Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I
,,. DEVELOPMENT SERVICES PERMIT #: ELR2005 -00265
eel I 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 DATE ISSUED: 9/7/2005
PARCEL: 2 S 102 D D -00200
SITE ADDRESS: 13500 SW HALL BLVD ZONING: R -12
SUBDIVISION: EDGEWOOD LOT: 001 JURISDICTION: TIG
Project Description: CCTV /DVR upgrade.
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 /DVR X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
CITY OF TIGARD SELECTRON INC
13125 SW HALL BLVD 7225 SW BONITA RD
TIGARD, OR 97223 TIGARD, OR 97224
Phone: 503- 639 -4171 Phone: 503- 639 -9988
Reg #: LIC 64341
ELE 26- 497CLE
FEES SUP 974LEA
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 9/7/2005 $75.00
[TAX] 8% State Surcha 9/7/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: �C) L1 /% Permittee Signature: c� � 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'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.
�,� - :� l u T - J- -} �'P '. `'spy r'- '� '' r J '^t � �.(t sl L 3 'fi'k. ..Il,St 4 � # 'v. '��'� q yam`,` �'
:r dt''t ;131v c 1 1'v`� ' !711 _ ?' 3�� �1 .? M :� "�� t "`" - , ,tct4 �'.. M ;, y � I -�� .
12ereived n _ e7 _O� / i__
City of Tigard � ' j 00 Bv I I I P N o 6 C. os oo�6) --
13 25 SW Hall Blvd.. pare, OR 97223 Pla Review
Phone' 50:.6:x9 41 ; 1 Fax 503.59S.1960 ti Pl an Re other Permit:
..
Inspection Tine: 503.639 ti 176 •a �`� Ca te i�eldyiBy: See e 2 for
1t.1,. :4 ct: www.c'.tigard.Or -uS PtAlleppmstaitte— Nontne(UMechodh 1 V I Supplemental Information
5r , :, 'T 5d . - , � w ,, , ,� ,� ��r ,. e.:: ,a, . -�;.,.< PLa_t_ y3E <. :.:
{ ,'�'I .. _ s_: r 5 ;. " >`�` a,�ss; ? : }. „:1,-,-, - - ..a�. +_� y.,p.,',1:',,,',";0,,, , _ � i�'.�.�. :��.�'..'� y . .,...a �. <' io '' _ , i
r I [ Ncr,v construction • Df! : �dditionralterationireplacement I Please check all that apply: u
/` H, l.c.
I ' ' rmo!itir;n ❑ Other: over 225 ms, „omm I El location Service � an
- - - -- -- over 10
r te= _ � � n .. ,, - r „�,.� ., »,: �taa
LiSert icy over �0 amps rating EBuildng o z 000 sq.
�, �:v.t:.,. . , �?�; <. , �: a' I�EtGC) RrY•: a1 +�,.C�..�1�TtRL;,G:TiOc:. = °' . <<:..K�: -, >0. -;tit; of 1- and 2—family dwellings Y or more new rep aennal
° , ❑System over 600 volts nominal units as one structure
r
and 2-family dwelling g Commercial industrial ❑ Accessory / uilding,
❑Building over three stories ❑Feeriers, 400 amps or more 1
D iviui ti- ittn111y ❑Master builder ❑Other: _ _ Occupant load over 99 persons ❑Manufactured structures or 1
�...., :._ ��� -� LoR S I a ��: .a�r oi�,i'rx�rzo�a•� : ��;.•iec
i ,.. ” <�: - $ =fI ""' I ❑E /li plan R park
Job no 2_j Job site address: ,�0 �/ A6,1_4._ 61 ❑
Health -care facility ❑Other:
—_I Submit 2 sets of plans with any of the above.
City /State /ZIP: T( &AgeD •
ae C -7Z2 The above are not applicable to temporary construction service.
,gyp ,4. FEE S' ifi' t
Suite /bldg. /apt. no.: I Project name: �O� � � ” ��C./ w r;% _.:
De scription Qt Fe e. I Total 1
Cross street /directions to job site: I New residential single- or multi - family dwelling unit. I
Includes attached garage.
