Permit ,l ,1 •a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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=� COMMUNITY DEVELOPMENT Permit #: ELR200900280
Date Issued: 08/28/2009
T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S136DD03800
Jurisdiction: Tigard
Site address: 11675 SW 66TH AVE
Subdivision: WEST PORTLAND HEIGHTS Lot: 7
Project: City County Insurance Services
Project Description: Low voltage for voice and data.
FEES
Owner:
CITY COUNTY INSURANCE Description Date Amount
1313 COURT ST Restricted Energy Permit 08/28/2009 $75.00
SALEM, OR 97303 12% State Surcharge - Electrical 08/28/2009 $9.00
PHONE:
Contractor:
TECHNOCOM INC
7929 SW BURNS WAY STE. F
WILSONVILLE, OR 97070
PHONE: 503 - 682 -4195
FAX: 503- 682 -2781
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 $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
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. • NTION: Or - ••n la. equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 • -0010 through OAR • -001 -∎ ' • You may obtain a copy of the rules or direct questions to OUNC by calli e . • . 46.6699 or 1.800.332.2344.
0 Issu: • B : - / gi L .1, i ' ' Permittee Signal � - ' �� Ofir __
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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.
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• -- Klectrical Permit Application 1 ()I:VICE ISI. (.1/N1.Y •
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City of Tigard ---,, , ,„. ,.., ... : „, ,, , _ ,,, Received ,'' .9..,. i
Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 eg-2/2.074:7"..-aag'90
' , .. ' '
: . Plea Review
' • ' . Phone: 503.639.4171 Fax: 501.59R.1960 ' clmam).: Other Permit:
TIGARD
incpection Line: 503 1 . ,639.4175 Date Ready/By: Alm See Page 2 for
• . Y 2 3
Internet: www,tigatd-or,gov U 3 . Notified/Method: / (Jr- Supplemental Information
1 ,'.';4:; '.. i '' . ''' : ' .. '' . '''',g .'1 .:;.'''',:.:. ! "! : !' - ' ' ' :; ; , 44 t A l k!.PW' ' '''::'1 . '...'''''''''•:.:? .. :.' .. '''." ..::''''..•.' ''''' l .
0 New construction - 1 - 5 Additiontaiteratiootieouement , , ! Please check all that oroply (submit Z sets of plans vditems checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 1:3 Other: where the available mutt current Q Manns and boatyards,
....:!, i; l exce t ech 10,or amps at or 0 Floating buildings.
0 cial-u agriultural
se c
[] 1 - and 2-family dwelling gCommercial/industrial El Accessory building maps for ell other format:6=R. buildings,
0 Multi 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
- ''''Y r'';"i'"I'llitiii'iltittii'• H i . 'S '. :' :.' : • i '44401tittiiitiet*:llii';t:114,..,.4,ji,,...,•, 0 a 0 M nc7cncY sYglall. n of new motor load of 0 larger separately derived system.
•;ll:14ll . ..',...!),— • '.. . „. ., , . ,..,,, ..' ... ••• . . ,. '•••'. 'i:l;l1"' .1" l , l r:' ditio
lob no.: q 404.0 Job site address: 1J1o15 ,. L4 . ) tele-th 1 4.1/0 _ 0 100HP or more, occupancy.
Six or more residential units, 0 Recreational vehicle parks
City/State/ZTP: --rittiird icyy--e.." 1:1 01-1.irli-ovre facilities. 0 Supply voltage for more than
Ha na
zardous locarlo. 600 vul/s nominal.
Suitc/bldg./apt. no.: Project natricilahi
.... . -...i. _f r_t• Id
A i pi C ,e j a r tp .,, Service or feeder 600 amps or morc.
_
Cros.; street/directions tn kit sitp.• f :, •:' . . •,
Detuieti.e. 1 iZsr. I Fee. I _Torn! -
New residential single- or multi-family dwelling unit..
Includes attached garage.
Subdivision: Lot no.; 1.000 eq. ft, or Jose 145.15 4
Ea. addl 500 sq. R. or portion 33,40 1 I
Tax map/parcel no.:
Limited energy, residential
75.00 2
' ::''' (with elm,c by. A.)
