Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 S COMMUNITY DEVELOPMENT Permit #: ELR2010 -00211
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/12/2010
Parcel: 2S101 BC00900
Jurisdiction: Tigard
Site address: 12291 SW KNOLL DR
Subdivision: Lot: 0
Project: The Knoll at Tigard
Project Description:
FEES
Owner:
THE KNOLL AT TIGARD Description Date Amount
PO BOX 23206 Restricted Energy Permit 10/12/2010 $75.00
TIGARD, OR 97281 -3206 12% State Surcharge - Electrical 10/12/2010 $9.00
PHONE: 503 - 293 -4038
Contractor:
JACOBS HEATING & AIR CONDITIONING
4474 SE MILWAUKIE
PORTLAND, OR 97202
PHONE: 503 -234 -7331
FAX: 503 - 808 -9108
Type of Use: MF
Class of Work: NEW
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /lnigation: 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
Issued By: t�� Permittee Signature: ON L /e� e ,, .
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 603.639.4175 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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Electrical Permit A ED
pplicatlikCEIV ,..,,,, ()Fri( 1.: USE ()NIA
City of Tigard , f f n
qr i i ,._ m Received
Date/By: 4,74.1
/d/Tzlie - — &
!-. . - z..eao/o - Do.21/
4 13725 SW Hall Blvd., Tig 8 ard. OR 972.M — _
111 Plan Review
" • ' Phone: 501.639.4 171 Fax: 503.598.1960 ...sr, Date/B : Al
Other Permit:ea/ -." 0 i
Inspection Line: 5n3.639.41 75 CITY OF TIGPitku
1-1,7A i“, Date Rcady/Bv:
Internet; www.tigard-or.gOv Notified/Meth-0d:
IMI S ' Pn
uppleme1 T
...)'::3 ' .!.'•::',.;:•••:.:;,„'..,::::::'.„;•. i: . ' . ......;i : : : , ,:, , ,: ,.; , ,. . 11UvvitittILDIN...G1:VEit,S,..,l....0,...N ,,,,y,..,,.,,,:.....,i.,.:,:i...„.i i.,..,....:,,,,,,.....iiiii..,,ii.,30.,i.0n.:::wtiwiltotevtl:....:.:..,..,,.,,;,,i,i:,;,,ii.,,.6.,
5 New construction 0 Addition/alteration/replacement Please cheek all that apply (submit 2 sets of plug w/irems checked below):
0 Service nr feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other:
where the available fault ciment 0 Marinas and boatyards.
:,:, ..., •; '1!:''.".. ;•'1' Atiliibbikilit'etif4t4AttittioS1'1":*.'‘;.'„;:ii,;•;:iiii'i.1111.:,-"':•7,.;:,,:;,.,:i",:,11 m mea d a 10,000 amps at 150 volts or El Ranting buildings.
less to ground, or exceeds 14,000 0 Commercial-use agrictiln mat
0 I. and 2-famify dwelling I:Commercial/industrial 0 Accessory building amps for all other installations. building4
ell' Multi-family 0 Master builder 0 Other: 0 Firc pump, CI installation of 75 K vA or
: i .. , . v ..-,. :.. • 0 EMCfgeney ftygcm, separately derived s ystem.
;: •.::.,!.',±,,:";":::•!,• ,f :.,00 gilt : :;4;..•(*it#!11.0.S.44'0.7.:0:00301'.::., : ...". : ',1 . ',',..::.1::' , ; . i:::. ,...:,......;; ID Addition of new motor Toad larer
of C3
100HP Or more. occupancy.
Job no.: Job site address: w ,Ct
• 1) II m
0 si. or more residential % Inds. 0 Recreational vehicle mks.
City/State/ZIP: — amp 0 , y d . DR 0 Ikalth-eare facilitie4. 0 Supply voltage for more than
0 Hazardous locations, 600 volts nominal.
Suitc/bIdg./apt no.; Project name:-, Knut 0 Service or feeder 600 amps or more.
.t ■ii" , : ir . iStlatritjtt; : ■.b i:.• 6 W
Cross street/directions to job site:
Dest00000 on Pm Total
New residential single- or multi-family dwelling unit.
Includes attached garage.
