Permit 3
pp! CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00071
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/14/2007
PARCEL: 1 S 126BC -01700
SITE ADDRESS: 09050 SW WASHINGTON SQUARE RD ZONING: R -40
SUBDIVISION: GEORGETOWN MANOR APARTMENTS LOT: JURISDICTION: TIG
PROJECT: GEORGETOWN MANOR
Project Description: Door holder /smoke install.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: 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: DOOR HOLD : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
MCGILL, ANITA M TRUSTEE AND METRO SAFETY AND FIRE INC
MCGILL, ROBERT ESTATE OF 7055 NE GLISAN
1662 GRAFF CT PORTLAND, OR 97213
SAN LEANDRO, CA 94577
MdI i, ANITA M TRUSTEE AND Contact #: PRI 231 -2999
MCGILL, ROBERT ESTATE OF
1662 GRAFF CT
SAN LEANDRO, CA 94577
TIMOTHY & RACHEL JANZEN, BEM & DEBORAH DOUGLA: Reg #: ELE 26-1 I54CLE
LIC 63651
0331 4L LAN_ KU, #'LUU
PeWL9496. OR 97267 Date Amount
[ELPRMT] ELR Permit 3/14/2007 $75.00
[TAX] 8% State Surcha 3/14/2007 $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 r adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OA' \ 952-0 1 -0100. Yo - mar obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued 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.
• 1
-- . DD _
Electrical Permit. Appl cation, -- : y : , ., F. .. - FOR OFFICE USE ONLY "
t �t 0 p ! Received / ii;i rint City of Tigard 1� h.s.- t ,� li ' >� .. , . - DateB : . �07 1 �-" �� ,0 — /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
' II • Phone: 503.639.4171 Fax: 503.598.160 Date/By: Other Permit:
T I G A It D Inspection Line: 503.639.4175 1 1 ' . : 21307 Date Ready /By: lw is. ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYk b1 *oak' i i Jc 1W PLAN REVIEW .
❑ New construction X, A dliltiitiTal e'tta )o'rGeplaa 3ifetT�1 `''; Please check all that apply (submit 2 sets of plans wiitems 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 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 ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 1001W or more. occupancy.
S Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: T iC � ne • Q — � Z �
� �`• ` 4 - ❑ Health -care facilities. ❑ Supply voltage for more than
7 ` ry] ❑ Hazardous locations. 600 volts nominal.
N
Suite /bldg. /apt. no.: Project name: Gep au \ / I R El Service or feeder 600 amps or more.
T � FEE SCHEDULE
Cross street/directions to job site: S w t Description I Qty. i Fee. I Total 1 •
"`+t 11 • Qty. 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'l 500 sq. ft. or portion 33.40 l
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
I 'boo / �7 /� Limited energy, multi - family 75.00 2
M AJ'C.JQ"t c, B a° 04,24& /SYYI n t.e. 7ivS ` residential (with above sq. ft.)
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 /GIP: 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
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: T B. 19912 TfLO S Ps °_ 1 4r B Fee for branch circuits
without service or feeder fee,
Contact name: m A r .S first branch circuit 46.85 2
Address: y3 ay S S•i•A -R s7-. Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: p 1.1 �k N� ni 2. A Z33 Each manufactured or modular 90.90
2
dwelling, service and/or feeder
Phone: (w3 ) a3' _ Z9g9 Fax: : (e,3 ) 6,1 ( / . Reconnect only 66.85 2
E -mail: /» 4.2C Q al a ,.a SikreAf •A W 0 Pi Ala ? Pump or irrigation circle 53.40 2
CONTRALTO Sign or outline lighting 53.40 2
o Signal circuit(s) or limited -
Business name:
1 \ m a nt° s14 4:4— p, /l a ! �.L N C • energy panel, alteration, or
Address: J k (3 L S E S�?grQlC sr . extension. D + Page 2 2 ILL ea- S-
City/State /ZIP: 2- 33 it I (g) Each additional inspection ov r allowable in any of the above
�� ��I ` A� I O Per inspection 62.50
Phone: (5)3) o3 I_ ICI Fax: ( ) / Investigation per hour (1 hr min) 62.50
L- CCB Lic.: (3651 Electrical Lic.: 31 LE 1 4 Suprv. Lic. :_ 7/ o l _' 0-itue Industrial plant per hour 73.75
�� ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 04-Q� Subtotal:
Print name: ► � 1 F i r �. Date. Plan review (25% of permit fee): -
3-/-0 y 7 State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
•• Number of inspections allowed per permit.
I:\Building \Permits \ELC- PermitApp.doc 05/23/06 440- 4615T(t 1/05 /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:
❑ 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- 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
r
•
❑ Nurse Calls • t ,
❑ Outdoor Landscape Lighting*
•
❑ Protective Signaling
111: Other ,
Total: number of commercial systems:
*No licenses -are required. 'Licenses -are required
for all other installations
I: \ Building \Permits\ELGPermitApp.doc 03/23/06,