Permit ,, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00068
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/18/2011
Parcel: 2S112DB00200
Jurisdiction: TIGARD
Site address: 15255 SW 72ND AVE
Project: Pittman & Brooks Subdivision: FANNO CREEK ACRE TRACTS Lot: 45
Project Description: Fire alarm.
Contractor: CURRENT ELECTRICAL CONST CO Owner: BROOKS & PITTMAN RENTALS
P O BOX 19652 15255 SW 72ND AVE
PORTLAND, OR 97280 PORTLAND, OR 97224
PHONE: 503 - 245 -5997 PHONE:
FAX: 503 - 245 -2919
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/18/2011 $75.00
12% State Surcharge - Electrical 03/18/2011 $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: N Fire Alarm: y
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 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 ado•ted by the Oregon Utility Notification Center. Those rules e set in OAR
952- 001 -0010 through O • 2- 001 -0090. You may o • - • - - • thect questions to OUNC by calling 503.232.1987 or 1.800.332.
Issued By: �- _ Permittee Signatur• - ���∎/
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 l'SE ONLI
14 City of Tigard �t� Received Permit No G Ii i
't 1 3125 SW Hall Blvd., Tigard, OR 972 * w 11// Plan i an Review / ..O / .
S Phone: 503.718.2439 Fax: 503.598. l Date/B Other Permit:
TI G A R D Inspection Line: 503.639 1 Date Ready/By: ® See Page 2 for
Internet: www.tigard- or.gov 1 , Notified/Method: Supplemental Information
TYPE OF .WORK W
❑ New construction ® Addition /alterationire t3 of " ' ' Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: `'," ` ` where the available fault current ❑ Marinas and boatyards.
C Off, CONSTRUCTIO 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 ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JO SITE INFORMATIO AND LOCATION A
❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3"
a 1/(4 6, I nd 100HP or more. occupancy.
Job no.: T Job site address: 15255 SW 72 Ave
❑ Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
.N4' ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: Pittman Brooks ❑ Service or feeder 600 amps or more.
' i t
�)� SCHEDULE € �
Cross street/directions to b it
job site: �`�" T �
J Description I Qty. I Fee. i T otal l ���
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'! 500 sq. ft. or portion 33.92 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
Added Fire Alarm (Low VOltage ) circuit extension residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
PRt (a 1 E z amps to amps 133.56 2
201 0 400
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
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 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
; `1'rPT aTA E11I = 7.42 2
above feeder f ve service or fee ee
<< each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'! branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
IRACTOIi S ignal circuit(s) or limited- energy
Business name: Current Electrical Construction panel, alteration, or extension. I Page 2 75.00 7
Each additional inspection over allowable in any of the above
Address: PO Box 19652 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Portland, OR 97280 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 245 - 5997 I Fax: (503) 245 - 2919 Inspections for which no fee is 90.00 / hr
specifically listed (V: hr min)
CCB Lic.: 46994 1 Electrical Lic.: 26 -471C I Suprv. Lic.: 5232S ELECTRICAL PERMIT. PRESS
Subtotal: 75.00
Suprv. Electrician signature, requi - .. 7 o
Plan review (25% of permit fee):
Print name: JAson Jacobucci - Date: 3/18/11 State surcharge (12% of permit fee): 9.00
TOTAL PERMIT FEE: 84.00
Authorized signatur • -11i....- This permit application expires if a permit is not obtained within 180
Print name: Kier. O'Brien Date: 3!18111 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1 \ Building \Permits\ELC- PermitApp.doe 07/01/10 440.4615T(11/05 /COM/WEB
Electrical 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*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
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: 1
*No licenses are required. Licenses are required
for all other installations
1 \ Building \Permits\ELC- PermitApp.doc 07/01/10