Permit •
,, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
! COMMUNITY DEVELOPMENT Permit #: ELR2009 -00136
Date Issued: 05/18/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S1010600500
Jurisdiction: TIGARD
Site address: 12670 SW Hall BLVD
Subdivision: Lot: 0
Project: Apex Industries
Project Description: Burglar alarm installation
Owner: FEES
TCTPI LLC Description Date Amount
25977 SW CANYON CREEK RD #J Restricted Energy Permit 05/18/2009 $75.00
WILSONVILLE, OR 97070 12% State Surcharge - Restricted Energy 05/18/2009 $9.00
PHONE:
Contractor:
PHONE:
FAX:
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: N
HVAC: N Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: Y 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 OA' 952 - 001 -0100. ou may obtain a copy of the rules or direct questions to OUNC by calling 5'. • or 1.800.332.2344.
, ,
Issued By: 1 .•Lj tt 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'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 Applicati t FOR OF FICE USE ONLY
RE CEIVED ,
Received
City of Tigard Date /B : S ,p U � Permit No.: . - / / 9• 0 /3 _
N - ° 13125 SW Hall Blvd., Tigard, OR 97^�� y/ Q p Plan Review
Phone: 503.639.4171 Fax: 503.598. 18 2009 Date /B : Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: IFIM ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Jr Supplemental Information
`'.. a � M -A', N a
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❑ New constnietion Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
i't * t' '' °C `d exceeds 10,000 amps at 150 volts or Floating buildings. t , `, t CATEGORY,OF CO :''' % , .., . a`. p g s
i g
� ��°' ^`" """ � �' ��- '�� - less to ground, or exceeds 14,000 ❑Commercial -use agricultural
❑ 1- and 2- family dwelling A Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
. -Aw �, q ,, „ , P t ❑ Emergency system. larger separately derived system.
-� JOBSITE IN 4TI LOCATI(N <, Addition of new motor load of ❑ "A ", "E ", "1 2 ", "1 -3 ",
Job no.G� L 1 j q4 Job site address: f c ri G, t -`- t e , . 1 more. occupancy.
❑
�a , r ❑ Six Six or or more more residential units. Recreational vehicle parks.
City /State /ZIP: f-- I 1 l r l.,f aa El Health-care facilities. El Supply voltage for more than
UU l ( Jl Y l/ 1 3 ❑ Hazardous locations. 600 volts nominal.
Ar'ov
Suite/bldg. /apt. no.: Project name: 1� �" p c t ❑ Service or feeder 600 amps or more.
!VEX �r//`` : * ... 5, .., FEE SCIIE„DULE - ....°`s .
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' 1500 sq. ft. or portion 33.40 1
Tax map /parcel no
Limited energy, residential
i` ' °
, � ' ' . DES OFt . ,` y , ' " (with above sq. f
. ft) 75.00 2
Limited energy, multi - family 75.00 2
ff. t _ . .tr . it ei _„ AL .A—fre 1 1 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' < 0 P ROPERTY OWN I ,, " g D-. TENANT 4 , 1 : *^ 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: ( ) 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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
y ' r ❑° APPLICANT ® >CONTA C1T PERSON p Fy, above service or feeder fee,
each branch circuit 6.65 2
•
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name:
first branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
'' , .. - _ : .
CONTRACTOR ; ' 0' 3 , .A ., . € Sign or outline lighting 53.40 2
Business name:. C Signal circuit(s) or to, limited-
' t \ energy panel, alteration, or
Y N ��YY
Address: 1 , r .1 ��' v I ( a � extension. Describe: ( Page 2 '5 a 2
City /Stat /ZIP: If: • 0 J 7 t t � /j 1 " 6 .� �r+ Each additional inspection over allowable in any of the above
(� /f �? Per inspection 62.50
Phone: e. Fax: ( C5� L� ✓ Investigation per hour (1 hr min) 62.50
CCB Lic.: 1i I ndustrial plant per hour 73.75
� n �� Electrical Lic.:3(„i< -(�Z Suprv Lic 5
a� P P
`� \ _ �� / � / � / ; t ,:'ELECTRICAL PERMIT »FEES °�' -r , °>'
Suprv. Electrician signature, required: l(--)-
- - ` l' �r2�_ Subtotal:
Print name: /'T �` f 1 . // j Date: _ Q Plan review (25% of permit fee):
/ / L / /7 �' t'L'`i State surcharge (12% of permit fee): q .
Authorized signature: / _141 . 0 ' !. 401 f e TOTAL PERMIT FEE: J /.
t
This permit application expires if a permit is not obtained within 180
Print name: (�i Date: i� days after it has been accepted as complete.
* Number of inspections allowed per permit.
I.\ Building \Permits\ELC- PennitApp.doc 05/23/06 4 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
=RE§ITAIVT:WW764(70%f Y ` • ''
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COIVIMERCIAT WORK ONLY' „ ; ,; t` , ,;_,:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
H 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
i �, o Q� {-fi
Other�a2W gtO.\ OSL J v& 11.9L_ -Q
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
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