Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
ti e
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00050
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/26/2010
Parcel: 1S134BC00300
Jurisdiction: Tigard
Site address: 12240 SW SCHOLLS FERRY RD
Subdivision: Lot: 0
Project: Rite Aid
Project Description: Install limited energy for voice and data.
Owner: FEES
FW OR- GREENWAY TOWN CENTER LLC Description Date Amount
PO BOX 790830 Restricted Energy Permit 03/26/2010 $67.84
SAN ANTONIO, TX 78279 12% State Surcharge - Electrical 03/26/2010 $8.14
PHONE:
Contractor:
ALLPHIN COMMUNICATIONS INC
23220 SW BOSKY DELL LANE
WEST LINN, OR 97068
PHONE: 503 - 638 -9000
FAX: 503- 638 -9100
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 $75.98
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 at other applicable law. All work wit
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 AR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 332 2344. o
Issued By: 0 CU (IQ �` ^ LAT- Permittee Signature:
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:
C ` 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.
03/26/2010 FRI 9:52 FAX 503 638 9100 Allphin Communications Z001/003
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Electrical Permit Application • •-•••.•• ••• .....', USE ONLY , • . ....:-.-.......': . ...:...:-•:...: 1 ,:::: . ...::•::
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City of Tigar d MAR 2 6 2010 R„ied 1 mot No.: • ..„.
" 13125 SW I lall Blvd., Tigili'd, OR 97223
111 1),Ite!l3y:
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1 12 .. Phone: 503.639.4171 Fax; 503.59g.1960 . :. - '',"...1!1*11.) olber l'ecinit:
Dattif By: , ,
Inspedion Line: 503.639,4175 , 't • .' ; 10! r'i'ti Dm Ready Ily: ro, I liff See Page 2
TARD for
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tern www.tigard-o
ov Notified Method: Snnolemeorol Information
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Please check oll :hat 000ly (mmoni 2 ,er, of pions w:itcoo: checked below
III i \I tne construction 0 Addition/alteration/replacement
CI scrvice or 'I'i 400 it Or mine CI Building over thus: storie,..
0 DeiriOlition
.)ilier; where the availaide hodt eurron 0 Marinas intl liwilyank.
„ •-•
• • • . . CATEGORY Or C()NSTRI)(11 • .. • • ... • .. .. exceeds 10.000 amps ce IS() volts or 0 Floating buildings.
—, ; • : : less to ground. or excee C) ds 14.000 ( 'onimerciakinai Arricillthol
El i - mid 2-litinily dwelling / 4Commercial/intlostrial 0 Accessory builcling ■1111)1N for ;ill ililr install:dim, buildings.
[1 Multi•1'1111th 0 Master builder [3 Other: D lc pump. 0 installation 01'75 KVA or
. 0 Emergency :iritem, lin pta semoately denred sy..rtem
: • : Jori sac INFORIVIATION AND LOCATION • • EI Achlicion or IleW 1110101' 111:1(1 Of
."..,', . ...... ...,.
(,-'' (.,," e i .. i i , ,-.. LoOlii' or [now. n e
(KCop:moy. ,,
Job OO.: ,,/ / / / I Job site in1dress: /,;/../(„) ,.. 5 iA C.' 1 C) -•
t . ., .. I I /5 i .: yi / vr 0 Six or moil; r,xidelliiiil ttiiiIN.
„ R„„1 \Thick, p:110,
CitY/Statk,/Z1P: . / i c. (1 fr — ,-/. --)
(17 2 - ..." 01001111,MIC faCiliti Simply o
N oo re tha n
............. ... c i . _,._ . 1
0 thwart:Ions Itioanons. on0 colts nominal, rr m
Suite/bldg./apt. no Project MIttle! 4 ( 1 , ( . .,.. 7 .. :) „, . ..- . - : 3 o Sci vice or tilecler 600 l llllllll or more.
-` FEE, SCIIED11.111,E
Cross street/direetions to job site: 1/4,....:ri i 9 T F-. .1__ Foiti_L
New residential single- or multi-family dwelling unit
Includes attacked garage.
- .
.
1,000 sq. 11. or 1 168.5 4
StibtliviSion: 1 Lot no.,
• i :a. alil'l 500 sq. n. , 37.92 1
. EilX inap/pmeei no,: I ,iinii eneri,,y, resikinial
.__,.,... 67:•14
DESCRIPTI()N ()F WORK 0 111 0 1 al
• ” "
. Limited energy, muiti-ramily
e i C .Q. /
.\/ ) -
,)'
7 b . '' ' - : ,,. / ( I ( j
(.. -j / 1 iesidential (with Ilbl Sll, 11,) 67.g,I
Scryke t or feeder s instailation alteration n
. ad/or relOCilitiOn
' . ,.. , '
200 3111115 Or ICSS L100.70 2
. . ..
ri PROPERTY ()WNER ,1» TENANT 201 , amps to 400 conpc 153.56 ?.
