Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
S Permit #: ELR2011 -00145
., III COMMUNITY DEVELOPMENT
Date Issued: 09/30/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S113AD01700
Jurisdiction: Tigard
Site address: 16850 SW 72ND AVE
Project: Bridal Exclusive Subdivision: ROSEWOOD ACRE TRACTS Lot: 30
Project Description: Fire alarm system.
Contractor: METRO SAFETY & FIRE INC Owner: BRIDGEPORT LAND LLC
PO BOX 33650 3939 NW ST HELENS RD
PORTLAND, OR 97068 PORTLAND, OR 97210
PHONE 503 - 231 -2999 PHONE.
FAX. 503 - 256 -4691
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/22/2011 $75 00
12% State Surcharge - Electrical 06/22/2011 $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 acco • , - .: • h 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 AT . + ION Oregon -w re•uires 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 -10 .0 ' • Yo ay obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1. 00 332 2
Is ued By: ` � 4jr L 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
City of Tigard " Date /B y 6/ ), /1 1 ' Permit No, 9.01 ( (i tit
IN ..•
13125 SW Hall Blvd , Tigard, OR 97223 e ), `\ Plan Review
Phone: 503.639 4171 Fax 503 598 1' Date/ By V Other Permit
ti � yp5o )l— 0007(0
r l c n It in Inspection Line 503 639.4175 Il • I D.. e Ready/By' Juns See Page 2 for
Internet www tigard -or gov ��� � \ f,� tjjj: " ied/Method �� ' Supplemental information
TYPE OF WORK ` Q` r , ` ? 6 A\ PLAN REVIEW
❑ New construction 41,Addition /alteration /repla \ ` Please check all that apply (submit 2 sets of plans w /items checked below)
\�
❑ Demolition ❑Other: CO
❑ Service or feeder 400 amps or more ❑ Building over three stones
where the available fault current ❑ Mannas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or El Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Li 'Commercial /industrial ❑ Accessory building amps for all other installations buildings
❑ 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 ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: / 6crS'0 So..) 72 41/c. 100HP or more occupancy
J ❑ Six or more residential units ['Recreational vehicle parks
City/State /ZIP: __2 i ?, /l G 9 7 ,) ' El Haz do use facilities ❑ Supply voltage for more than
❑ Hazardous locations volts 600 volts nominal
Suite/bldg. /apt. no.: J Project name: T6 e6„,71 4-49,,,.., l n ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I city. 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 168 54 4
Ea add'l 500 sq ft or portion 33 92 1
fax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft) 75 00 2
Limited energy, multi - family 75 00 2
�1 r / f , 7 ��t5 A residential (with above sq ft )
� Services or feeders installation, alteration, and /or relocation
.�72 l c,ie 7 I 1.r-' ' 200 amps or less 100 70 2
❑ PROPERTY OWNER ❑ 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
City/State/ZIP /State /ZIP Temporary services or feeders installation, alteration, and /or
Y relocation
Phone: ( ) 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
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
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7 42 2
each branch circuit
Business name: c ,,,,-, J 5 ,r, ` .ter- B Fee for branch circuits without
service or feeder fee, first
Contact name: .Ti Sy, "e J," t branch circuit Each add'I branch 57 12 2
anch cucmt 7 42 2
Address: `5/3 j s-1�� a .r.,e. -7- Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP:
/J.iop - riff Juo , 4 97 .39 dwelling, service and/or feeder 67.84 2
Phone: (.j - 021 ) .2 / —Z 9 Fax:: Jai ) �,' �i <,/ Reconnect only 67 84 2
E -mail: ��� � Pump or irrigation circle 67.84 2
� �® s F Df 1' ,P' rz /fie' �/%A Sign or outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited- energy /
Business name: panel, alteration, or extension l Page 2 2
g,Q ' ' , 1 5 Al'�VVf Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66 25/ hr _
City /State /ZIP: investigation (1 hr min) 66 25/ hr
Industrial plant (1 hr min) 78 18/ hr
Phone: ( ) Fax. ( ) Inspections for which no fee is
specifically listed (/ hr min) 90 00/ hr
CCB Lic.: 0 (Q Electrical Lic.: %C6, Suprv. Lie.: TS/ ' ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �� ��jj Subtotal. 76-.6'6'
��` Plan review (25% of permit fee):
Print name. � � j 0 0 : t ' S . , < . / . -rid/4W Date: X17 ' „/ State surcharge (12% of permit fee) 7, O v
TOTAL PERMIT FEE W d�
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: a days after it has been accepted as complete.
* ��i� � .`�,�� ��,.����/ Number of inspections allowed per permit
I \Budding\Permns\ELC- PermitApp doe 07/01/10 440- 4615T(I1 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Buddmg\Permds\ELC- PermiApp doc 07/01/10