Permit rt CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00181
13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/10/2009
TIGAR Parcel: 2S 110DCO2300
Jurisdiction: Tigard
Site address: 11555 SW DURHAM RD A -4
Subdivision: Lot: 0
Project: Oregon Music Academy
Project Description: Voice /data cabling
FEES
Owner:
HIP WILLOWBROOK LLC Description Date Amount
BY TAX DEPARTMENT, PO BOX 2708 Restricted Energy Permit 07/10/2009 $75.00
PORTLAND, OR 97208 12% State Surcharge - Electrical 07/10/2009 $9.00
PHONE:
Contractor:
TECHNOCOM* *USE OTHER **
7929 SW BURNS WAY STE. F
WILSONVILLE, OR 97070
PHONE: 503 - 682 -4195
FAX: 503 - 682 -2781
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 Total $84.00
Intercom /Pagin• N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR p 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: l Permittee Signature: 0
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 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.
•
eetrical Permit Applica ' . . .)RR,,,,,cf: ('SE ONLY
;-•- Received /
City of Tigard Date/Bv: 1— A Permit No. Y- 00 9 —03 I I
1 ,
n 13125 SW Hall Blvd., Tigard O ' Osher Permit;
!(1 Phoor.: 5(1'16,'104171 Fnx• 501 598 � �f1
I' i G >> k G Inspection Line: 503,639.4175 J UL 0 7 2009 Date Rcady/Ey: luri : H Sea Nee 2 for
Internet; wwW,ligard- or-gov Notified/Method: Supplemental Information
Tvl� y r 0 1C.ARl i IrI ;ATV 1RLV'I v , ,.,
❑ Now construction - Additi /a /eri o . ILV N Please check all that apply (submit 2 sets of plans whtems checked below):
ID Demolition Other: ❑ Service or feeder 400 amps or more D Building over three stones.
whore the available fault cult cut ❑ Mat tuax mai lxsalyaltly.
6: ! i i ' "' "��"''!1i�$`E i , bin.,a, f; � � hj' CTi(b " - ?i'."' exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
I' y ,. ' STRLI N I :
' � + + � less to around, or exceeds 14.000 El Commcrciai -nee agricultural
�
1- and 2-family dwelling Commercial/industrial Q Accessory building amps for all'othcr installations. buildings.
❑ Multi - family ❑ Master builder Q Other: ❑ Fire pump, ❑ installation of 75 KVA or
"' , ;t;;;, ' j' :' ,• .,:. . 'stem, anger separately system.
„ii
• •• ,} Em s 1 rely denved
i r l rl i t .' 1 11,1'y.08,01Clia tdit1 F,ORA4 i ( (ti,ND!!!tim A' iO ' N''" r l : ...Vi t °a, '; ,
i . r . + � �. ■�, , I ,) : ,1 „ , .. �i + , , , , !i14;,( i .+,. ❑Addition of new motor load of ❑ "A" "E" "1 -2", "1-3",
Job n0.:' �� "' � Job site address : , j , ma y . /� ,� ., Six or or more. occupancy.
� W /) �u / 1 ❑ Six or more residential units. ❑ Recreational vehicle parks,
City /State/ZIP: ! l qa a- ❑ Health -care facilities• D Supply voltage for more than
` �� ❑ 1lnanrd000 10eatioMe, 600 volts nominal.
Suitc/bldg. /apt. no.; i Project name: j amps
rnss street /directions to - job site: !h.'1 : : :' .. , . "'EE : „IIEPUTX: ; : "',. ,.!:
' / r Service or feed 600 am s or more.
•) f, /LI or .0 . �..- .
. co ' Frc ", , " .. r*i.l . � w
' New residential single- or multi - family dwelling unit.
• Includes attached garage.
Subdivision: I Lot no.: 1.000 sq. ft. or 1055 145.15 4
Tax map /parcel no.: Es. add'l 500 sq, ft. or portion 33.40 1
1lJS O N'.i6f. ` +t�VO}kg'. Limited energy, residential 75.00 2
L im ited energy. multi-family
�?oic��d rr,G�, 75.00 2
residential (with lti-f s i y
Services or feeders installation, alteration. and /or relocation
200 amps or 1055 80.30 2
P�ROP,Et2T ,, ; OWN
Ti:
,. ... ? 77y1�fuhV 1, ^'' " 201 amps to 400 amps ,_ ::, s IU6 85
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 L 454.65 : I 2
City /State /ZIP: Temporary services or fccncrs installation, altcratibn, ants /or
relocation I
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 1 00.30 2
intended for sale. lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 133.75 2
Branch circuits -- new. alteration, or extension, er anel
Owner signature: Date. A. Fee fOr branch' circuits with
o ,
+ 1. +i - • U� Gi1TI'A�":PERSON above service or feeder fee:
each branch circuit 6 65 2
Business name: B. Fur; rut blttiicli circuits
without service or feeder fee,
Contact name: fir t Branch circuit 46.85 2
Address; Each add'I brnnoh oirouit 6.65 2
Miseellaneoas (service or feeder not includes
City / State/ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) I Fax; : ( ) Reconnect only ;
66.85 2
E-mail: Pump or irrigation circle 53.40 2
, IV,+ ii ; : GOriI'.9 'G74It ',::E?,:'•' •::c Sign or outline lighting 53.40 2
Business name: ( j /7 a Signal circuit(s) or limited -
„ . h 1.1' 'L - energy panel, alteration, or . i
Address: 5 exnsiurt. Describe: P age 2 2 •
City /State /ZIP: IA i t 1 01 c te
0 Each additional inspection o allowable in any of the above
/ Pcr inspection 6,7. 5(1
Phone: 62 t i1 r1'� � i 1 i 80, � I ( n Industrial P lant
q I� Fax: (5-%'l ' l (/ 2- 77S I Investigation per hour (1 hr min) 62.50
C B I,ie. :7 g1
�"/ � Electrical Lic � t . :: ., f per hour 73.75
p I >�LECTRTC T1T1".rkrB7 ]C1C;p g ,..'.: '
Suprv. Electrician s 1�t�,;ld I re uircd: � ; !/�' . _ ,, 1 1 Subtotal; 7 OD
Print name Plan review (25% of permit fcc):
ti rc r ''
State surcharge (124o of permit fee): q , 00
Authorized signature: TOTAL PERMIT FEE: � (,1 , 0 /9
This permit application expire,' if a permit is not obtained within inn
Print name: _77,,_ F r S ct n d ��-, Date: ? — 7 - 0 9 days after it hat been accepted as complete,
" Number of inspections allowed per permit.
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