Permit /i 0
r.
a CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
I : , COMMUNITY DEVELOPMENT PERMIT #: ELR2006 -00274
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/14/2006
PARCEL: 2 S 113 B 0 - 00600
SITE ADDRESS: 16580 SW 85TH AVE ZONING: I -
SUBDIVISION: SEWER TREATMENT PLANT LOT: JURISDICTION: TIG
Project Description: Low voltage (audio /video)
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: X 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:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
CLEAN WATER SERVICES DELTA SYSTEMS INTEGRATION INC
2550 SW HILLSBORO HWY 4040 SE INTERNATIONAL WAY STE
HILLSBORO, OR 97123 -9379 MILWAUKIE, OR 97222
r. - -- , :y r:7, , - - --
Phone: 503- 681 -3600 J u !J4 I ), ,- - Contact #: PRI 503- 786 -3733
FAX 786 -3803
FEES Reg #: ELE 26- 923CLE
LIC 113213
Description Date Amount
[ELPRMT] ELR Permit 11/14/200€ $75.00
[TAX] 8% State Surcha 11/14/200€ $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: 4 Permittee Signature: K ■ r 4. 1
� N
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.
Electrical Permit ApplicaRFCEIVED r )I OFFICE tiSl:: ONLY
City of Tigard Received
. I Permit Noci„Q 2 006 _apa 79
a 13125 SW Hall Blvd., Tigard, OR 97� 1 4 2006 Plan Review
' Phone: 503.639.4171 Fax: 50 3.598.1960 Date/By. Other Permit:
TIGARD
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Dins: .- ® See Page 2 for
Internet: www.tigard -or.gov BUILDING DIVISION Notified/Method . Supplemental Information
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
❑ I- 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ['Addition of new motor load of ❑ "A ", "E ". "I -2 ", "I -3",
Job no.: Job site address: 1 b 5 cgQ S\„ 1 g,
` � ^ IooHP or more. occupancy.
w , v ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: .1 6 C\(-■_, 1 Q ('-e_, ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suitelbldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qtr. 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 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
. DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
, Limited energy, multi - family
.. lA( A ► ,I ,S(f \l PO ,t`Ct4 lV1 Sy 'eI!).1 residential (with above sq. ft.) 75.00 2
^ Services or feeders installation, alteration, and/or relocation
J f\ J � C.0 �Y�G n,� o ` BS 200 amps or less 80.30 2
❑ PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 106.85 2
Name: r,, 1 401 amps to 600 amps 160.60 2
'V 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 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 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
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, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
• Miscellaneous (service or feeder not included)
City / State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E-mail: C Pump or irrigation circle 53.40 2
• J 'CONTRACTOR Sign or outline lighting 53.40 2
•
. Business name: l-k A - .. ySrt S Signal circuit(s) or limited -
energy panel, alteration, or
Address: 40140 s 1 I N fe J r-4",V /`..a\ WA7 S 1°6 extension. Describe: Paget 2
City/State/ZIP: rn\ 1 b t (v 4 C ( - / I Q( 9 I Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5a)) ) ,f' 6 - . Fax: ( A Investigation per hour (1 hr min) 62.50
CCB Lic.: I I i3 E lectrical Lica, -� e Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: --7/1 --7/1 /0 Subtotal: 76- _
Print name: /0 Date: Plan review (25% fee):
S State surcharge (8% of permit fee): 4, Authorized signatures TOTAL PERMIT FEE:
• Print name: �� Date: This per mit application expires if a permit is not obtained within 180
t - �. \\ days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PamitApp.doc 0523/06 4404615T(I1 /05 /COM/WPB
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 - 260 -260)
Check T of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
• ❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
•
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
•
•
*No licenses are required. Licenses are required
• for all other installations
I: \ Building 'Pamits\ELC- PermitApp.doc 0323/06