Permit
q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2010-00022
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/03/2010
Parcel: 1 S136AD04000
Jurisdiction: Tigard
Site address: 11505 SW PACIFIC HWY D
Subdivision: Lot: 0
Project: Holistic Pet
Project Description: Low voltage for data.
FEES
Owner:
NORRIS STEVENS Description Date Amount
621 SW MORRISON #800 Restricted Energy Permit 02/03/2010 $67.84
PORLTAND, OR 12% State Surcharge - Electrical 02/03/2010 $8.14
PHONE: 503-223-3171
Contractor:
BRY-COM
14244 SE BUSH
PORTLAND, OR 97236
PHONE: 503-761-5156
FAX: 503-760-7501
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom/Paging: N Landscape/Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issue ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be clone l de with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
daregon law r Tres you to follow the rules adopte d by the Oregon Utility Notification Center. Those rules re set forth in OAR
95AR 952-rules or direct questions to OUNC by calling 503.246.6 oo 1.8000,332.23
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 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.
-tleiltrical Permit Application FOR OFFICE USE ONLY
City of Tigard DateBea ~U PermitNo.: 43290 v~t
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review & ?A0 ,9- OO
Phone: 503.639.4171 Fax: 503.598.1960 Date1B : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: ®See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction El 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 E@ 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
❑ I- 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: P95- ) C 100HP or more. occupancy.
_ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
16 G7 ❑ Service or feeder 600 amps or more.
Suite/bldg./apt. no.: Project name: Hc) Z) (V J / L
FEE SCHEDULE
Cross street/directions to job site: Description t . Fee. Total
New residential.single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK with above sq. ft. 67.84 2
a~ 9 'q,l Limited energy, multi-family
^~5~ l~~Qrr~~( (.Jl (l~s C/~~ residential with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
El PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
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 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
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,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
Miscellaneous service or feeder not included
City/State/ZIP: Each manufactured or modular dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Signal circuit(s) or limited-
energy panel, alteration, or
Address: Z/ I/ S q extension. Describe: I Page 2 7, g 2
City/State/ZIP: 7 46 W~ t f2_3 Each additional inspection over allowable in an of the above
(~3) ~(r 675-4, &3 4a - _,,33 Per inspection 66.25
Phone: Fax:
~ Investigation per hour (1 hr min) 66.25
CCB Lic.: Electrical Lic.: 5- u v. Lic : 3~('!SA Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Elec ician signature, req re (Ilp4.~VA4 ~~~1 tl Subtotal: 8
Print name: ~~~/S I Da e: -7 3 Plan review (25% of permit fee):
State surcharge (12%ofpermit fee): 1.14
Authorized signature: TOTAL PERMIT FEE: 75. 9$
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.
1:~3uilding\Permits\ELC-PermitApp.doc 10/01/09 440-4615T(II/05/COM/WEB
Electrical Permit Application - City of Tigard .
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for a residential systems combined $67.84
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 $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ H VAC
❑ I nstrumentation
p Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
,*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09