Permit •
: CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00069
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/13/2007
PARCEL: 2S 102AA -04700
SITE ADDRESS: 08900 SW COMMERCIAL ST ZONING: CBD
SUBDIVISION: MORINS ADDITION LOT: JURISDICTION: TIG
PROJECT: BALLROOM DANCE STUDIO
Project Description: CCTV
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: CCTV X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BROWN, DEAN A PERFORMANCE SYSTEMS INTEGRATION
PO BOX 583 7324 SW DURHAM RD.
CARLTON, OR 97111 PORTLAND, OR 97224
Phone: Contact #: PRI 503- 641 -2222
FAX 503- 641 -1464
FEES Reg #: ELE 34- 522CLE
LIC 150747
Description Date Amount
[ELPRMT] ELR Permit 3/13/2007 $75.00
[TAX] 8% State Surcha 3/13/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, St. - of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit wi expire if ork is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law re you o follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 41 t I. You may o tain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. _ .
Issued By: llk, . / Permittee Signature: . A 'A.
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'N: 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.
Electrical Permit Application FOR OFFICE USE O�NLY '
r a Cl Of Tigard P ermit N >,
`J g n $ i L/ e /By ti ILA a I . � ` tJ0(7‘,
13125 SW Hall Blvd., T OR 97223 -, Plan Revie
C : • Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit:
T I Gn R Inspection Line: 503.639.4175 i :" A 1 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard- or.gov I'j 1 3 2007 Notified/Method: Supplemental Information
TYPE OF1�WgORIy, l x A " 0 4 p, _r _> , ' PLAN REVIEW
El New construction Additio te i i i�/ n
" �° Please check all that apply (submit 2 sets of plans w /items checked below):
I'+ + TY4� Tal+; ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. building.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
' ' JOB SITE .INFORMATION AND LOCATION ❑ Emergency system. larger separately , derived system.
❑ Addition of new motor load of ❑ "A ", `T ", "1 -2 ", "1 -3 ",
r „,, /1 100HP or more. occupancy.
Job no.: Job site address: ggiv 5'� „ oceu anc
l 14.114lian¢t- ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: / d n . /� ❑ Health -care facilities. ❑ Supply voltage for more than
�!U / t' /� I V ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name J ,V 6C 200 ix. ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
, 1/4r ^^ �� , , >, I Limited energy, multi - family
if �� l �C.. . V residential (with above sq. ft.) 75.00 2
f Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY .OWNER I 0 TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
p APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
� each branch circuit
Business name: g s aZD� eesz Q B . Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: 2,t Ce 577our first branch circuit
Address: S' 2 *-124? Each add'I branch circuit 6.65 2 ( Ir . Miscellaneous (service or feeder not included)
City /State/ZIP: � 02 Each manufactured or modular
I / `t ' dwelling, service and/or feeder 90.90 2
Phone: (” ° �
j) / ,Z�z Fax: : (503) (.¢/ ^ /1� Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: riv Signal circuit(s) or limited -
�'S es energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) : ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.: i 5t) �4 - Electrical Lic . Suprv. Lic.: 3456 £b:* Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES .
Suprv. Electrician signature, required: / 1 .--.. Subtotal:
Print name: Date: '3 A 3 tro... Plan review (25% of permit fee):
CCCC���I State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440.4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
•
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
' RESIDENTIAL W(ORKc`oNixt' #
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:
°COMMERCIAL, WORK'ONIsI':. W . ' ' ° w •
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
p Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC •
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control* •
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑
Protective Signaling
x i Other WI -
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
C\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD ,,
BUILDING DIVISION PERMIT #:TAWY0'CI•CAttl
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 OPVili
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6 ^n. t TIME: PAGE:
SITE ADDRESS: 89a0 K t . , 41. CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: L` (
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 6'.. • 0 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 ,11 °% off, tonci-6 t
Corrections /Comments /Instructions:
ra G{ 01b ! t46i CAS. 6mJ
..) c6`tt eJ Eta„ =On .° 0003$
\ \.
/�4 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: LTA. ‘\s Dater" AV•' (), Phone #: (503) 718 -29'