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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT III - q a._ - COMMUNITY DEVELOPMENT Permit #: ELR2013 -00140 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 06/25/2013 Parcel: 2S110AB00200 Jurisdiction: Tigard Site address: 14385 SW PACIFIC HWY Project: Harbor Freight Tools Subdivision: CANTERBURY PLACE, AMENDED Lot: PTS 1-4 Project Description: Low voltage for voice & data, also pulling wire for 6 speakers. Per Mark, ok as (1) system. Contractor: NORDISK SYSTEMS Owner: KOLVE, G C 6400 SE LAKE RD #450 14389 SW PACIFIC HWY MILWAUKIE, OR 97222 TIGARD, OR 97224 PHONE. 503 - 252 -1462 PHONE FAX: 503 - 252 -2343 FEES Description Date Amount Specifics: Restncted Energy Permit 06/25/2013 $75 00 12% State Surcharge - Electrical 06/25/2013 $9 00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo 0 Boiler Controls. 0 CCTV' 0 Clock Systems: 0 Data & Telecommunications: 1 Fire Alarm: 0 HVAC 0 Instrumentation. 0 Intercom /Paging: 0 Landscape /Irrigation: 0 Landscape Lighting: 0 Medical: 0 Nurse Calls 0 Protective Signal' 0 Security Alarm: 0 Other: 0 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 i cordance wit = •prov - = •lans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days ENTION Oregon la . requires ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 1 -0010 thr.ugh OAR 95 101 11 1 may obtain a cog of the rules or direct questions to OUNC by calling 503.232 1987 or 1.800 332 2344. I sued 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' 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 Applicati E D FQR orricE usr• ONi III City of Tigard Dat ° v � Permit No . • - —46.) ° 13125 SW Hall Blvd , Tigard, OR 972 N 2 5 13 Plan Review ' - .: Phone. 503.718.2439 Fax: 503.5}1 DateBv Other Permit T I G A R D Inspection Line: 503.639 4175 1.11 i OFTIGARD Date Ready/By. Axis ® See Page 2 for Internet: www tigard- or.gov BUILDING DIVISION 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 more ❑ Building over three stones ❑ 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 El 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 denved system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", Job no.: Job site address: )1/385 SLLJ �� C- I>, . c No I OOHP or more v ❑ Six or more residential units occupancy ts ❑ Recreational vehicle parks. City /Stale /ZIP: I 6-4/144 2 ❑ Health-care facilities. 0 Supply voltage for more than �� q L � � ❑ Hazardous locations. 600 volts nominal Suite/bldg. /apt. no.: Proj ct name: ,L � ) t' •IP , t �r ❑ Service or feeder 600 amps or more. / FEE SCHEDULE " Cross street/directions to job site: Description Qtv I Fee. I Total New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft or less 168 54 4 Tax map /parcel no.: Ea add'I 500 sq ft or portion 33 92 I Limited energy, residential 75 00 2 ' ∎ DESCRIPTION ';OF WORK ' • (with above sq. ft ) a Limited energy, multi- family 1 W o � 1© /6 (o;ce., 004-7-4,-- residential (with above sq ft.) 75.00 2 � 9 �� Q Services or feeders installation, alteration, and/or relocation 6 5p QAtty i - 1[J 0••CL �vp 200 amps or less 100 70 2 ❑, PROPERTYipWNER , ' I, NANT v 201 amps to 400 amps 133 56 2 401 amps to 600 amps 200 34 2 Name: 601 amps to 1,000 amps 301 04 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 I 201 amps to 400 amps 125.08 2 Owner installation: This installation 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, per panel Owner signature: Date: A Fee for branch circuits with ❑ APPLICANT ❑ CONTACT ',PERSON above service or feeder fee 7 42 2 • each branch circuit Business name: B Fee for branch circuits without service or feeder fee, first 56 18 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67 84 2 Pump or irrigation circle 67 84 2 E - mail: Sign or outline lighting 67 84 2 CONTRACTOR Signal circuit(s) or limited- energy �� f panel, alteration, or extension C Page 2 7s 2 Business name: N�k is K S <j ream_s Each additional inspection over allowable in any of the above Address: C Ln® .C6 ' 14-lee- - t24 , 11 1, 5p Additional inspection (1 hr min) 66 25/ hr r �" r Investigation (1 hr mm) 66 25/ hr City/State /ZIP: t / / J ' �1%� i e O ' Q" 72 2- Z Industrial plant (1 hr mm) 78 18/ hr Phone: To 3) 7-5 7-5 L(� •- i Fax: (, f ` ) a, L_. 2 2 vl 3 Inspections for which no fee is 90 00/ hr J specifically listed (V2 hr min) CCB Lic.: 1956 6 Z') Electrical Lic.: (E 2 9 2 Suprv. Lic.: 17 8812,9 • ELECTRICAL 'PERMIT FEES , , � Subtotal: Suprv. Electrician signature, required: 7 5 Plan review (25% of permit fee): Print name: - - , :c: , ,,,_ Date S tate surcharge (12% of permit fee): 9.0° TOTAL PERMIT FEE Its 3 60s � "6 7 - 9 ?S 1� oc, Authorized signature: � 1/4/6/-z_ This permit application expires if a permit is not obtained within 180 Print name: Date: j days after it has been accepted as complete. g Num of inspections allowed per permit. I \Building\Permits\ELC- PermitApp doc 07/01/10 440- 4615T(11/05/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: El Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* El Other: COMMERCIAL WORK ONLY: Fee for each commercial . $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: El Audio and Stereo Systems ❑ Boiler Controls El Clock Systems fgl ,_ Data - Telecommunication Installation El Fire Alarm Installation El HVAC ❑ Instrumentation El Intercom and Paging, Systems El Landscape' Irrigation Control* El Medical 1 l El Nur Calls El Outdoor Landscape Lighting* r , El Protective Signaling • ❑ . Other ,Total number of commercial systems: *No-licenses are required. Licenses are required for all other installations 1\ Building\Permits\ELGPcimitAppdoc 07/01/10 •