Permit 1
pet CITY OF TIGARD I ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT
PERMIT #: ELR2006 -00279
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/15/2006
PARCEL: 2S11380
SITE ADDRESS: 16060 SW 85TH AVE ZONING: I -
SUBDIVISION: SEWER TREATMENT PLANT LOT: JURISDICTION: TIG
Project Description: Installation of audio /video system in conference room.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
CLEAN WATER SERVICES DELTA SYSTEMS INTEGRATION INC
2550 SW HILLSBORO HWY 4040 SE INTERNATIONAL WAY STE
HILLSBORO, OR 97123 -9379 MILWAUKIE, OR 97222
Phone: 503 -681 -3600 Contact #: PRI 503- 786 -3733
FAX 503- 786 -3803
FEES Reg #: ELE 26- 923CLE
LIC 113213
Description Date Amount
[ELPRMT] ELR Permit 111151200E $75.00
[TAX] 8% State Surcha 11/15/200E $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility ion- Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules r direct questions to t 0 C - 503.246.6699 or 1.800.332.2344.
Issu d 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'N: 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. /,
/
(
,ctrical Permit Applica EIVE FOR OFFICE USE ONE)
Received � .
'Cify of Tigard Date/By 4 Permit Not
13125 SW Hall Blvd., Tigard, OR 9715 \; .( . 2006 Plan Review/
Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit:
Inspection Line: 503.639.4175 CAIN OF r I GARD Date Ready/By: June: 0 See Page 2 for
T I C A R D , Notified/Method Supplemental Information
Internet: www.tigard- or.gov ' LlILDIN DIutSI.0 �
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w/items checked below):
El New construction ❑ Addition/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 ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ". 'T "1 - "1 - ".
IOOHP or mote. occupancy.
Job no.: Job site address: /6660 5Lt-\ gl5 de . -- . ❑ Six or more residential units. ❑Recreational vehicle parks.
❑ Health -care facilities. ❑ Supply voltage for more than
City/State/ZIP: • t � 0 C� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: e 1 j e) ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Taal I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: 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.)
` 1 ` Limited energy, multi- family 75.00 2
.} • 1:N& f\l r tV . I V I C S 'fS1 residential (with above sq. ft.)
oo�st Services or feeders installation, alteration, and /or relocation
n CO Yl v 'C11 200 amps or less 80.30 2
❑ PROPERTY OWNER I . ❑ TENANT • • • - 201 amps to 400 amps 106.85 2
Name: C. 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
tY relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 l
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
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, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: 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 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
• S
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name:) A �y.51 L' energy panel, alteration, or
� 5 L/' r�' extension. Describe: Page 2 2
Address: Li O L I 'J s ; i :tie) Av -' \ '# ( c l o Ain,' c /% DE.�
City/ State/ZIP: rn\ ) W nv. 14t oc 7 / Each additional inspection over allowable in any of the above
l Per inspection 62.50
Phone: (6Q)) 1 216 - *3 Fax: ( A Investigation per hour (1 hr min) 62.50
CCB Lie.: (r3ra 13 Electrical Lica - 3 Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: -7/i / Subtotal: 7 S
Plan review (25% of permit fee):
Print name: / 1D So.py3.444.
Date: State surcharge (8% of permit fee): 4,
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
• Print name: "S L-p �;-,� Date: days after it has been accepted as complete.
K • Number of inspections allowed per permit.
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