Permit y CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
". $- � COMMUNITY DEVELOPMENT Permit#: ELR2013 00257
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/15/2013
Parcel: 2S 102AC00202
Jurisdiction: Tigard
Site address: 9110 SW BURNHAM ST
Project: Ferguson Enterprises Subdivision: BURNHAM TRACT Lot: 3
Project Description: Low voltage for data
Contractor: TELESPHERE Owner: MILLER, PRUDENCE M TRUST
449 SW ALDERWOOD BY PRUDENCE M MILLER TR
WEST LINN,OR 97068 4220 SW GREENLEAF DR
PORTLAND,OR 97221
PHONE: 503-880-9412 PHONE:
FAX: 503-638-9286
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/15/2013 $75.00
12%State Surcharge-Electrical 10/15/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: Total $84.00
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 accor ance 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. ATT ON: Orego law -•'es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 10 through OAR 95 I' -0090. Yo. ay obtain a copy of the rules or direct questions to OUNC b - • r . . •; or 1.800.332.23
Issu d By: k — ' , � 7 / Permi -e Signature: .� r��4--c.
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 503.839.4175 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.
Oct 1 1 13 02:41a Telesphere 5036389286 p.2
9FCT'
Electrical Permit Application i -.� '''''sq i ;I___,,
City of Tigard OCT Il ® 2013 Da /a /q �3 C7,4 PemtitNo. 44.J0,3-GVaS7
Da[eJB�:
e 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.196 or, Q� DaterBy: OtherPennit: t, ufio?oi3-49/3
lnspection Line: 503.639.4)75 'p� or, �V = � Dam Ready:13y: tom: 21 See Page 2 for
T I GAR f] Internet: vvww.ti and-or.•ov' p LLI r, Tr !Sill:, t NotifieGtvte:hod: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 stets of plans wliterns checked below)
❑Service or feeder 400 amps o:more ❑Building over three stones.
❑Demolition ❑Other: where the avarlabk fault currant ❑Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,00)amps at I50voha or ❑Floatingbuiidings.
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. ❑L-istallation of 150 KVA or
❑Emergency system larger separately dern'eo system.
JOB SITE INFORMATION AND LOCATION C]Addition of new motor load of ❑" "E',"I"',"t-3",
1 UGHP or more. cccupanec.
Job no.:87213 Job site address:9110 SW Burnham Rd ❑Sic or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-cart facilities. ❑Supply voltage for more than
y ❑Hazardous locations. 600-.ohs nominal.
Suite/bldg./apt.no.: Project name:Ferguson front desk ❑Service or fender 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:Burnham and Main St Description Q . I Fee. I Taal I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.it.or less 168.54 4
Ea.add'!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
Limited energy,multi-family
75.00 2
Cable remodeled area of store ---T-Df}Tr9- residential(with above so..ft.) ,
- Renewable Energy _ ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 1 100.70 2
201 amps to 400 amps i 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 55226
City/State/ZIP: Temporary services or feeders installation,alteration,and/or 2
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent or exchange,according to ORS 447,449,670,and 701.
401 amps to 599 amps j 168.54 2-
Owner Si rlD nat lure: Date: Branch circuits-new,alteration,or extension,per panel
❑' APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee.
7A2 2
Business name: each branch circuit
-- 13.Fee for branch circuits without
Contact name: sm-vice or feeder fete,first 56.18 2
— branch circuit
Address: Each add'I branch circuit 7.42 2
City/Stale/ZIP: Miscellaneous(service or feeder not included)
t} Each manufactured or modular
)
67.84 2
Phone: l;
dwelling,service and:or feeder
t has: .( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting I 67.84 2
Busincrss name:Telesphere Signal circuit(s)or limited-energy i Scc
I pastel.alteration,or extension. 1 Page 2 76"(1° 2
Address:449 SW Alderwood Dr Each additional inspection over allowable in any of the above
Additional inspection f1 hr min) . 66.25/Er
City/State/ZIP:West Linn,OR 97068 -
investigation(1 hr min) 66.25/hr
Phone:(503)880-9412 Fax:(503)638-9286 Industrial plant(I hr min) 78.18!hr
Inspections for which no fee is 90.00/hr
CCD Lie.': 1491.54 Electrical Lic.: CLE118 Suprv.Lie.: 45511E13 specifically listed(Y:hr min)
. ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 75
Print name: Michael Ciccotelli Date: 10-10-13 Plan review(25%of permit fee):
G Slate surcharge(12%of ponnil fee): 9
Authorized signature: �1r;`r,�, TOTAL PERMIT FEE: $84
This permit application expires if a permit is not obtained within 180
Print name: Frederic Ciccotelli Date: 10-10-13 days after It has been accepted as complete.
• Number of inspections cticwad per per-nil
t.\suilduyw\f'emu.s`E':C_P°rnitApp_El-R_ERI:doc Rev05.'21/2013 440-461 51(5 I/0_V00M•`WEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9110 SW BURNHAM ST, TIGARD, OR, 97223
Commercial - Electricial Limited Energy
199 Electrical final
2013-11-14 (null)
ELR2013-00257
PASS - No C of O
Violation Summary:
Inspector Contractor