Permit I p CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I s . - COMMUNITY DEVELOPMENT Permit #: ELR2012 00243
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/29/2012
Parcel: 2S112DC00500
Jurisdiction: Tigard
Site address: 15895 SW 72ND AVE 120
Project: Watson Subdivision: FANNO CREEK ACRE TRACTS Lot: 40
Project Description: (1) low voltage for Data/Telecommunications and (1) low voltage for alarm installation
Contractor: AA TECHNOLOGIES Owner: PACIFIC REALTY ASSOCIATES
3439 NE SANDY BLVD #321 ATTN: N PIVEN
PORTLAND, OR 97232 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 888 - 756 -1151 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/29/2012 $75.00
12% State Surcharge - Electrical 10/29/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: Y 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, o 'f work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Ce J. Those rules are set forth in OAR
952 - 001 -0010 through OA 9 2- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 . 2.19 . :00.332.2344. '
Issued By: Permittee Signature: A∎ \ _
OWNER INSTALLATION ONLY I
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 RECEI FOR OFFICE USE ONLY
City of Tigard . t a /0/61411; --�,,r Permit No.: &la,,_ 6D4
1 3125 SW Hall Blvd., Tigard, OR 97223 OCT 2 9 2 i „ Review
' Phone: 503.718.2439 Fax: 503.598.1960 n+ DateBy: � OF T ■ r i : Ready/By: Other Permit:
I' I G A 1i D Inspection Line: 503.639A175 Ready/By: runs: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIV1 - 4 �r_ t •
lfied/Method: f1 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling jg 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 derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.: Job site address: 151 ! 5 - O G) 7 210 /,, 1 0 r I GO Six or or o more. Recreational ' , V ❑ Six or more residential units. ❑ Receational vehicle parks.
City/State /ZIP: Po-,rA 1,61,4 0R. i 7 2 tt ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: ) 2_0 Project name: IAA, trA/\ CL L() ❑ Service or feeder 600 amps or more.
CL l 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.)
—it/IA a IXAlits C ie./ Li r e si d energy, mu fve sq. / ` � L`V 4 b residential (with above sq. ft.) 75.00 2
((( Services or feeders installation, alteration, and/or relocation
XFENANT 200 amps or less 100.70 2
❑ PROPERTY OWNER I 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: � 2 L
� 0 I" ( 6'C. i 601 amps to 1,000 amps 301.04 2
Address: / / 1 Over 1,000 amps or volts 552.26 2
(( Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: (013) 4 3 q n il /f I Fax: ON) 6 c7 9 2 7 (.0 200 amps or less 59.36 1
(I ( 201 amps to 400 amps 125.08 2
Owner installation: This in Ilati 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, . er panel
Owner signature: Date: A. Fee for branch circuits with
g° APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: , _ , 163 } i Gi B. Fee for branch circuits without
q service or feeder fee, first 56.18 2
Contact name: �( J branch circuit
U Each add'I branch circuit 7.42 2
Address: 3 it 3 1 j o - 1.- _ f i/I . Fi��J D J ) L4 , ( - j 2 ( Miscellaneous (service or feeder not included)
Each manufacturd or modular
City/State /ZIP: D D'�/ v' ' )Z. dwelling, service feeder 67.84 2
( ,) ? `W — //J / I ( ) Rec onnect only 67.84 2
Phone: SW Fax: : 1
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
C'- ` panel, alteration, or extension. _ Page 2 2
Business name:
A"� I �° � �1 J Each additional inspection over allowable in any of the above
Address: ((// Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State /ZIP: Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Tia &f t3 I Fax1 111 i I Oi I I ((�/ Inspections for which no fee is 90.00 / hr
II specifically listed (%: hr min)
CCB Lic.: ( t) ' ,e t 31 I Electrical Lic.: 7 , ,. yVd Suprv. Lic.: y `�� Lh' ELECTRICAL PERMIT FEES
/ Subtotal:
Suprv. Electrician signature, required: 0' P Plan review (25% of permit fee):
p � r
Print name: 9 o J ` i ' �
D — State surcharge (12% of permit fee):
- TOTAL PERMIT FEE: 'List DV
Authorized si ature: ' �� � $ This permit application expires if a permit is not obtained within 180
/� Date: • days after it has been accepted as complete.
Print name:
�(JbtM y. / t JAN Number of inspections allowed per permit.
1:\Building\Permits\EL ermi • • ..doc 07/01/10 U 440-4615T(11/05/COMIWEB
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Electrical Permit Application - City of Tigard! ' , _ �„
Page 2 - Supplemental Information • • • • •- , ; •
LIMITED ENERGY PERMIT FEES:
j 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*
l _
❑ 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*
4• ❑ 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
C\ Building \Permits\ELC- PermitApp.doc 07/01/10
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