Permit I(
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 �. ' COMMUNITY DEVELOPMENT Permit #: ELR2009 -00265
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2009
Parcel: 2S112DD00701
Jurisdiction:
Site address: 15800 SW UPPER BOONES FERRY RD 120
Subdivision: Lot:
• Project: Jonathan Plant DVM
Project Description: Installation of low voltage for data
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 08/18/2009 $75 00
#300 12% State Surcharge - Electrical 08/18/2009 $9.00
PHONE
Contractor:
8TH DAY COMMUNICATIONS
33712 E HISTORIC COLUMBIA RIVER HWY
CORBETT, OR 97019
PHONE: 503- 740 -3870
FAX:
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls N
CCTV: N Clock Systems: N
Data & Telecommunications y Fire Alarm: N
HVAC. N Instrumentation: N Total $84.00
• Intercom /Paging:' N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical N
• Nurse Calls: N Protective Signal N
Security Alarm. N Other: N
Other Desc'
This permit :is issue subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and II.- they applicable law .1111 work will
be done accordance wi approved • ans This permit will expire if work is not started within 180 days of issuance, ovi rwork is suspended for more 't e 180
days ATTENTION' Oregon I. r =• uire you • follow the rules adopted by the Oregon Utility Notification Ce er. Those riffs are set forth I R
95 01 -0010 through OAR 952 -01 1100 u obtain a copy of the le or direct questions to OUNC by calling 503.24 699 or 1 800 332.234 .
I ued By: 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 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. -
•
Elegrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received 0 , O G Permit No L [.IG 9 QQa�s
Date/By U /
13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
Phone 503 639 4171 Fax 503 598 1960 Date/By Other Permit
Inspection Line 503.639.4175 Date Ready/By turf El See Page 2 for
Internet: www tigard or.gov Notified/Method e4 Supplemental Information
TYPE OF WORK PLAN REVIEW
El 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
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling pa Commercial /industrial ❑ Accessory 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 denved system.
yy �� El of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address �I -s 1.0 u.Pl�ti'/� e ex-17 100HPormore occupancy.
��D y h� a a ❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP: o . /, '1 / v / ❑ Health -care facilities ❑ Supply voltage for more than
�t �� N </ / ��' \ \\ ❑ Hazardous locations 600 volts nominal
Suite/bldg./apt. no.: ProJec ame. re
Pk/ 4f - ❑ Service or feeder 600 amps or more
�/ FEE SCHEDULE
Cross street/directions to job site: D�r'/' A /✓ ,,, J i (_ Description I Qty. I Fee. I Total I •
(S' /!7 s/ New residential single- or multi - family dwelling unit.
;akW Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft or less 145 15 4
Ea. add'I 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 )
/-0 u/ �o)l('��i �' — ^ ` ^ Limited energy, multi-family
f
1 l
v/' �/ /) T ({°r residential (with above sq ft ) 75 00 2
( // Services or feeders installation, alteration, and/or relocation
�� 200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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: ( ) I 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, 6 65 2
r / each branch circuit
Business name- i�a y '• ( C� i , A�� B Fee for branch circuits
Contact name: / without service or feeder fee,
y--A
� f G f ( 6K— Y 5 �� first branch circuit 46.85 2
Address: C 14.u) Each add'l branch circuit 6.65 2
3 yi r �� �/L C f7 t fJ � Miscellaneous (service or feeder not included)
City/State/ZIP: r ,, ,., g � J' / 9 Each manufactured or modular 90 90 2
Phone: ( ��✓
5,,, C �) 2 ,^ 0 q ' 7 Fax:: Reconnect me, service and/or feeder
J ( ) r Reconnect only 66 85 2
E -mail: IQ p y Ii . fj4 0 �d f J` / / i_e Pump or irrigation circle 5340 2
CONTRACT Sign or outline lighting 53.40 2
Q� Signal circuit(s) or limited -
Business name:
(' y �. C /. ,,, ,_e__, C CI l
� / �(f energy panel, alteration, or J [�
Address: 5� ,,,, Q`l —, l 6?, L extension Desc „.� l Page 2 7J 2
City /State /'LIP: / D g 6 Each additional inspection over allowable in any of the above
'� ` / / Per inspection 62 50
Phone 5,N Far `u N p
( 1 �� 4(3 ( ./ t 1.1:‘ . Investigation per hour (I hr mm) 62 50
CCB Lic.: 4 Electrical Lic.: ' uprv. L. / C Industrial plant per hour 73 75
•
�' L ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: • ��j / Subtotal: '? ••
I
�' Plan review (25% permit fee
\ v Printname:e }r 1 L A� S 't ✓ . I / P ate: �/ ��9 o p ): .tea
L )' State surcharge (12/0 of permit fee):
Authorized signature: e, I bl / , TOTAL PERMIT FEE t / .00
Zi This permit application expires if a permit is not obtained within 180
Print name: C / ! Date:
1 _e C .;, / of after it has been accepted as complete.
• Number of inspections allowed per permit
I.\ Bwlding\Permits\ELC- PermitAppdoe 05/23/06 440- 4615T(II /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: 1
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:
*No licenses are required. Licenses are required
for all other installations •
I.\BuddingWermus\ELC- PermItApp doc 03/23/06