Permit a
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
.< COMMUNITY DEVELOPMENT Permit #: ELR2009 -00338
:Ti G PRIG 13125 SW Hall Blvd , Tigard OR 97223 503.639 4171
Date Issued: 10/28/2009
f ,w Parcel: 2S101CA00200
Jurisdiction: Tigard
Site address: 7904 SW HUNZIKER RD
Subdivision: Lot: 0
Project: Plas2Fuel
Project Description: Installation of (2) low voltage systems, burglar alarm and CCTV.
Owner: FEES
WALL STREET INDUSTRIAL LLC & Description Date Amount
A RICHARD VIAL EXEC CENTER LLC, 7000 SW Restricted Energy Permit 10/28/2009 $135.68
VARNS ST 12% State Surcharge - Electrical 10/28/2009 $16 28
PHONE
Contractor:
PROTECTION ONE ALARM MONITORING
15500 SW 72ND AVE
PORTLAND, OR 97224
PHONE: 503 - 624 -0244
FAX
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo N Boiler Controls N
CCTV' Y Clock Systems N
Data & Telecommunications. N Fire Alarm: N
HVAC N Instrumentation: N Total $151.96
Intercom/Paging N Landscape /Irrigation N Required Items and Reports (Conditions)
Landscape Lighting N Medical" N
Nurse Calls N Protective Signal y
Security Alarm: N Other: N
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 • -ccordance wi : • •roved 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 •TTENTION Oregon law - quir=- •. to •low the rules adopted by the Oregon Utility Notification Center. Those rules are forth in OAR
95 901 -0010 through OAR 952 -001 -0 . You may • • • - a copy of the rules or direct questions to OUNC by calling 503 246.• •99 or 1 800 332 2344
sued By: � I ` / -' 4-41 _ . / Permittee Signature: L . _ / / .ii / / �_ !�
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.
•
a
Electrical Permit Application FOR OFFICE USE ONLY
lIl City of Tigard Date /B : l0 as- Permi No.: £�� • � S 3 1
V 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ,
Phone: 503 639 4171 Fax 503.598.1960 Date/B Other Perm
TIGARD Inspection Line- 503 639 4175 Date Ready/By ® See Page 2 for
Internet www.tigard - gov Notified/Method Supplemental Information
TYPE OF WORK - PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below)
❑ New construction E A ddition /alteration /replacement
❑ 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 dwelling Er ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA ur
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.:Gl ( Job site address 1 �, ' ` v Q ,/ 100HP or more occupancy
d�S�Y 1� c G_4 tM� sl�� IJ-�1 ❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP: �p ' � 9 0 0 j Q - ❑ Health -care facilities El Supply voltage for more than
3 "" ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no Project name: ,etSa Flel ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft or less 145.15 4
Tax map /parcel no.: Ea add' 1500 sq. ft. or portion 33 40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK . (with above sq ft )
�p�,� �
�� 1r GA \ ce a. l e `( 1 lr triAl Limited energy, multi - family 75 00 2
residential (with above sq. ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ P ROPERTY 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 ❑ CONTACT PERSON above service or feeder fee, 6 65 2
each branch circuit
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
y
1 � ,xl ny circuit(s) or limited- 95. 61C
Business name. a' � /`� energy p
y pannel, , alteration, , or or , 7
Address• lG j) - 2
/� AVe ^ � ,IlX') extension Describe t Paget 2
? '
City /State /ZIP. a t C) _ c� 914' Each additional inspection over allowable in any of the above _
n Per inspection 62.50
Phone: (S) '-t _ 2 I I Fax: ( 223- a F� Investigation per hour (1 hr min) 62.50
CCB Lic.: 1q Electrical Lie.: 34_14 eS . Lie.: ash Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal . (/4
Plan revi (25% of permit fee)
Print name: / �r /` / ' A � 1 �/L: s� �o Date: G, �� Sta surcharge (12% of permit fee).
` /�
Authorized signature: , . TOTAL PERMIT FEE: T
1 This permit application expires if a permit is not obtained within 180
Print name: k I1oix ja Dat e: 1D_Z N days after it has been accepted as complete. �� �5�1 * Number of inspections allowed per permit. t
I \Bwlding\Pennns Et.C- PenndApp doe 0523/06 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
r
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
system
(SEE OAR 918- 260 -260)
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
❑ utdoor Landscape Lighting*
Protective Signaling ^^,, �� I 31 \ / 1
ther r (Of �LQfm � 1 V 1
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I UBuddmgTenutsELC- PenmtApp doe 03/23/06