Permit (104) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00224
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439
Date Issued: 10/18/2011
Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 350
Project: Plaza West Subdivision: ASHBROOK FARM Lot: PTS 5 &
Project Description: Low voltage for fire alarm
Contractor: FIRE SYSTEMS WEST INC Owner: SUN LIFE ASSURANCE CO OF CANADA
600 SE MARITIME AVE #300 BY NORRIS BEGGS & SIMPSON
VANCOUVER, WA 98661 121 SW MORRISON ST #200
PORTLAND, OR 97204
PHONE 360- 693 -9906 PHONE 503 - 352 -8113
FAX 503 - 289 -2208
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/18/2011 $75.00
12% State Surcharge - Electrical 10/18/2011 $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: N Fire Alarm Y
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. 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 ti 952 -001 -0 You may obtain a copy of the rules or direct questions to OUNC by calling 503 987 or 1 800 332 2344
/
Issued t =y: ► 4 ..I " '- -/ Permittee Signat ) <
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 . . 'Fe OFF Ice usrEoILs' '
City of Tigard eVI Date/B Received if, C/ �X � Y Permit No L 1010/! �Q '5
° 13125 SW Hall Blvd., Tigard, OR 97 2 Plan Review
Phone: 503.718.2439 Fax. 503.598 1960 1 011 Date/By Other Permit �P5,Rev, -�n ��7
T I G A D. Inspection Line: 503 639 4175 V.:\ RQ� Date Ready /By Suds ® See Page 2 for
Internet www tigard-or gov -V ' nG - S AO' Notified/Method Supplemental information
YPE OF WORK �� IyG I PLAN REVIEW
/li Please check all that apply (submit 2 sets of plans w /items checked below)
❑ New construction Addition/alterati p acement
❑ Service or feeder 400 amps or more [irBuilding over three stories
❑ 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 U4mmerclal /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 ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
600 Sl Q�� 6 Six or or more occupancy
Job no.. Job site address: 9600 / (J ❑ Six or more residential units ❑ Recreational vehicle parks
,ly, /� !'1 �. J� ❑ Health -care facilities ❑ Supply voltage for more than
City/State /ZIP:
��� l (90 0 f Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: Project name: / �- f . '� 3 0 ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: 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'! 500 sq ft or portion 33 92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft.) 75 00 2
C � Limited energy, multi -family 75 00 2
` '- A to, V , residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
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
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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: [ B Fee for branch circuits without
S et 1 1._ Ce 5 y eWe4 ) 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)
Each manufactured or modular 67 84 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67 84 2
Pump or irrigation circle 67 84 2
E -mail:
Sign or outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: �'1 1e 6vIsi- ou LJ►6 panel, alteration, or extension Page 2 / 2
0 /
� Each additional inspection over allowable in any of the above
Address: 101)0 101)0 5 G 4 44- 1 . 7f Additional inspection (1 hr min) 66 25/ hr • Investigation (1 hr min) 66 25/ hr
City/State /ZIP: liA CO U eV— WA • q ' ^' / Industrial plant (1 hr min) 78 18/ hr
Phone: (. ) 03 _,g 9 Fax: ( ) Inspections for which no fee is 90 00/ hr
specifically listed (%I hr min)
CCB Lie: d 2 e. [ q 73Z Electrical Lic.: ?1 65•. Suprv. Lie.: ELECTRICAL PERMIT FEES
77 J
Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: /// /// Date State surcharge (12% of permit fee): �� d
/{ TOTAL PERMIT FEE: . d
Authorized Signature: ✓(/X` This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ILk I !_�i L Date 10 /�g /I * Number of inspections allowed per permit
I
i \Bu dmg\Permits\ELC- PermitApp doe 07/0 � 440- 4615T(11/05 /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*
❑ 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 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n 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 \Buddmg\Permns\ELC- PermitApp doc 07/01/10