Permit .,v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT . PERMIT #: ELR2007 - 00148
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/17/2007
PARCEL: 1 S 135AA -05600
SITE ADDRESS: 08753 SW MAPLE CT ZONING: MUE -
SUBDIVISION: MAPLE RIDGE ESTATES LOT: 011 JURISDICTION: TIG
• PROJECT: MATHEWS
Project Description: Installation of all encompassing low voltage.
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: LL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL #.OF SYSTEMS:
Owner: Contractor: •
SEAN MATHEWS OWNER
8753 SW.MAPLE CT
TIGARD, OR 97223
Phone: 503 - 804 -7642 Contact #:
FEES Reg #:
Description Date Amount
[ELPRMT] ELR Permit 5/17/2007 $75.00
[TAX] 8% State Surcha 5 /17/2007 $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 rules adopted by the Oregon
Utility Not ' : '. : Ater. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
' rules t direct questions .. O . at 503.246.6699 or 1.800.332.2344.
Is-ued By: l " 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.
Electrical. Permit Application FOR OFFICE USE ONL •
{" Received 5-- / 7 c 7 GA t Q 9 v7 4'
" Qt7/ �
City of Tigard Date /By: Permit No. F-P� T
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' I Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready /By: lurts See Page 2 for
Internet: www.tigard - or.gov Notified/Method: / .. 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 mute ❑ 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.
• D Addition of new motor load of ❑ "A ", "E ", "I - ",' l - ",
Job no.: Job site address: J(' 7 5`"3 S wrncp C I Six or or a residential R occupancy.
0 or more residential units. ❑Recreational vehicle parks.
City /State /ZIP: / '�/ �j 7 ❑ Health -care facilities. ❑ Supply voltage for more than
�' t� `� / 2 2 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: L a IJ V e o /Shc� Are
pi ' ❑ Service or feeder 600 amps or more.
J^/ 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 145.15 4
Ea. add'l 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.)
��" • / " Limited energ multi - famil 75.00 2
I n S 4p ti G l vc l trail,( A,k el ro is 014 ✓ tell s peacet.// 6 v7 . residential (with above sq. ft.)
/ / Services or feeders installation, alteration, n. /or relocation
/
Lo w U� I k Solt J 200 amps or less 80.30 2 •
PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 106.85 2
• Name: ,, , �� �QWs 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 87 S 3 St.) merle C/4-- Over 1,000 amps or volts 454.65 2
City/State /ZIP: ._✓ a4fJ Q n q 7 'L Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( go3) toci 76 ( Z 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, ren , r exchange, a cording to ORS 447, 449, 670, and 7 1. 401 amps to 599 amps 133.75 2
Owner signature: _ Date: S 0-7 Branch circuits - new, alteration, or extension, per panel
A. Fee for•branch circuits with
❑ APPLICANT ❑ CONTACT PERSON' above service or feeder fee,
each branch circuit 6.65 2
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
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
•
Signal circuit(s) or limited -
Business name: energy panel, alteration, or
Address: 0160/2 ex f AeO M � Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (I hr min) 62.50
CCB Lie.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
ectrician sI a e, reqired: Subtotal: op
tnt Date: Plan review (25% of permit fee): /
State surcharge (8% of permit fee): CY•
Authorized signature: TOTAL PERMIT FEE: 8- /.. C°
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
r\ Building \Permits\ELC - PermitApp doc 05/23/06 440- 4615T( I I /05 /CO.M/WEB
Electrical Permit Application - City of Tigard
-
Page-2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL NIVORICONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
1=1. Audio. and Stereo Systems*
, .
Burglar Alarm .
0 . Garage Door Opener?* •
111 Heating, Ventilation arid Air Conditioning System*
- Ej Vacuum Systems*
Ir4ther: AL gie_ev-iiel3i/r•la •
, COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system '
(SEE OAR 918-260-260)
Check Type: of Work Involved:
El Aildi6 and SiereaSystems •
fl Boiler Controls
El Clock Systems
Data Telecommunication Installation .
El Fire;Alarm Installation
El HVAC •
El Instrumentation
El Intercom:and Paging Systems
El Landscape Irrigation Ciintrol*
1111
Medical. •
El : Nurse Calls
El •
Outdoor. Landscape Lighting*
El Protective Signaling -
El Other . •
Total tiumher ofcornmerdal systems;
*No licenses are required. , Licenses are required •
for all:otherinStallations
I: \BuildingTermits \ELC-PennitAPp doc 03/23/0 • •
•