Permit -- A
CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
LOPME T SERVICES PERMIT ELR2006 -00213
6411, ®ESE DATE ISSUED: 9/11/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1 S125CD 08800
SITE ADDRESS: 07530 SW RED CEDAR WAY ZONING: R -4.5
. SUBDIVISION: JACKSON WOODS LOT: 003 JURISDICTION: TIG
Project Description: All encompassing •low voltage.
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: OUTDOOR LANDSC'LITE
OTHER: LL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER
TOTAL, #'OF SYSTEMS:
Owner: Contractor:
JACK LYON OWNER
7530 SW RED CEDAR WAY
TIGARD, OR 97223
Phone: 503- 236 -2202 Contact #:
FEES Reg #:
Description Date Amount
[TAX] 8% State Surcha 9/1`1/2006 $6.00
[ELPRMT] ELR Permit 9/11/2006 $75.00 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 arerset 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 41s. . ` Permittee Signature: JILL / .. 1 --:, -
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 L pilfa>k O l N ® Z � $ a x P " " "4 ^ � ¢� �'` n �> s "' P,.c s t '"u yx'�."'.1 l 5 + G] c 'p ( i � tti3 t ' ,.
, I _e rr ; 1 O12�,O I IGL III SLNOi\I 1 � i � a . .
� K'R 3 1ty U f Tlgard ■ C 2006 Re e/B e, ��✓ / > r ' . .. Permit No . /.. - .. I1 ° = ®1'
t a . ° 13125 SW Hall Blvd:, Tigard, OR 9 22 Plan Revi
" l � Phone: 503.639.4171 F pme/g Other Permit: a 3
JO G A K U Inspection Line: 503 Date _ Read y B y : ; El See Page 2:for
r4 T'ati,.ilise , Internet: www.tigard - or. DING DIVISION Notified/Method:- Supplemental Information.
TYPE OF WORK • 4._ ie: , a1; _ , e ." PL' AN REVIEW 3; , ?:'
❑ 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 stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
A9 ^CATEGORY OF CONSTRUCTION • eV, r exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
3i"b. �..m M o .., '?�z,�. i s{` . ,iu'.''1 . »� :.�r„ �: ... .. .. r _ ss i @r x `,'@ °s," .z
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
s x „, ❑ Emergency system. larger separately derived system.
.' r -1 ., JO s 1NFORMA�TION : AND - LOCA TION .a ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: 7530 5u) 1ZeD (I'��(�✓ 100tP or more. occupancy:
❑
I'Ti T ❑Six or more residential units. Recreational vehicle parks.
City/State/ZIP: -dry ,` Q ?� ❑Health-care facilities. ❑ Supply voltage for more than
`�f�Q - 1 �� •� ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
. w 1 -e
�.� •- ,. � -FEE SCHEDULE; `�
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 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'l 500 sq. if or portion 33.40 1 • •
Tax map /parcel no.: Limited energy, residential
. r L,` . t ,t . DESCRIPTION OF. WORK• . ° ;° ;.. a (with above sq. ft.) • / 75.00 7c 2
Limited energy, multi- family 75.00 2
.LA.- El.) CD/Aft f•JC l.TV. --1- ."N�"'`�� �/ residential (with above sq. ft.)
1 Services or feeders installation, alteration, and /or relocation
200.amps or less 80.30 2
rt PROPERTY,OWNER .; ,,,, ,�, ❑ TENANTS, , ,, 201 amps to 400 amps 106.85 2
Name: ��G< ` LYo 1J 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 'f S.-S 0 SW ' ' S C_ 61,Q JA ( Over 1,000 amps or volts 454.65 2
City /State/ZIP: TtivP•1zD o-z ert -Z..-Z.--"S Temporary services or feeders installation, alteration, and /or
relocation
Phone: (51:5) tC, 5 • 1 q 1 ic Fax: ( 503) ZSG ..7:102. 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, e o range, according to ORS 447, 449, 670, and 701. 401 ariipsto 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: 9 • I1. 0C. A. Fee for branch circuits with
n i, IN ?APPI:ICANT t " i "'` 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
4.1 t` :. ,o „.:.6. -c1.4. .;°4, CONTRACTOR ..., I el • W ' ,,, , ` t" , ,u ,, . ej, u,, Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited-
��^ energy panel, alteration, or
Address: extension. Describe: Page 2 2
City / State/ZIP: Each additional inspection over allowable in any of t a bo v e
Per inspection 6 2.5 0 '
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 6
C CB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
,` " 3?0 ` :JELECTRICAL" *PERMIT FEESr*.i 4r " ''
Suprv. Electrician signature, required: Subtotal: -2c
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): Co
Authorized signatur : TOTAL PERMIT FEE: In , Da
This permit application expires if a permit is not obtained within 180
Print name: J `-"4L 1.... Date: q . l ! .0 6 da after if has been accepted as complete.
• Number of inspections allowed per permit.
L\ Building \Permits\ELC- PesmitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
R ESI,DEN'T.IAL .,:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener* ° '
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
Other: LQ4 +
?COMMERCIAL'�WORK;ONL�Y _ , �: ;,• u 3�''t'. �� � �•, ;�,�.t.
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems T
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ 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 \Pennits\ELC- PermitApp.doc 03/23/06