Permit 0 C I
MI CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00011
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/8/2007
PARCEL: 2S 102DD - 00200
SITE ADDRESS: 13500 SW HALL BLVD ZONING: R -12
SUBDIVISION: LIBRARY LOT: 001 JURISDICTION: TIG
Project Description: Camera add at coffee bar. Job #107011.
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: X
INSTRUMENTATION: OTHER:
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: Contact #: PRI 503 -639 -9988
FAX 503- 684 -4357
FEES Reg #: ELE 26- 497CLE
LIC 64341
Description Date Amount SUP 974LEA
[ELPRiMT] ELR Permit 1/8/2007 $75.00
[TAX] 8% State Surcha 1/8/2007 $6.00 REQUIRED ITEMS AND REPORTS
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 or 1.800.332.2344.
Issued By: > �/� Permittee Signature: _1,e A �Q
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.
•
EYectrical Permit Application FOR OFFICE_USE ONLY
City of Tigard Received No _ Permit No.: � l f
13125 SW Hall Blvd., Tigard, OR 97223 Pla
g / Plan n R Re e
L../ view Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 1 ", Date /By.
Inspection Line: 503.639.4175 • : - Date Ready /By: IIM Ill See Page 2 for . •
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
❑ New construction f2d Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: over p u location
Service over 320 amps c rat� g Bud n ['Hazardous
10,000 sq. ft.,
- CATEGORY OF 'CONSTRUCTION ::•.:.::• ':; : - 11 : : ;::` of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling 51 Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi- family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
persons ['Occupant load over 99 ers Manufactu red structures or
• , JOB. SITE. INFORMATION %'AND LOCATION ' : ❑Egress/lighting plan RV park
❑Health -care facility ❑Other:
Job no.: t5 70 I 1 Job site address: 1 j j S1,4 11. 131 Vd Submit 2 sets of plans with any of the above.
City/State/ZIP: i I n The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: -r ej J bra( s cr Description = : ; '; . _ . :SI Qty. EDU Fe
E ';: e. : `I ::.. Tot :'"':.I :
1 - De s cr �•� . ' . �� . . � �� e nl � �
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'! 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: 75 00
"
___ — energy, -rest
: .:D SCRIP TION+-F W ORK : : ;. :• ; :..:: ; : ..
" = ' =• - • O ... ` -' Each manufactured or modular
bay
C.a�'yie.4' . add a+ ',- 4 -e_-
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
• 201 amps to 400 amps 106.85 2
.PROPERTY OWNER • :? . ';;.' : >• :: ':. ::..:: �';TElYA1VT:: :.
. . . 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 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 I 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 70!:
401 amps to 600 amps 133.75 1 I 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
• ❑c ',; ':_-_- : `':; "` ±:; ::: : ❑ :CONTICT °PERSON :: A Fee for branch circuits with
service or feeder fee, each
Business name: e*---.. branch circuit 6.65 2
AP f " B. Fee for branch circuits
Contact name: �.� F .. C - �jU�• without service or feeder fee,
46.85 2
AO Address: each branch circuit
0 a ■ Each add'I branch circuit 6.65 2
City /State /ZIP: r - ..o.jf Miscellaneous (service or feeder not included)
n r�i" �
I Pump or irrigation circle 53.40 2
Phone:( ) Fax::( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
:.:,:-:;-: .:- r ::. ; : �;: ;:�;;._ :.: ; :.CONTRACTOR': : , ;-., :::: :::: . :...:..'.: ±• ;•,:_:. :
• energy panel, , a teratton, o r
extension. Describe: 1 Page 2 `75,Se- 2
Business name: je a I rL
Address: ' sy,,i - Each additional inspection over allowable in any of the above
1 Per inspection 62.50
City /State /ZIP: 7p,,\ U Z Q Investigation per hour (I hr min) 62.50
Phone: (5)3 ) IZC OC t Fax: ( 3) b _4+3s-7 Industrial plant per hour 73.75
;EI ECTRICALTERMIT: FEES' '' .":.1:',:F:
. CCB Lie.: (1„4'?,4 \ Electrical Lic.:2 44-6 Suprv. Lie.: yS L(4 Subtotal - is, D
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 6100
Print name: Date:
TOTAL PERMIT FEE .2) .60
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: ' Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits \ELC -Penn itApp.doc 12/03 440- 4615T(10 /02/COM/WEB