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Permit • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 1 COMMUNITY DEVELOPMENT Permit #: ELR2012 -00166 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/31/2012 Parcel: 1 S 135ACO2500 Jurisdiction: Tigard Site address: 9160 SW MANDAMUS CT Project: Reserve at Ashbrook Subdivision: ASHBROOK FARM Lot: 25 Project Description: (1) signal circuits or limited energy panel for fire alarm system Contractor: WESTERN STATES FIRE PROTECTION Owner: J.T. SMITH CO 13896 FIR ST STE B 5285 MEADOWS RD SUITE 171 OREGON CITY, OR 97045 LAKE OSWEGO, OR 97035 PHONE: 503 - 657 -5155 PHONE: 503 - 975 -7639 FAX: 503 - 657 -5182 FEES Description Date Amount Specifics: Restricted Energy Permit 07/31/2012 $75.00 Type of Use: O f T 12% State Surcharge - Electrical 07/31/2012 $9.00 l Class of Work: ALT 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 a d 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Centel Those rules are set forth in OAR 952- 001 -0010 through OAR 9 2- 001 -00 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987\•r 1.800.332.2344. Issued By: Permittee Signature: 40111110M1-� 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 FOR OFFICE USE ONLY City of Tigard Received 2— Permit No.:g a„O021/5( NI q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 0 D0O3 ` . - Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Perm ,d ") — 7 T I G A R D Inspection Line: 503.639.4175 Date Ready /By: la See Page 2 for Internet: www.tigard - or.gov Notified/Method: IMMI Supplemental Information TYPE OF WORK PLAN REVIEW constructionAdditi n /alteratio /rep acement 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. D emolition 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- d 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. � ulti- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or V' ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E "I -2 ",' 1 -3 ", Job no.: Job site address: q i /-b M�� ON&u C� I Six or or more residential R occupancy. Recreational P 'f� tJ � 0 or more residential units. ❑Recreational vehicle parks. City /State /ZIP: -' kq� 0 2 G -7723 ❑Health care facilities. 0 Supply voltage for more than l ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: (Z %U,.,N( Prc k j Q-pp l e_ ❑ 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 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 00 2 l I WI E `t6 micati. 9 , q " s residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 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 Temporary services or feeders installation, alteration, and /or City/State /ZIP: 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 S APPLICANT I 'CONTACT PERSON above service or feeder fee 7.42 2 each branch circuit Business name: v 5--(0,.. 0 kcit,-S'-‘01..( B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: u 1( I M) V<INVO branch circuit d Each add'l branch circuit 7.42 2 Address: 1 0 llo El 'ft. ST, StA' I" g Miscellaneous (service or feeder not included) City/State/ZIP: (� Each manufactured or modular 67.84 2 tY © (Lp}k �� 0 ( I���S dwelling, service and/or feeder Phone: (5p3 ) ( _St 5 c Fax: : ( 5113 ) 6S-) - S \ 61— Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: SCo# err WS Sign or outline lighting 67.84 2 _ CONTRACTOR Signal circuit(s) or limited energy r ')5.61, p� n� panel, alteration, or extension. ` Page 2 2 Business name: <ckw, A5 f��NJ6 . /oh /I Each additional inspection over allowable in any of the above E , Address: �i.f Additional inspection (I hr min) 66.25/ hr City /State /ZIP: 1- 1� �Y 074, � Investigation (I hr min) 66.25/ hr "" lll u� . Industrial plant (1 hr min) 78.18/ hr Phone: ( ) ,k Fax: ( ) 4 ' / "l � LOA Inspections for which no fee is 90.00/ hr specifically listed (V2 hr min) CCB Lic.: i 0 1 -1 � (D �Electrical Lic.: t ILA Suprv. Lic.: ELECTRICAL PERMIT FEES [�l.L ,J Subtotal: "1S.Oo Suprv. Electrician signature, required: 7 �. EA "I NS 3 Plan review (25 %ofpermit fee): Print name: S fp -ii pu k Date: l 3i `Zp1'L State surcharge (12 %of permit fee): Ci l TOTAL PERMIT FEE: � 0O AUthorlZed Signature: T his permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: S c 0p .t % l Date: t ' \ \20 12 • Number of inspections allowed per permit. 1:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440 I /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: El Audio and Stereo Systems* El Burglar Alarm E l Garage Door Opener* El Heating, Ventilation and Air Conditioning System* El Va - • Systems* M Other: � P —. /, • COMMERCIAL WO ' . ONLY: Fee for each com t • • rcial $75.00 system • AR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems El Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation Fire Alarm Installation ❑ HVAC El Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* El Medical El Nurse Calls El Outdoor Landscape Lighting* El Protective Signaling El Other Total number of commercial systems: f *No licenses are required. Licenses are required for all other installations I:\Building\Pennits\ELC- PermitApp.doc 07/01/10