Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00271
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/06/2012
Parcel: 2S113AC00102
Jurisdiction: TIGARD
Site address: 7272 SW DURHAM RD, STE# 100
Project: Indio Spirits Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 25 -27,2;
Project Description: (1) low voltage for Data Telecommunications
Contractor: HECKTEC TECHNICAL LLC Owner: PACIFIC REALTY ASSOCIATES
3484 HILLSIDE CT ATTN: N PIVEN
HUBBARD, OR 97032 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 572 -1938 PHONE:
FAX: 503 - 982 -4823
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/06/2012 $75.00
12% State Surcharge - Electrical 12/06/2012 $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: Y Fire Alarm: N
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 - 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. • if work is suspended for more the. 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C= ter. - Those ules ar- set forth in OAR
952- 001 -0010 through OAR 952-001-0090.
J/.441 952- 0011- 00090. You may obtain a of the rules or direct questions to OUNC by calling 503. • .1987 or 1.80/.33 •.2344. /
Issued By: fldt .d1.��` Permittee Signature: /4111,1
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 RECEIVE e FOR OFFICE USE ONLY
UPI t e B /�
City of Tigard DaeB : ��/ / (��'�� Permit No. `(�[_ (� al
13125 SW Hall Blvd., Tigard, OR 97223 DEC 0 6 2012 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639 /+ /ti T l/± p R f1 Date Ready/By: June / El See Page 2 for
Internet: www.tigard- or.gov
CITY 1 ► lfr K7ftfIJJ Notified/Method: V Supplemental Information
BUILDING DIVISIO'
TYPE OF WORK PLAN REVIEW
ID New construction 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.
El Demolition ` Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling 't"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: --) —7 2 S^ ) ) a { t y ' f Six or o a re s. R c r eation.
� J V 0 or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP:
El Health-care facilities. ❑ Supply voltage for more than
r ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: idlip O Project name: j d ` c> t (4,4 ❑ Service or feeder 600 amps or more.
� FEE SCHEDULE
Cross street/directions to job site: 7? Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
sq. 75.00 2
DESCRIPTION OF WORK ( with above q ft. )
Limited energy, multi - family 75.00 2
12. C ✓ (,e-J- residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ 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
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation
Phone: ( ) I 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
*APPL*APPL I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
ICANT each branch circuit
Business name: // Q (C"-P .ec1►k ■ ∎ cG ( B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: 1 1 IL_ branch circuit
Each add'I branch circuit 7.42 2
Address: 5 4 (t A I S I de C Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State /ZIP: V �c. U 7 Z �� dwelling, service and/or feeder 67.84 2
Phone: ( 0 L— 1 k.Z 7 I Fax: : ( ) N 14_ Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
k P.L k j' S .00 1^" Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
' / I_ panel, alteration, or extension. L Page 2 2
Business name:
�Cl( "� �2 �t'\N�`C C ( Each additional inspection over allowable in any of the above
Address: l� 14 ( A l ` I ( s " - d c Additional inspection (1 hr min) 66.25/ hr
Ci /State /ZIP: l r,, Q l J 2 Investigation (1 hr min) 66.25/ hr
ty �� J t/� �(l� O ✓ Z Industrial plant (1 hr min) 78.18 / hr
Phone: (col) 511_ -- I 0 21 Fax: ( ) N � 4 - Inspections for which no fee is 90.00 / hr
rI
specifically listed (%2 hr min)
CCB Lic.:I 1 23 '� r( 1 I Electrical Lic.:05- Et I Suprv. Lic.q/ 5 Q,. . ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: � 1 1 (0! I ct I' Subtotal:
Plan review (25% of permit fee): •
Print name: Date: iti l b I State surcharge (12% of permit fee):
Authorized signatur
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: y , V
Da te: ,_. P TOTAL PERMIT FEE: et—
L � 2 r ` L • Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 46t5 /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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
ra Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: l
*No licenses are required. Licenses are required
for all other installations
1: \Building\Permits\ELC- PermitApp doe 07/01/10