Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
•
s COMMUNITY DEVELOPMENT Permit #: ELR2013 -00052
Date Issued: 03/12/2013
T IGARD' 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 15136CC00100
Jurisdiction: Tigard
Site address: 8200 SW PFAFFLE ST
Project: Westside Christian High School Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: Install temporary low voltage cabling for data
Contractor: TELEDIGIT INC Owner: CITY BIBLE CHURCH
PO BOX 22287 9200 NE FREMONT ST
PORTLAND, OR 97269 PORTLAND, OR 97220
PHONE 503 - 722 -8084 PHONE
FAX 503 - 722 -9914
FEES
Description Date Amount
Specifics: , Restricted Energy Permit 03/12/2013 $75 00
12% State Surcharge - Electrical 03/12/2013 $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. 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 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 A - ' • • egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0% -0010 through OA' =52 -s = -“090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 •87 or 1 800 332 2344
r
sued By: / _ 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' 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 FOR OFFICE USE ONLY
UPI City of Tigard Date/By
d 22 o7 12. 1 '3 6:72110
Permit No GL /Li(Y / - oc1I2,5 ..
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review � 1 5 ���,�,
Phone. 503 718 2439 Fax 503 598 1960 Date/By Other Permit 00002/
Inspection Line 503.639 4175 Date Ready/By Juns I See Page 2 for
fIGARD Notified/Method Su lementalInformation
Internet: www tigard- or.gov PP
TYPE OF WORK PLAN REVIEW
❑ 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 stones
❑ 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
❑ 1- and 2- family dwelling 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 ? � e � � Z f ❑ Emergency system larger separately derived system
l Q 4 ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: Job site address: T -fi j Lis) •F?.. or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks
❑ Health -care facilities ❑ Supply voltage for more than
i �^
City /State /ZIP: T Q rG� �� , 1 a v ^ 7 13 Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: C ` i wQ. ❑ Service or feeder 600 amps or more
to T'yl D', ti Witt $77-4,4 FEE SCHEDULE
Cross street/directions to job site: y t? !f-.c 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 168 54 4
Ea add'I 500 sq ft or portion 33 92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft ) 75 00 2
j Limited energy, multi - family
`t eryt • P �t.0 a ettA -t() eRb`an �rG/`//i residential (with above sq R)
75 00 2
"J Services or feeders installation, alteration, and/or relocation
-re i L t f'— 200 amps or less 100 70 2
❑ PROPERTY OWNER ❑ 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
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
Y . relocation
Phone. ( ) 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 401 amps to 599 amps 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B Fee for branch circuits without
service or feeder fee, first 56 18 2
Contact name: branch circuit
Each add'I branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
tY dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67 84 2
Pump or irrigation circle 67 84 2
E - mail:
Signor outline lighting 67 84 2
CONTRACTOR Signal circmt(s) or limited- energy i pO
Business name. . 1, ( i 4. � ' .1/rl L • panel, alteration, or extension Page 2 7 2
Each additional inspection over allowable in any of the above
Address: P` 0 . c3Q )CI . 2 (,' '&'7 Additional inspection (1 hr min) 66 25/ hr
(J ` p �- v a bet Investigation on (1 hr mm) 66 25/ hr
City /State /ZIP: f O
Industrial plant (I hr mm) 78 18/ hr
Phone: (So3 ) --p Q6 2,tA I Fax: (5'b ) - pa get ILi Inspections for which no fee is 90 00/ hr
I�(� a specifically listed (Y: hr min)
CCB Lic.: 11 b i1D I Electrical Lic.: 3 Li �� Y� a Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal. `7 -G o
Plan review (25% of permit fee).
Print name: $n .n � ! ;x Date: 3/) a State surcharge (12% of permit fee) 5.c'"
TOTAL PERMIT FEE «f ,U
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit
t \ Budding \Permits\ELC- PermitApp doc 07/01 /10 440- 4615T(1 I/05 /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*
El Burglar Alarm
❑ Garage Door Opener*
El 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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \Building Permits\ELC- PermitApp doc 07/01/10