Permit o- y f• 1 t- V
A .
CITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
i DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00236
A �J I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/28/2006
PARCEL: 1 S135AB - 00100
SITE ADDRESS: 10350 SW LINCOLN ST ZONING: R -4.5
SUBDIVISION: TOWN OF METZGER LOT: 005 JURISDICTION: TIG
Project Description: METZGER SCHOOL: (1) smoke detector, (1) horn stobe.
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: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD TUALATION SCHOOL DIST #23J SIMPLEXGRINNELL
6960 SW SANDBURG ST 6305 SW ROSEWOOD
TIGARD, OR 97223 LAKE OSWEGO, OR 97035
Phone: Contact #: PRI 503= 693 -9000
FEES Reg #: ELE 26- 946CLE
LIC 149921
Description Date Amount
[ELPRMT] ELR Permit 9/28/2006 $75.00
[TAX] 8% State Surcha 9/28/2006 $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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
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.
•
Electrical Permit Application• • FOR 1)PFILL IISE (1N1.\
City of Tigard o ; ivVed, S Li I . 1
° 13125 SW Hall Blvd., Tigard, OR 97223 h EC E V E I an Review
: C Phone: 503.639.4171 Fax: 503.598.1960 Date/B . Other Permit: '
Tl G n u D Inspection Line: 503.639.4175 S E P 2 8 2006 Date Ready/By. IIM ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method Supplemental Information
TYPE OF WOR CI T C7 T :GAnD PLAN REVIEW
1II1 r3li\I0 I111VISIQN
❑ New construction 5 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 ® 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 -2 derived system.
A
❑ Additioo of "A
Addition of new motor load of ❑ "A", , "EE"", , " "11 -2 "", , "I -3 ",
• Jobno.�,2(fpgog I Job site address: lass' so 9D Ave, Six or occupancy.
+�
❑ ❑ Six or more residential units. Recreational vehide parks.
City /State/ZIP: T'4 / 972 ` 3 ❑ Health -care facilities. ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: keze (a, 66yewitil.qe ❑ Service or feeder 600 amps or more.
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'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.)
Limited energy, multi - family 75.00 2
4b I St43 - -Tarr 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/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 I ❑ 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
� � ,� , p
Signal circuit(s) or limited -
Business name: l�d�
energy panel, alteration, or
Address: ts2Se c .urelb --• extension. Describe: Page 2 7< - 0 0 2
City/State/ZIP: (.A M(JJE_4� be_ 9708 S' Each additional inspection over in any of the above
,
SrO5 6 • 9000 Fax: (5'.3) Investigation 62.50
Phone: (
975' �� Investigation per hour (I hr min) 62.50
CCB Lie.: (y-99Z( Electrical Lie. - ,( Suprv. Lic.: S) tEA Industrial plant per hour 73.75
• ELECTRICAL PERMIT FEES
Suprv. Electrician signature, requir Subtotal: 45 ' S -
. Print name \`c 1 t '� "" — — . Date: 9 , �8 •((jJ Plan review (25 %ofpermit fee):
`�`^ State surcharge (8% of permit fee): L •
Authorized signature: TOTAL PERMIT FEE: 2, l • 00
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. n U
1:\ Building Wermita\ELC- PemitApp.doc 05/23/06 4104615T(I I /05 /COM/WEB / 4 y . /
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:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
•
El 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
El Clock Systems
El Data Telecommunication Installation
▪ Fire Alarm Installation
El HVAC
El Instrumentation
• ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:' BuildingTamia\ELC- PmnitApp.doe 0323/06