Permit v CITY OF TIGARD, !1 ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00291
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/14/2008
PARCEL: 2S102DB - 00500
SITE ADDRESS: 08815 SW O'MARA ST ZONING: CBD
SUBDIVISION: FANNO CREEK PARK LOT: JURISDICTION: TIG
PROJECT: SENIOR CENTER
Project Description: low voltage for fire alarm.
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: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD, CITY OF METRO SAFETY AND FIRE INC
13125 SW HALL 14324 SE STARK
TIGARD, OR 97223 PORTLAND, OR 97223
Phone: Contact #: PRI 503- 231 -2999
FAX 503- 256 -4691
Reg #: ELE 26- 1154CLE
FEES LIC 63651
Description Date Amount
[ELPRMT] ELR Permit 10/14/200€ $75.00
[TAX] 12% State Surch 10/14/200€ $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
•
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 I =w requires you to follow rule - •opted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through *AR 952 - 001 -0100. You • ay octain copies of these
rules or direct questions to OUNC at •.- : .99 or 1.46 - 4.
Issued By: Permittee Signature: 1Jj .411L
OWNER 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 O Re ceived FOR OFFICE USE ONLY
City CI of Tigard ( le a t ermit No.:
• 13125 SW Hall Blvd. Tigard OR 9 Plan Review `
Phone: 503.639.4171 Fax: 50 . ' � Date/By: Other Permit:
T I G A It D Inspection Line: 503.639 i �� Date Ready/By: 1urig: HI See Page 2 for
Internet: www.tigard - or.go � c � '1 o i _ 9 w \ Notified/Method: 7770 Supplemental Information -
TYPE OF WORK �` (V ` ` ► \�j _ � `_ PLAN REVIEW
12 New construction Addition/alterater Please check all that apply (submit 2 sets of plans w /items checked below):
�r► "` ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: V o` where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CO1�CTION 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 El 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: 'c IS — St,,) 0.401.640 5 i • i x or or more. Recreational ❑ Six or more residential traits. ❑ Recreational vehicle parks.
City/State /ZIP: 1-14 ' A A CA . q 7 2Z3 ❑ Health -care facilities. ❑ Supply voltage for more than
I f - ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Se-N ; 02 C 1 „.4.44„,_ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qt I Fee. I Total I •
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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.) • Limited energy, multi - family 75.00 2
= t 0 AI • 442 - PAN. l ii. v �rf2 Ab e. (,v S rtrt O residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I m( TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
-�'�'y op T t ci we(tJ, �.e iv t O �- 601 amps to 1,000 amps 240.60 2
Address: $' /S c.SIA 0s4n A.a.ter S Over 1,000 amps or volts 454.65 2
City/State /ZIP: T `,,q,,zJ O cil ZZ 3 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT ❑ 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'l 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
CONTRACTOR Sign or outline lighting 53.40 2
�}''' Signal circuit(s) or limited -
Business name:
/yJs% �a s /� �/ ��`t , J � F t 2� �NC-. energy panel, alteration, or
Address: / 4 3 a - ..se._ S A J k extension. Describe: ' Page 2 7 2
City/State /ZIP: ,_ P0R4.l ,."•D Q T 7 Z 33 Each additional inspection over allowable in any of the above
( Per inspection 62.50
Phone: (5.3) e' _ a �r Q F Fax: (,5b3 c S _Cf(c' / Investigation per hour (1 hr min) 62.50
CCB Lic.: 4, Electrical Lic.: 3$3i La A Suprv. Lic. 6, j (S it C� I ndustrial plant per hour 73.75
ph ,i_oc.) - ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 75: °P.-- '6
Print name: m ARL S Date: /8 ^ t 4( Plan review (25% of permit fee):
State surcharge (12% of permit fee): 9
Authorized signature: TOTAL PERMIT FEE: 32
c
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
t :\ Building \Permits\ELC- PermitApp.doc 05/23/06 440-4615T(I1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
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
❑ 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
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #:ELR,2 5.
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639- 4171 l
Inspection Requests (24 Hrs.): (503) 639 -4175 ' . � 'LL
INSPECTION WORKSHEET FOR DATE: 2.-11 -09 TIME: PAGE:
SITE ADDRESS: iMS *5 VJ b'mAkix T. CLASS OF WORK:
SUBDIVISION: , LOT #: TYPE OF USE:
PROJECT NAME: Sib let. CE ER, , .
DESCRIPTION: F IALAa.IA
OWNER: PHONE #:
I CONTRACTOR: riymo 5 Af'e d PHONE #:
Inspection Request Scheduled For: Date: 2 '3 '1 Pour Time:
Code # Inspection Description Confirm # Contact # Message
191 Fi q at LL CAL.
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G • Wt li V" Date: 2 -' 4. 31 Phone #: (503) 718 - %•