—
Subdivision: 1 Lot no.: 1,000 sq. ft. or fess 168.54 4
Ea, add' I 500 Sq. ft. or portion 33.92 1
Tax map/parrxIno.:
energy, residential
.........;...,; 75.00
':1-.1"7'&i''''i.1.:.:Y.'''''''•'..:.;•."•:',•:::',..'.4.••••i'.:'".,':::,:'11i1".:::::.•0103--- Limited
16 R11, 1 1,0, 1, 0, " 4 .1 4 1 ,10. 1 t . k,:10!11,9••'. : .•;.•:'•„ . ;;!':;i!ii4h:;111!Vi: , •-i'• ; _ TT S ,irriid
wl aborvgye.F4;uilliL 2
mily
75.00 2
1 48 Uni-i- laILLA/ci-iacie, +Ineyrnoc-4e..--L- residential (with above sq ft)
Services or feeders installation. alteratron, and/or relocation
200 amps ar less 100.70 2
3 • • •''''' • ' ••• "; 201 amps to 400 amps
Iil•••:;•;:;;III,1101;fitt*IV:.'tti**•.':::1:::1F•k.i;•::t...:.?:•.',i'i'9:•;)-i!..,Ut j 401 amps to too am 200.34 2 pi 133.56 2
Namc:
—
601 amps to 1.000 amps 301,04 2
Address:
Ovcr 1.000 amps or volts 552.26 2
Temporary services or reeders installation, alteration, and/or
City/State/Z1P:
relocation
Phone: ( ) Fax: ( ) 200 amps or less
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 curios 168,54 2
intended for sale. lease, rent. or exchange. according to ORS 447. 449, 670. and 701.
Branch circoib— new, alteration, or extension, ptijoneI
Owner signature: Date: A. Tcc for branch circuits with
" • " . , ,
!:;.,i;;;;;;;),:V;':•V:a..Aft000tf above service or feeder fee
...:::y.:J.....,..::......r7:777:11rolq•AqiiititoNi.':L: each branch circuit 742 2
Business name: Et, Fee f o bran r ch
56,18 2
Contact name: branch circuit
Each addi branch circuit 7.42 2
Address:
Misedlaneous (service or feeder not Included)
Each manufactured or modular
City/State/Z1P:
dwellinervice and/or feeder 67.84 2
1110110 ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
. Sign or outline. lighting 67,04 2
' ' ' ...... '.''. •':. : ,;' ,.. ;:,): : :rii;:: :'.. . :: ;• :' :,•,... : ;.!; . : : ; :': ' ' :g FiP. . •••1•: .. ...' .. .::::•A1 . 1 • ,: Sgma] circuit(s) Of limted
_panel. alteration. Of extension. Page 2 2
Business name: • 6. Dino • / situ ti a i
pa
Each additional Inspection Over allowable in y of the above
Address: L„.11.4 q F.,, .11 Li. gerp... Additional inspection (I hr min) 66.25/ hr
_Invcsugution (I hr min) 66.25/ hr
City/State/ZIP! ^- piy,ilicind , _ cil aL..) a
Industrial plant (1 hr min) , .
7/1.18/ hr
1 ,Fri:.oric5n3 a ..--7 1 h no fcc is
Fax: ua ac:lip-)..)..1 v s ca ; l ht min) 90.00/ hr
O CCB Lie.: LA LI lectrical Lie.: 1 .,, suprv. Lic . 6_,.! .: meg .; ,...,..2:.
Suprv. Electrician sigma re, required: 7 / 8 - 7// /, Subtotal: -- 1,CIO
Plan review (25% of permit fix):
Print name:
— State surcharge (12% of permit fee): q. tr6
TOTAL PF.RMIT FEE: ei ,-9
Authorized signature: ..4,44_1 j irt ky ni
This permit appliniana expires ir fl permit k not obtained within IRO
days after it has been accepted as compktc.
Print name: A ix) 1 ), 9 „1, 7 , 9 „ mele, ,, v Dote /0_8 / 6
• Number of inspections allowed pc permit.
lAnktildiNt‘PerrnitaLC-PennItApp,o0e 07/01/1 440-461511 m03icomwsm
10/08/2010 13:35 5038139257 JACOBS HEATING PAGE 03/03
Electrical Permit Application - City of Tigard
Pagc 2 - Supplemental In,formation
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems ca ...r "
mbined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
ft Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
Fee for each commercial $75.00
system
•
(SEE OAR 91 8-309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock, Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation.
�] J- VAC
❑ 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 agt,lldlneormitaLC- Pemirapp, (Molt in