Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELR2011 -00194
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 0$(16/2011
Parcel: 1 S133CC80111
Jurisdiction: Tigard
Site address: 14178 SW BARROWS RD 1
Project: Scholls Village Condominiums Subdivision: SCHOLLS VILLAGE CONDO STAGE 3 Lot: 11 - 1, BL
Project Description: Building 11, replace damaged fire alarm panel with like kind.
Contractor: MPD SYSTEMS INC Owner: HEIM, DAVID L
10117 SE SUNNYSIDE RD STE F517 14178 SW BARROWS RD #11 -1
PORTLAND, OR 97015 TIGARD, OR 97223
PHONE: 503 - 334 -6315 PHONE:
FAX: 503 - 387 -5123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/16/2011 $75.00
12% State Surcharge - Electrical 08/16/2011 $9.00
Type of Use: MF
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. ATTENTI• . : •regon - • requi == ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 rough OAR 952 -001 -:• • 0. You may obtain a copy of the rules or direct questions to OUNC by • • . 32.1987 or 1.800.332.2344.
Issue. By: 4 " r/ ( i/ ; ,L ��% Permittee Sign- re: � g . i !, ,rte/ r - z
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' / 7 / 1 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.
•
Fm:MPD Systems Inc To:City of Tigar F ( ta d t e ( 4,503598.1 : 960)1 1(.2 ' 13:26 08/12/11GMT -08 Pg 01-02
Electrical Permit Applica ijlin
1 2 2011 rclr OFFICE 1. .SE osau
IL
Received (
City of Tigard pp, DaDate/f3 g �/1-- II r Permit No.: 4./(� "Of? �,
V 13125 SW Hall Blvd, Tigar i 97 � a 1 " �r ; Plan Review
' Phone: 503.718,2439 Fax• „5(Q3.598,1 V 960r�ff 66 S O , Other Permit:
T Pc; :� K 1:) Inspection Line: 503,639.` Ready /By: 1) UINU I v Date/E1
Read Page 2 for
�
Internet: www.tigard - or.gov - Notified/Method: ® fill Se e ag Supplemental Information
TYPE , WORK PI AN REVIEW .::'
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition
❑ Other: ` where the available fault current 0 Marinas and boatyards.
• • CATEGORY OP CONSTRUCTION exceeds 10,000 amps at 150 volts or (] Floating buildings.
- less to ground, or exceeds 14,000 0 Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
$ Multi- family 0 Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
30$ SITE :INFORMATION AND LOCATION Emergency system. larger separately derived system.
.. ❑ Addition of new motor load of ❑ "A” "E° °I -2" "1 -3"
• Job no.: 21743 Job site address :: 14178 SW Barrows Rd. 1001W or more. occupancy.
I Q Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard, Oregon 97223 - . ❑ Health -care facilities. 0 Supply voltage for more than
' Et Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: / —,5 Project name: )C #oe.4, 6 ' t k,R- . j Co a-.Do6 0 Service or feeder 600 amps or more.
FEE SCHEDULE., '
i Cross street/directions to job site: 4./ t , /( Description I Qty. I Fee. l Taal
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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: . Limited energy, residential 75.00 2
- DESCRIPTION OF'- W ORK.. (with above sq.. ft.) _. .
Limited energy, multi - family 75 00 2
Replace existing damaged Fire Alarm Panel with like Panel residential (with above sq. ft.) .
Services or feeders installation, alteration, and/or relocation
• 200 amps or less 100.70 2
0 PROPERTY OWNER." i } .' " - " CI TENANT ' . "" 201 amps to 400 amps 13336 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
Cit /State/ZIP: Temporary services or feeders installation, alteration, and/or
Y relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 atnps 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 16834 2
intended for sale, lease, rent, or exchange according to ORS 447, 449, 670, and 701.
i Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT .. I 0 CONTACT PERSON above service or feeder Fee 7.42 2
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'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Cit JStatelZlP: Each manufactured or modular 6° 84 2
Y . • dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
: CONTRACTOR. .... , • Signal circuit(s) or limited-energy
Business name: IVII'D Systems, inc. panel, alteration, or extension. I 00
Page 2 75. , 2
Each additional inspection over allowable in any of the above
Address: 10117 SE Sunnyside Rd., Suite! F517 Additional inspection (1 hr min) 66.25/ hr
ity /State/ZIP: Clackamas, Oregon 97015 Investigation (t hr min) 78. hr
Industrial plant (1 hr min) 78.18 18 / hr
. Phone: (503) 3446315 i Fax: (503) 3875123 Inspections for which no fee is
90.00/ hr
• 1 specifically listed (V hr min)
CCB Lic.: 179280 Electrical Lie,: C360 � lilt 1 Suprv. Lie,: 5693S )o ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ,, ���' �" (25% Subtotal: 75.00
of permit fee): , /�,
Plan review (25 /v o
P rint name:. J effrey Hill Date: 8/12 State surcharge (12% of permit fee): 9.00 �
TOTAL PERMIT FEE: 84.00
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N u mb er of inspections allowed per permit
I:\ Building 'Pamits\ELC- PenaitApp.dec 07/01/10 440- 4615T(11/05iCOM/WEB
i