Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00050
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/02/2011
Parcel: 2S102CB01802
Jurisdiction: Tigard
Site address: 13407 SW PACIFIC HWY
Project: AutoZone Subdivision: Lot: 0
Project Description: Data telecommunications system.
Contractor: HECKTEC TECHNICAL LLC Owner: BAR -AM, LLC
3484 HILLSIDE CT BY GODFATHER'S PIZZA
HUBBARD, OR 97032 1416 THIRD AVE
SEATTLE WA, 98
PHONE: 503 - 572 -1938 PHONE:
FAX: 503 - 982 -4823
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/02/2011 $75.00
12% State Surcharge - Electrical 03/02/2011 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes an. - I other - •plicable 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 •r if work is - uspend: for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification ' enter. Those ules a set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You m- in a copy • the rules or direct questions to OUNC by calling 50 . 32 ' 1.8' ■.3 '.2344.
Issued - Permittee Signature
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 the next available inspection date.
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
11 .1 City of Tigard �+� Received i i, :sr, Permit No. , d_ 0 0
13125 SW Hall Blvd., Tigard, OR 972 ++ Plan Review i
Phone: 503.718.2439 Fax: 503.5 + rLO \` DateBy. Other Pemtit: 4 ?Ail j j f'
/�
1 i c ` t I Inspection Line: 503.639.4175 Y 1 • Date Ready/By s_ See Page 2 for
Internet: www.tigazd or.gov P� C
+ 0 Jut H Se
otifreddMethod: �� ' . Supplemental Information
TYPE OF WORK , , PLAN REV/1144P, 3 ' .,. :s
ef New construction �'Addition/alteration/P� n`,` Please check all that apply (submit a sets of plans winters checked below),.
❑ Service or feeder 400 amps or more ❑ Building over threestorte .
Demolition ❑Other: V� where the available fault current E l Marinas and boatyards..
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, Or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling n- Commercial/industrial ❑ Accessory building amps for all other ,natallations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMA .ND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of of new motor load of
Job no.: Job site addressW Pacific Hwy
10011P or more . occupancy.
❑ Six or more residential units. ❑ Recreational, vehicle parks.
City/ State/ZIP: Tigard, Or 97223 ❑ Health -care facilities. ❑ Supply voltage for more than,
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 0 Service or feeder 600 amps or more.
FEE SCHiULE
Cross street/directions to job site: Description 1 Qty. I Fee Total I `
New residential single- or multi - family dwelling unit.
Includes attached garage.
' Subdivision: Lot no.:
1,000 sq. ft. or less 168.54 4
Ea. add'1500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential
. DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family i
75.00 2
Data wiring residential (with above sq. ft.) 1
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee,
∎` APPLICANT 1 [] CONTACT PERSON 7.42 2
each branch c
Business name: Hecktec Technical B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Kevin Heck branch circuit
Each add'1 branch circuit 7.42 2
Address: 3484 Hillside Ct. Miscellaneous (service or feeder not included)
Cit / State/ZIP: Hubbard Or 97032 Each manufactured or modular
y + dwelling, service and/or feeder 67.84 2
Phone: (503) 572 -1827 Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: hecktec@msn.com
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Hecktec Technical panel, alteration, or extension. 1 Page 2 75 2
Each additional inspection over allowable in any of the above
I Address: 3484 Hillside CL Additional inspection (1 hr min) 66.25/ hr
City / State/ZIP: Hubbard, Or 97032 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 572 - 1938 Fax: ( Inspections for which no fee is
lir
specifically listed (' /z hr min)'
CCB Lic.: 162394 Electrical Lic.: 419. A ' p . Lic.: ELECTRICAL P ERMIT FEES if Subtotal: 75
Suprv. Electrician signature, required: �i
p Plan review (25% of permit fee):
Print name: Kevin Heck
//�J ` D. /1 /11 State surcharge (12% of permit fee): 9
���etL:,j"�-'C. r Te-C /"� application TOTAL PERMIT FEE: 84
Authorized Slgnatul�: This permit lication ezpires if a permit is not obtained within 180
Print name: Rachel Heck Date: 3/1/11 days after it has been accepted as complete.
* Number of inspections allowed per permit.
l:\Bnildnmg \Permits \ELC- PermitApp.doe 07/01/10 440- 4615T(1 t /05ICOMIWEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for an 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
I I 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
n Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
I: \Building \Permits \ELC-PemntApp.doc 07/01/10