Permit •
q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
`1' a COMMUNITY DEVELOPMENT Permit #: ELR2013 -00001
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/07/2013
Parcel: 2S113AC00103
Jurisdiction: Tigard
Site address: 7244 SW DURHAM RD 900
Project: Foremost Forwarders Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 25 -27,2:
Project Description: (1) low voltage for camera installation
Contractor: EMMONS ENTERPRISES Owner: PACIFIC REALTY ASSOCIATES
20525 S UNGER RD ATTN: N PIVEN
BEAVERCREEK, OR 97004 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 632 -3535 PHONE:
FAX: 503 - 632 -6329
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/07/2013 $75.00
12% State Surcharge - Electrical 01/07/2013 $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: N 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: y 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 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 0 952- 001 -0090. You may / obtain a copy of the rules or direct questions to OUNC by calling 503 .232.1987
Issued By: . "�'_` Permittee Signature: OKI Pp -te i // f oki
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.
Jan 04 13 11:31a Emmons Enterpris 503-632-6329 p.1
Electrical Permit Application JAN '0 7 Z013 FOR OFFICE USE ONLY
I - City of Tigard 7 C — Permit No.g D/3 - 00001
IIII u 13125 SW Hall Blvd.. Tigard, Olt 9 2_ ITYO�TIGARp 'Ian Review
Phone: 503.718.2439 Fax: 503.59nIALDINGDIVISIO Date /By. DthcrPermit:
I'1GARp lnapedionLine: 503.639.4175 Date Ready/By: m� 1 See Page 2for
hamlet: wu•w.tigard- or.gov YotilioNMet l j Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction E Addition/alteration /replacement Please cheek all that apply (aubunit a sets or plans •.a•:itents checked below):
❑ Demolition E1 Other: ❑ Service or feeder 400 amps or more ❑ Peitz tog ow Larec stories.
where the available faith current ❑'_.iar_n s and boatyards
CATEGORY OF CONSTRUCTION cceccds I0.0)0 amps at 150 volts or ❑ F:orting buildings
less to ground, or exceeds 14.001 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling E Comnlercial/indtstrial ❑ Accessory building amps for all other installations buildings.
❑ Multi- family ❑ Master builder 0 Other: ❑Fire pump. ❑ Installation of7>livA.
❑Emergency ,■ large: scrarrodl? derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition ninety motor'.oad of ❑ "A', E `I - -t -3 .
Job no.: Job site address: 7244 SW Durham Rd t001{P or m0 -e occupancy.
, ❑ S.s a more residenti al twu, ❑ Racreatiomd vehicle parks
City /Stat&ZlP: Tigard, OR 97224 ❑ Ecnith. -care . ❑ Supply voltage for more than
❑l:azarclnuslceot :ortt. •rr30 volts nominal
Suite/bldg. /apt. no.: 900 Projxt name: Foremost Forewarders ❑ Servtx cr realer 003 amps or mare.
FEE SCHEDULE
Cross strc t/dlrectiolls to job site: Deurlplbn I Qty. I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. lL or less 165.54 4
Ea. add'] 500 sq. H. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential 75.()) 2
DESCRIPTION OF WORK (with above sq. R)
Limited energy, multi - family 75.00
Camera installation residential (with above sq. lBA -
Services or feeders installation, alteration, and /or relocation 1
200 amps or !eta 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps In 600 amps 200.34 2
Name:
601 amps to 1,000 arnps 301.04 2
I Address: Over 1.000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City, State r ZIP:
relocating
Phone: ( ) Fax: ( ) 200 amps or loss i 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
2
intended for sale, lease, rent or exchange, according to ORS 447, 449, (37(1, and 701. 401 amps to 599 amps 163.54
Branch circuits— new, alteration, or extension. per panel _
Owner signature: Date: A. Fcc for branch circuits with
® APPLICANT I ® CONTACT PERSON above service orfeaderfee. 7.42 2
each branch circuit
Business name: Emmons Enterprises Inc B. Fee for branch circuits without
service or feedt.•l live. first
56.18 2
Contact name: Gary Emmons branch circuit
Each add'I branch circuit 7.42 2
Add-es_s: 20525 S. Unger Rd miscellaneous (service or feeder not included)
City, Slate. ZIP: Beavercreek, OR 97004 duelling, manufactured and/or or modular
duelling, scn•icc and /rx larder 67.84 2
Phone: (503) 201-7115 Fox: : (503) 632 -6329 Reconnect only i 67.84 ' 2
Pump or irrigation circle 67.84 ' 2
E-mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal eiroait(s) or limited- encr67
Business name: Emmons Enterprises Inc panel alteration or cxteusion. 1 Page 2 75 _ 2
Each additional inspection over allowable in any of the above
Address: 20525 S. Unger Rd Additional inspection (1 hr min) 1 66.25: hr
investigltion (1 hr min) 66.251 hr
City/StaterZU : Beavercreek, OR 97004
Industrial plant (1 la min) 78.19! hr
Phone: (503) 632 -3535 Fax: (503) 632-6329 Inspections lbr which no fee is
90.00/ hr
specifically listed ('•: hr min 1
CCB Lic.: 106940 Electrical Lic.: 33CI 1 Supn;. Lic.: 570LEA ELECTRICAL PERMIT FEES
Supra. Electrician signature_ required a 7 Subtotal: 75
c4 Emmons l� y�- " / Pl an revie.v (25?- ol'pert»it fee):
Print name: Gary Enons I Dale: 1/413 State surcharge (12% of patnit f:e): 9
Zil TOTAL, PERMIT FEE: 84.00
Authorized signature: ` / / �� This permit application expires if a permit is not obtained a'itltin 1 BO
days after it has been accepted us complete.
Print name: Gary Emmons Date: 1)4113 Number of inspections allowed per permit.
I :tB ridurg%Pemtit..tE LC- PenniLlpp AD.: 07'01/10 44G-405T( I I.115.::0MAVEB
Jan 04 13 11:31a Emmons Enterprises Inc. 503 - 632 -6329 p.2
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*
❑ Bu rear Alann
❑ Garage Door Opener*
❑ Nearing, Ventilation and Air Conditioning System*
O 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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
® Other Camera
Total number of corn nercial systems: 1
*No licenses are required. Licenses are required
for all other installations
1: +AmIAmq:Pemmit :\F[-C- Permddpp floc 07101lIO