Permit (56) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00166
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/26/2009
Parcel: 1S136DD05300
Jurisdiction: TIGARD
Slte address: 11850 SW 67TH AVE, STE# 110
Subdivision: TIGARD TRIANGLE COMMONS Lot: 13
Project: Grange Capital
Project Description: data /telecommunications
FEES
Owner.
PNWP LLC#2 & Description Date Amount
PNWP LLC, 6600 SW 105TH AVE #175 Restricted Energy Permit 06/26/2009 $75.00
BEAVERTON, OR 97008 12% State Surcharge - Electrical 06/26/2009 $9.00
PHONE:
Contractor:
FIRE PROTECTION SERVICES
5573 SW ARTIC DR
BEAVERTON, OR 97005
PHONE: 503 - 590 -3732
FAX: 503 - 628 -6214
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 Total $84.00
Intercom/Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 OAR 952 - 001 -01.0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
Issued By: �� � Permittee Signature: DA/ g/ z- /C�77r, r!
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 603.639.4175 by 7:00 a.m. for an inspection that business day.
This permft 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.
Jun 25 2009 9:45RM Fire Protection Services
IL-_ 503 628 -6214 p.l
RECEIVE Received i:lt 4.
Electrical Permit Application „� r ; Ne'l,Q�6 09' - /6 (
Re
City of Tigard JUN 2 5 2009 R e 2 ��
i . 13125 SW Hall Blvd., Tigard,OR 97223 ate Review / Other Permit
• Phone: 503.639.4171 Fax: 503.598.1960 Date/By: r,p s. ` !a See Page 2 for
`� CITY OF TIGARD "6 t` Y: ` Supplemental Information
TIC...,. I:I) Int Liner: SO f d 639A v 75 Notific
Internet: www.ti or. ov
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11 '• . ' 7.--- w c oast ruc l io n 3'= i lease check all that apply (su b of plans w /items checked below):
❑ New construction ® Addition/a 0 Service o r feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
tLL••� �x +'+�� rci " � T n a a ri;' 'tgi ^,'�n�� .1` j y ° yr� [ai fig} c3 1. �"1 �t exceeds round, r amps at exceeds 1 volts or ❑ p bwldi a.
I a I Mi r-:n. i 11MsTa7 asir i--an® >cg i� less to ground, a ps at 14,000 CI Commercial-use ating b din agricultural
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. ❑ b l � of 15 KVA or
Master builder ❑ Other: ❑ Fire pump. ❑ Multi-family ❑ ,,,^ ❑Ematgeacy stem,
larger separately derived system
caumS fi r�, l y g 3 ;F, i � � - a ❑Add o f new mo tor load of ❑ "A ". "E ", 1.3 ", °1.3"
i�. liicek Yj a.2iit- �^ i!!' � occupancy.
100HP or more.
Job no.: 2611 Job site address: 11850 SW 67 Avenue Suite 11 InSix or more residential units, ❑ Recreational vehicle parks.
❑ Health - care facilities. ❑ Supply voltage for more than
City/State /ZIP: Tigard Oregon 97223 0 Hazardous locations. 600 volts nominal.
1 Pro' net name: GRANGE CAPITAL ❑ Service or feeder 600 amps or more.
Suite/bldg./apt. no.: 110 J ' - - 1��
Daa * °o Qtr. Pet. Total •
Cross street/directions to job site: New reddential single- or multi - family dwelling unit.
includes attached garage.
Subdivision: `Lot no.: 1,000 sq. R or less 145.15 4
Ea. add'! 500 sq. ft. or portion 33.40 1
Tax map/parcel no.:
Limited energy, residential 75.00 2
=��''- (wish above R)
. -)'"a zi�m� Limit energy, a_ nergy, 75.00 2
LE - ADD PHONE/DATA CABLE RUNS _ residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
400 ami amps or less 80.30 2
_
�. �+avavag r=- ` ' "� 201 amps to ps 106.85 2
-Z: t;", -., t. .�3��tt�Ait�=;�'r&��i
--. J�_'., ='Ef1g �° `��'- 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
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
( ) 200 amps or less 66.85 1
Phone: ( ) I Fax:
201 amps to 400 amps that 1 o wn which is not
100.30 2
Owner installation: This installation is being made on property
intended for sale, lease, rent, or exchange, according to 401 amps to 599 turps 133.75 2 _ ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel _ _
Owner signature' Date: A. Fee for branch circuits with
._ , -- Vx �: • I 4-! - above service or fader fee, 2
F1 . _ -, . - i i� " i ,4p g l li tt � ` u l _ A. ,_ - 6.65
-raj A a each branch circuit
Business name: FIRE PROTECTION SERVICES, INC. B. F e�� circuits
toe der fee,
Contact name: DAVID M. PHIPPS
46.85 2
first branch circuit
_Each add'1 branch circuit 6.65 _ 2
Address: 5573 SW ARCTIC DRIVE Miscellaneous (service or feeder not included)
City/State/ZIP: BEAVERTON, OR 97005 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 590-3732 I Fax:: (503) 628 -6214 Reconnect only 66.85 2
Pump or irrigation circle 53.40 2
E-mail: phipps@tpsnw.cotn ! -� r=y _ Sign or outline lighting 53.40 2
i rl- sla e,.y t di gntOs -%. =
r_ l'i x- J � , - Signal circuit(s) or limited -
Business name: FIRE PROTECTION SERVICES, INC. energy panel, alteration or
extension. Descnbe: i Page 2 75.00 2
Address: 5573 SW ARCTIC DRIVE
City/State/ZIP: BEAVERTON, OR 97005 Each additional Inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 590.3732 1 Fax: (503) 62814 Investigation per hour (1 br min) 62.50
' I rv. Lic.: 4120LEA„rr Inr plant per hou 73.75 r
:_,
CCB Lic.: 154333 .) I Electrical Lic.: 3448 ". I ISup ) _ dustial :. . . Y "
r , 5 n - � . _
Suprv. Electrician signature, required: / Subtotal:
" " Plan review (25% of permit fee): 0.00
Print name: DAVID M. PHIP, S _ / Date: 5/� State surcharge (12% of permit fee): q 0-7) r
��%' pp TOTAL PERMIT FEE: , y,
Authorized signature: L �+
/' 6 /� Thi permit allntlon expires N a permit is not obtained within 160
Print name: DAVID M. PFIIPPS 1 Date: 6/25/09 days after it has been accepted as complete. ,
• Number of inspections allowed per permit. / [t
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ermitApp.doc corn 6 440.46151(11ro5/COMIEB
Jun 25 2009 9:46AM Fire Protection Services 503 628 -6214 p.2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for a m, 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.
' c- .;..sdS..4r`_`': ➢wh:61 ill F� �tl — . - ,,,
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
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: 1B=dld'n=s\FemiMELGpemiLApp.doa 01113/06