ce,v-77a0 � -
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
❑ t+ ock Systems
❑ Dat. Telecommunication Installation •
"ire Al. • Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging s ms
❑ Landscape Irrigation , on I .1*
. ❑ Medical -
❑ Nurse Calls
❑ Outdoor : ndscape Lighting*
❑ Prote • . ve Signaling
Cher ni'C t h '+'" SCGtal f
Total number of commercial systems:
*No licenses are required. Licenses are required
•
for all other installations
1:\ Building \Permits\ELC- PermitApp.dac 07/01/10