Permit
n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2010-00009
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/20/2010
Parcel: 1 S136CDO1000
Jurisdiction: Tigard
Site address: 11745 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Aarons Furniture
Project Description: Install restricted energy for cameras.
FEES
Owner:
MONAGHAN FARMS, INC Description Date Amount
14120 EAST EVANS AVE Restricted Energy Permit 01/20/2010 $67.84
AURORA, CO 80014 12% State Surcharge - Electrical 01/20/2010 $8.14
PHONE:
Contractor:
HECKTEC TECHNICAL LLC
3484 HILLSIDE CT
HUBBARD, OR 97032
PHONE: 503-572-1938
FAX: 503-982-4823
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: Y Clock Systems: N
Data & Telecommunications: N 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 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 in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or it work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through O R 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 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' ' 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.
z,r",011, /2010 WED 10:48 FAX 503 982 4823 Woodburn Ambulance 0001/002
ElectricalTermit Application C
City , 0 Tigard Received
(a Date/By: PermitNo.:
• 13125 SW Hall Blvd., Tigard, OR 97223 ` 1 plan Review O
Phone: 503:639.4171 Fax: 503.598.1960 DateB : Other Permit:
a Inspection Line: 503.639.4175 2 C AO Date Ready/By: J Ir : See Page 2 for l(J
Internet: www.tigard-or.gov Notifled/Method: SupplementalInformafroa
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans whiems 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
❑ I- and 2-family dwelling gCommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 7s "A or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "1-2", °1-3",
I C r 100HP or more. occupancy.
Job no,: Job site address: l7
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
„ Desrri lion 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.: Lunited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 6T84 2
Limited energy, nmlti-family 67.84 2
residential (with above sq. ft.
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ 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 sate, 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,
L LC each branch circuit 7.42 2
Business name: L l LLC B. Fee for branch circuits
wiihout service or feeder fee,
Contact name: i (Cr fast branch circuit 56.18 2
Address: 3qui ~ Each addl branch circuit 7.42 2
t^ Miscellaneous service or feeder not included)
City/State/ZIP: 66 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) 6101,- t ga _ Fax:: ( 5_b3)gl~a - _46603 Reconnect only 67.84 2
E-mail: e s com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited-
Business name:
energy panel, alteration, or r p
Address: extension. Describe: l Page 2 0101 2
City/State/ZIP: Each additional ins eetion over allowable in any of the above
Per inspection 66.25
Phone:( ) Fax:( )
Investigation per hotu (1 hr min) I66.25
CCB Lie.: Electrical e.: u rv. Lie.: CLe q Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, require Subtotal:
r
Print name: ~^V Plan review (25% of permit fee):
~ ~ Q Date: ~ ~ ! ~ O
State surcharge (12%ofpermit fee): r
Authorized signature: TOTAL PERMIT FEE: 75• q
D This permit application expires if a permit is not obtained within 180
Print name: e{ Q Date: (U days after it has been accepted as complete.