: _,-..,--..„
401 amps to NM amps 200.34 2
Narne: ' .\<,.. /. \„; „ .k ,
601 amps to 1,000 aropN
— 301.04 2
....... ...............„,,., „..„., ..... ..........._._ _ __________.................... ......... ....„.
1 - • - , - C 1\ t i . ' . over Lunn amp s or vo l 55126 2
t
AthlreSSI .2 ,.....)1-1 ( `••••)‘,,',. " • % ' 0 (- .1'(' II / 1( 1 )
Temporary serYieQS no' locttcrs installation, alteraliom and/or
, , ( v.
Illone: ( ..:16.3) 5 • ' 7 ?,/ ;" ( C
)
Fax'. ( ri reloehliOn
200 amps f:r less 592;6 1 1 :
- - , „ . 201 amps lo 400 amps [ 25.0;t
Owner inStidiation: Th IS inStnikition is being, MO& on property (ti I own which is »01
401 tips to 599 amps 168.5.1 2
i»lenderl for s:tle, lease, rent, or exchange, according to ORS 447 4 670, and 701,
....13raoch circuits -- I IMY, 1 111( I, Or e.lcosion,lier panel
(.)\vilta sign:novo" Date; X. Fee Ica branch circuits with I
, APPLII . C . AN . T ...... ____. ...... .____T
,9 1K 0 (X)NT.'( PERS()N al service or hran der li.•e,
........__,...... . .. ..,,„, .... ,...„.,,„ ..„ . ......eaci4ch citxmit _.._... ....._ ...,. ...........1.41 2
13. b'er Cot branch (Men its iv; liuntr
13usinuss mina:: . L (../...„; ,.., i(. ,,,, ...... SUFVICV Of 11:1, lel:, Ill SI
-
branch r iccciit
cont(tet name: T A( '• )4.' i i
1 ) rah .1(1(1'111mnd] circuit 7.42 1 /
....„,:
Address: --) ::.'i •-2 , 2 (.• , , i ,/ , , , 1 ,
Aliseella ncous (service or reetle not Ii clo(ted)
Each manollicturcil or modular
( ity/Slitter4IP: .. c,( .. .)0 r: •,. - ). . ,' ,, i ,,,- _ (..) ,), (7 1 - 7 ( (;:-> d‘vellii...,..vic,..inel/or rcrkirr 67.S4 2
......._...
„
Iccontlx:el only 67.S4 2
Phone: (tyN ) (,....:, ,:.. (,:;"..., e."/ -f . 7) 1 Fax: : (,/ ) 6., , 3 s '• .... q/ of)
... .,.. . Pliny or irrigation circle 67 i; 2
1i-tnail:
.„.,...._____.‹.±'(' (. \) : ( ' (:: 1 _4)i_LILL ( C...'el ti 6 4.2Y 1 .._.:______.....,..,,,.,.,„,...,......._........_..............______ Simi or outline lighting 6 7.S4
CONTRACT(/12
Signal c irru it(s) or limited-energy 1
t 7 tCY1
litiSineS.s narne: A i} .,i, ,„ , ., • ,.
„...; /,,e,, (,, Ell1C1, alteration, or extension. rano ?, ,,t7 ; _
------ — .."13 L i i f 1 C-.11.7/1 / ....t / / /... ( !..!:. L ....f...).1....,c. :-- , - Each arlditionafiriiSiiection truer ttovii: Pte in anyOt: Ilse ttliov • _....
Address:
:':•:.)/ L.). \ (:' /
,„ ....):\:-.;:- A ' (1 A dit
..-,,,,,i..--,-. dioid sp (I iiieetion hr ma))
........ nO.25/ hr
Investigation 11 hr min) (6.25/ hi
C.'ity/StateiZIP: --- ----
Industrial plant 11 hr min) 79..) X/
I
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Phone: ( ) 1 FaX: ( ,':)1)j ) (r, ;:: j ,S' - L i I (.:1() 1,INNel2ons liw which no rec. is
'ROW IP
.,
_ I IV limed OS cir min)
... 1
CC13 Lie.: l i . c-sr_./ c"., i Electrical Lie.: 3..k ,, 1 supi.v. 1,ic.: ,.. , /t... .;.....,,,_ ELE(.7rizteA l. PEIMIT FEES
Subtotal: 6 . >:.;
Suprv. 1 signature, required: .
p[a re v,ew (251/4 or mann fee):
„.... ,........... ............. ...................... _ .__._....... ....._......,.
...... / I i j i Stale surcharge (12% of permit lee): ,..,•:', 1'
Print W411112' .1 .
- I-1 - 1 ' d kfl P 1. 11.1 \ I Date: io
-- /7
Authorized noture
sig/
'n n
ib PCn , W1/ 11 ( . 111Inn expirot if ■1 inwinit Is not pEkm IT FEE: olit:it nen within 1811
i .. ,.- C ' cl b
ays cificr It Mit een accepti.41 AY complete,
Print name: TDate: , Nonther of inspections allowed per omodt.
I: noildimer,:moo,•41.e.NoMIApodo, if: ti: 04 .1•I(1. I ( 10/ COM V1A1
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