Permit
s CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2010-00015
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/27/2010
Parcel: 2S101 6000201
Jurisdiction: Tigard
Site address: 8255 SW HUNZIKER RD 203
Subdivision: Lot: 0
Project: Raven Construction
Project Description: Low voltage for voice/data.
FEES
Owner:
JOHANSON TRANSPORTATION SERVICE Description Date Amount
5583 E OLIVE AVE Restricted Energy Permit 01/27/2010 $67.84
FRESNO, CA 93727 12% State Surcharge - Electrical 01/27/2010 $8.14
PHONE:
Contractor:
AZIMUTH COMMUNICATIONS INC
P.O. BOX 508
WILSONVILLE, OR 97070
PHONE: 503-639-0110
FAX: 503-639-0115
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 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 if work is suspended for more the 180
days. ATTENTI law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00' 01 rough OAR 95 - 1-0100,ouummay obtain a copy of the rules or direct questions to OUNC by calling 503.2 69 or 1.800.3312.2344. 100, 1/ Issued Y. ( Permittee Signature: U1
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.
Mect
;rical Permit Application FOR OFFICE USE ONLY
City of Ti and V E D Received Permit No.:
D lLa0/D G~271
g Date/By: 11A 7//
° 13125 SW Hall Blvd., Tigard, OR 97 3 CT-1 1 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: Pt ~00a 3
e Inspection Line: 503.639.4175 JAN 21 2010 Date Ready/By: luris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WO OF TIGARD PLAN REVIEW
i
❑ New construction Addition/alter Wk 1'a e'meLh 11 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 separately derived system.
❑ Addition of new motor load of ❑ "A", "E", "I-2", "1-3",
Job no.: Job site address: a S5 SO ZI t IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: -7-) 614 ~2 q 72Z3 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: _)~v `3 Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description Qty. Fee. Toter
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
DESCRIPTION OF WORK (with above s q. ft. 75.00 2
h Limited energy, multi-family 75.00 2
VVi Co D residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ( TENANT 201 amps to 400 amps 106.85 2
Name: o C COO) % it C nV,/ 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
Branch circuits - new, alteration, or extension, er panel
Owner signature: Bate: A. Fee for branch circuits with
❑ APPLICANT CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: 42 l f►' t L T-4 COmo4 tt ( rWAIS B. Fee for branch circuits
Contact name: /p without service or feeder fee, 46.85 2
,g K first branch circuit
Address: ~0~- sU 53 Each add'l branch circuit 6.65 2
Miscellaneous service or feeder not included
City/State/ZIP: W J LSOA)d I tLLt= Qt2 7O7b Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (S ) 793-2 Fax: (S63) 632-0111- Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
CONTRACTOR: Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited-
~l a" 1-74 oar n u"tf/ LI•-l i?dyrS energy panel, alteration, or
Address: extension. Describe: ( Page 2 (O?'" 2
City/State/ZIP: k11`Sp-V dt Ll- Z PZ Q~22 9' Each additional inspection over allowable in any of the above
( ) l lQ (,bb 6 4 -,0 Per-inspection 62.50
Phone: Fax.
3 Investigation per hour (1 hr min) 62.50
CCB Lic.: 1-45 S28 Electrical Lic.: gCIG Suprv. Lic.:,2312- LL-`)} Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: &tt Subtotal: 7.
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): / f
Authorized signature: TOTAL PERMIT FEE: 75, g
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.
I:\BuildinglPermits\ELC-PermitApp.doc 05/23/06 440-4615T(I1/05/CONMEB