Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00345
TIGARD: 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/14/2007
PARCEL: 2S102AD - 03450
SITE ADDRESS: 08777 SW BURNHAM ST ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: CITY OF TIGARD
Project Description: Limited energy for access control. Job No. 6996
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: • HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: ACCESS CON X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
CITY OF TIGARD SELECTRON INC
13125 SW HALL BLVD 7225 SW BONITA RD
TIGARD, OR 97223 TIGARD, OR 97224
Phone: 503 - 639 -4171 Contact #: PRI 503- 639 -9988
FAX 503- 684 -4357
FEES Reg #: ELE 26- 497CLE
LIC 64341
Description Date Amount SUP 3645LEA
[ELPRMT] ELR Permit 9/14/2007 $75.00
[TAX] 8% State Surcha 9/14/2007 $6.00 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 N ' cation C- er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules direct question. t• • NC .t 503.246.6699 or 1.800.332.2344.
Issu By: E 1 40d Permittee Signature: A e% 2
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 Application FOR OFFICE USE ONLY
11111 Cit of Tigard Received / /, £�� �, .? /
Y g DateB `' / Permit No.: 7 `/
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DateB other Permit:
TIGARD Inspection Line: 503.639 Date Ready/By: Juris.r El See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental lnformation
TYPE OF WORK PLAN REVIEW
❑ New construction 4, 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
El l and 2-family dwelling Commercial /industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
y g ❑ 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 - ", "1 - ",
Job no.: 6996 I Job site address: ' r e t t t I_ I f Tt i 100HP or more. occupancy.
r 0 Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: i5atrd aR, 9`7223 8777 ' �` � F r 1 �tH ❑ Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: 044_y of Tieard ❑ Service or feeder 600 amps or more.
`' J 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
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family
l' `` j � ,� t _ , _ 11 JJ
Ins dax f d A +e- waitk �I)4' (with sq. ) 75.00 2
t� residential with above s fl.
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: 401 amps to 600 amps 160.6 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: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ) ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: first branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included) _
City /Slate /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 _
CONTRACTOR Sign or outline lighting 53.40 2
Business name: SELECTRON, INC Signal circuit(s) or limited -
energy panel, alteration, or
1
Address: 7225 SW BONITA RD extension. Describe: Page 2 75.00 2
City /State /ZIP: PORTLAND, OR 97224 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 639 - 9988 Fax: (503) 684 - 4357
investigation per hour (1 hr min) 62.50
CCB Lic.: 64341 Electrical Lic.: 26497CLE Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ��� Subtotal: 75.00
Print name: JIM LEPPER Date: q I ' p ` 7 Plan review (25% of permit fee):
State surcharge (8% of permit fee): 6.00
Authorized signature: TOTAL PERMIT FEE: 81.00
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.
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