1,000 sq. ft. or less 145.15 I ` I
•
Subdivision: -- -- -- I Lot no : - -- Ea. add'1 500 sq. ft. or portion I 33.40 l 1 :
r — — — — Limited energy, residential 75.00 I 1
Fax map /parcel no.: I�
__ - — — — Lin ited energy, nun- residential 7e.0 I _
DL9l >I2tP =it.0 \M,U.�- ::�V.O.Rh`.a �, <: r modular �
h ='�.;� „- � r. . <,'• "` : . .. .. . .. .. ... . . �,. _, �:.,;;,;.5;�:- .; " -:. „l�v ... .r.s Each manufactured o mo •
� dwelling, service and /or feeder 90
. • i- /� f/ /� , V Y � - / - � 90
I W j'TIL.wn e04901 35 k VP_ &e. ✓L Services or feeders installation, alteration, and /or relocation
I 200 amps or less 80.30 I ! '_
"- _•"� 201 amps to400am s 10635 '
D r ❑ ,.. , RO BRT ' OWNE;i? e,. ,� I-��<'; ;.. , -. `~ , (_I> 1'I.A '- �. ''�
€ s i'` ; ' s �- ,., t,a ,. 9451 ": _ ; .. ,,` 101 amps to 600 amps 160.60 l 2
I
Name: 601 amps to 1,000 amps 240.60 I
Address: Over 1,000 amps or volts 1 454.65 I I
— - -- - -- — — —I I Reconnect only 66 55 = I L_2.
tty /S1atc /ZIP: Temporary services or feeders installation, alteration. and /or I
I relocation
1 hone: bax:l, )
p I
J 200 amps or less I 66.85 I I 1 ,
1 ti being property t r T s vn �; which i s not ' -------- 7r -- -7 -
Owner installation: This installation is bein made on .ha. own v_- -chi_ 201 amps to 400 amps I Q 0.30 _ I _ I
intended for sale, lease, rent. or exchange, according to ORS 447, 449, 670. and 701. I 401 amps to 600 amps 133.75 I 2 I
� Owner signature: - Date: — Branch circuits- new, alteration, or extension, per panel —
;'s k ' ""N”: �`.r� A. Fee for branch circuits w ith
'%�1.2;L;1�:aaV`I'? p r� '`C.'ON'= �.�Ti,PE'KS�1Y� > <:
Business name: service or Feeder fee, each - -)
branch circuit 6 -6c
I ►T �( 0 �_Cz. p —
B. Fee for branch circuits I
Contact natne: h �W� � V-- SF��'R--� — _ vithour service or feeder fee, .�
I 46.85 55
each branch circuit I
Address: 1 � ' t2- l I. bQVL. -V Each add'l branch circuit 6.65 I
Ctty /State /ZIP. 11 C /(� ,/� cl - 7Z , 3 Miscellaneous (service or feeder not included)
i � J��/ j D F
I Phone: ( ' Q Fax:: p�/�_
Pump or irrigation circle 53 40 -'
J o f f Z�P� I ( �_Q"T Sign or outline lighting 53. 40 1 ?J
I E- mail: Signal circuit(s) or limited-
•- r: : -, :,,,,.v ue: - = energy panel. alteration. or
;Si - C, .? - ' .. OR s rn :r'. " ":rs:x. YP
1 — — extension. Describe: Page ? I �` , ✓'� ?
I Business name: � - r,� 1 1 I 1
V
Each additional inspection over allowable in any of the above
ddress: , '_ i i ✓ , I { �\hi l 'I� , .% 1, Per inspection • I o2.50 I
City, Stale, Z1P: � � J .,.L - ; m i l ( ;ice 04 • ri Investigation per .tour (1 hr mm) 6 - -00
- -
Phone: (' i • _ Indust ial plant Der hour 73.75
�" ) �_ nL' 7j'c I Fax: ❑,C ) : —T ' °, ;--1 _�; , , , 1.% -,,--
I 6 ^ ' . 1:12F- -�0 -'EI L:CTRIC. -U PERMI :;ti -i
CCB Lic.:I � - Electrical Lic.. ;; _L -j'7(" ' Su Lic.: 1_1::: ; ' - S ubtotal- j - `5
Suprv. Electrician signature, re cued: Plan review (25 °/ of permit fee)
State stn charge (S °,% of permit feel l t_
Print name: m / Date:
-i ,v ,\ r sue,.. :'f V
T OTAI. PER vIIT FEE A v3
I Authorized signature: This permit application expires if a permit is not obtained within 180
i — days after it has been accepted as complete
P rint ,ionic: I Date: F C Fee methodology set by Tri- County B:uidine industry Scrvi,;e Board
1 -- - - " Number ui inspections per permit allowed.
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