Limited energy, multi-family
V Ota/Olea" A o:Ailittli , Li residential (with above sq. ft.) 75.00 2
Services or &Mars inetatiatioo, *iteration. and/or relocation
200 amps or less 80.30 2
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'.•: .. .; . ).`;' 1 •:'.;•:.::';' , ,:.:;:':''(',171l#NAI`rt '!!::::: , ' :, •:':" 2 : 201 amps to 400 amps 106.85 2
,
401 amps to 600 amps 160.60 2
Name
601 amps to 1.000 amps 240.60 2
Address: Over 1.000 amps or volts 454.65 2
City/State/Z1P: Temporary services or feeders installation. alteration. and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
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Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.3 2
' intended for sale, lease, rent, or exchange, according t6 ORS 447, 449, 670. and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new. alteration. or extension, per panel
Owner signature.... Dux:
A. For for branch circuits with
!i above S kv der fca. 6.6$ 2
',,--• eachan
for branch circuits
Contact name: 0 / 104 , 7 d iri eir
43.
without service or feeder fee,
first branch circuit 46.85 2
Address: '7CV/4 ( LA) 8, 4.3 ,- /is bt)A.,,, .!M F Each add'l Inawell ciftwil 6.65 2
Miscellaneous (service or feeder not included)
City, /State/ZIP:T/01 411 v 1 1 k 0) Ci 4 latei 0
/ Each manufactured or modular
dwelling. coulee and/or feeder 90,90 2
Phone: SO (002_ Vic! Fax: : wpip ) k 9 21 I
Reconnect only 66.85 2
E-mail: . :LI kg or 0.,Alopv#,FT / , i . c oir Pump or irrigation circle 53.40 2
. •:..•.ill,■:,;: , ':i•;l:;: 1 l'1:: ..:,; ' e :, . .'ETI9W:::•l; "••:::;.'.:::::. !:l,• sign or outline l S3.4(1 2
Signal circuit(R) or limited-
Business name: -7 4 finriil_4 energy patiel, alteration, or
/ .. i . ,,T
V . Address: -- T ot2_01 ...A) f w vvC2-4 - 1 ) 1 *61:4 r
,_, D _exic.ion.Dsc....it,„ 1 p.. 2 . 75. be 2
City/State/ZJP: e I j Le 65- V e vo i_ Each additional inspection over allowable in any of the above
Phone; (56)
„i Per inspection 62.50 '
g t _ 16
1 15 .,, Fax:68) 6,6 1 investigation per hour (I lir min) 62.50
.. :11. , 1 :;
CCB Lic.: , -1317 ___ Electrical Lic. 3 1 -1-2 eLEprv. Lic...2"Zgl ti Industrial plant per hour A 73.75 j
Suprv. Electrician signature, required: -
. , Subtotal: 15, DO
Plan review (15% of permit fee):
l e _ Datc: C)jyx../ ioei
State surcharge (12% of permit fee): q , 0 0
Authorized signature: . f..- ,•• TOTAL PERMIT FEE: g it , 00
Print name: ,7 - _ .... . 1 -7 ,4 /
ef t a A tz./1 Date: og .. pliem This permit appticarion expires if a permit is not obtainer, within IP
days after it has been accepted as complete.
' Number of inspections allowed per permit.
1:lBuilding■DermittAELCIPLIApp.d0C 0503/06 440 615T(11/05/COMAVEB
lectrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
Burglar Alarm
Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
fl vacuum Systems*
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17 Other:
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Fee for each commercial $75.00
system
(SEE OAR 918
Check Type of Work Involved:
11 Audio and Stereo Systems
Boiler Controls
1 Clock Systems
Data Telecommunication Installation
E Fire Alarm Installation
HVAL
Instruinentation
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Intercom and Paging Systems
Li Landscape Irrigation Cont
E Medical
1:1 Nurse Calls
Outdoor Landscape Lighting:*
El Protective Signaling
El Other ..
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
nsuildir 03/230