Permit ... A CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�k DEVELOPMENT SERVICES PERMIT #: ELR2005 -00175
�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/1/2005
PARCEL: 2 S 102 C B -0230 0
SITE ADDRESS: 13200 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT: 008 JURISDICTION: TIG
Project Description: Date /telecommunication.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC PROPERTIES TELECOMM MANAGEMENT INC
BY MARTIN JOHNSON 15611 PARTRIDGE DR
13200 SW PACIFIC HWY LAKE OSWEGO, OR 97035 -3121
TIGARD, OR 97223
Phone: Phone: 503 639 - 8209
Reg #: ELE 3- 463CLE
• LIC 135355
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 7/1/2005 $75.00
[TAX] 8% State Surcharl 7/1/2005 $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 9 - 001 -0100. You may obtain copies of these rules or direct que • ns te-OU at 503 - 246 -6699.
Issued By: Permittee Signature:> �!L
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.
E ctrical Perm' tptl 'o I Oli 0,:,,,, 1. O Sl I_l
`City of Tigard D /B . fry •8 Permit No R. vv /7 .
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1Q60 l �. 2005 i ' , I � , DE,./B. Other Permit:
Inspection Line: 503.639.4175 � _ _,; '! �� Date Ready/By. RI See Page 2 for
Internet: www.ci.tigard.or.us CITY OF T!GARD Notified/Method Supplemental Information
BE ILD PEra NgZ PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑E plan RV park
Job no.: Job site address: 1 3 200 SW PAZ.Ft - 1)-wy ❑He 2 -care o ay ❑ �.
Submit 2 sets of plans with any of the above.
City/State/ZIP: 111 GA 20 (IK c q. 2.3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: f t I F G �,7 4 G■ctpt•,, FEE* SCHEDULE
Description I Qty. I Fee I Tote) I ••
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential i 75.00 2
�� DESCRIPTION OF WORK Each manufactured or modular
/ I� dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
' B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
•
Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: Pump or irrigation circle 53.40 2
( ) Fax. ' ( ) Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: i eAeCO Wl1✓1 WI Gt NtQc w1c �SNC
Address p 9 J �(� Each additional inspection over allowable in any of the above
� S� < < f a ` u S� r✓n' e . Per inspection 62.50
City /State/ZIP: /L V an__ 1 O3, Investigation per hour (I hr min) 62.50
/ Industrial plant per hour 73.75
Phone: (SjjTj -7Sp `t S-� Fax: ( ) ELECTRICAL PERMIT FEES*
CCB Lic.: t c acs Electrical Lic.: ; Suprv. Lic.: )0s%CEQ Subtotal '
Suprv. Electrician signature, required: ct'4., Plan review (25 °/n of permit fee)
Print name: State surcharge (8% of permit fee)
��, tO El (r _ Date: ^ l — �`� TOTAL PERMIT FEE e')
AUthOrIZCd Slgn8tUre: This permit application expires if a permit is not obtained wit / hio 180
days after it has been accepted as complete
Print name: I Date: • Fee methodology set by Tri- County Building Industry Service Board
• • Number of inspections per permit allowed.
i:\ Building \Pennits\ELC- PermitApp.doc 12/03 4r0- 4615T(10/02/COMAV®
Electrical Permit Application - City of Tigard
Q.
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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:
PCOMIVIERCIAL WORK ONLY
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
•
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ 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 V
❑ Other
Total number of commercial systems: V
*No licenses are required. Licenses are required
for all other installations
i:\ BuildinglPermilslELC- PennitApp.doc 04/03