Permit ,f,`'q CITY OF TIGARD - ..;. ~ ELECTRICAL PERMIT
1,
!: COMMUNITY DEVELOPMENT Permit #: ELR2009-00122
Date Issued: 04 /29/2009
T I G A R p 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1 S 136DD01300
Jurisdiction: Tigard
Site address: 6855 SW BAYLOR ST
Subdivision: WEST PORTLAND HEIGHTS Lot: 2
Project: Tillamook Cheese
Project Description: Instal restricted energy for voice /data.
Owner: FEES
GSP LLC Quantity Description Date Amount
BY DWIGHT SCHWAB, 15450 SW BOONES 1 ea Restricted Energy Permit 04/29/2009 $75.00
FERRY RD STE #2 1 ea 12% State Surcharge - 04/29/2009 $9.00
PHONE: Restricted Energy
Contractor:
WHIZ TO COHO
12800 NW BISHOP RD
HILLSBORO, OR 97124
PHONE: 503 - 572 -5072
FAX: 503 - 214 -5490
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
1 35 Low VoL`TA -k
Govt
,41 30, 0 01 Total $84.00
G-• N 0 v L. 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 through OAR 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.
Issued By: 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:
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.
• CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• II I COMMUNITY DEVELOPMENT Permit #: ELR2009-00122
• TIC; ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/29/2009
Parcel: 1 S 136 DD01300
Jurisdiction: Tigard
Site address: 6855 SW BAYLOR ST
Subdivision: WEST PORTLAND HEIGHTS Lot: 2
Project: Tillamook Cheese
Project Description: Instal restricted energy for voice /data.
FEES
Owner: Description Date Amount
GSP LLC
BY DWIGHT SCHWAB, 15450 SW BOONES Restricted Energy Permit 04/29/2009 $75.00
FERRY RD STE #2 12% State Surcharge - Restricted Energy 04/29/2009 $9.00
PHONE:
Contractor:
WHIZ TO COHO
12800 NW BISHOP RD
HILLSBORO, OR 97124
PHONE: 503 - 572 -5072
FAX: 503- 214 -5490
Type of Use:
Class of Work:
Total Number of Systems:
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Fire Alarm:
HVAC: Instrumentation: Total $84.00
Intercom /Paging: Landscape /Irrigation:
Landscape Lighting: Medical: Required Items and Reports (Conditions)
Nurse Calls: Protective Signal:
Security Alarm: Other:
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 thro e h !AR 952- 001 -0100. You may ob ain a cop of the rules or direct questions to OUNC by calling 503.2 .6699 of 1.800.332.2344.
i I •
Issued By: �� �. l �1 1 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:
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.
0 843
Electrical Permit Application = ^ r -, e ; U S E , ONLV . .
City of Tigard D ate /B : . ` ' Permit No.: 7 ��
!! 13125 SW Hall Blvd., Ti ard, OR 97223 APR 2 9 2009 � � • r -
g Plan Rev Received
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
I.IGARD Inspection Line: 503.639 CITY OF TIG Date ReadyB 0 See Page 2 for
Internet: www.tigard-or.gov BUILDING UI N i p i / : Notified/Method: Supplemental Information
� 3,�- .v��-: <�i,..� ': „��;�;-�.v��,. .;•.v- - " `rr ,��.:: pis :!�r� „�s9 >.,,�%F y- .,qA"�;, ::i �F t't-,'c:'s • -;,�
`'' a..�,�' ° -;... .> .,- ;�,,,. ,;�' >. �n :,:CIF `P]Ci'ElIN -. 'vI�'�
❑ New construction tg 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 stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
S' <s,� ; r s ." §e 2 `;- ' � =:x: ` „�y °`” `',u,' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
' 'GUR C O .. :,C It7N: ` l i ; K ;
.�. �, •te, >., <_...
~ '''' SJ�' "' _ ^ " ''" `� ��y`�"``' �" °' less to ground, or exceeds 14.000 ❑ Commercial-use agricultural
❑ I- and 2- family dwelling . 4 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
„a;r.: �,�; system. system.
� � „ , „,�: , ..,<,�,��,;,;,,,..,,- �,,,,;,,,, , ;;. `.; -: -- Emer sy st m larger separately derived s st
f- . ~ :Tt �B?aSt b ' (-- I ' NM ; II - tOCA `, •: : ' `
= s ''¢"1�'f s° _. � .< ... _ isz;a<� � - �';� � ° - < »�> . . - . .., o 6� �� ❑ Addition of new motor load of ❑ •'A „ E „ "1_2 •'1_3
Job no.: Job site address. g S5 s tJ MGA yG CI 2 5,' 1001 -IP or more. occupancy.
V ❑ S ix or more residential units. ❑ Recreational vehicle parks.
City /State /Z1P: p G . t O / 0 Q 2 Z ❑ Health -care facilities. ❑ Supply voltage for more than
I ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 7) LC h "oak C yaESe- ❑ Service or feeder 600 amps or more.
` i y , a tl , L EE SCHED I ,.1.W ^ �:i.l = s `-°„ .. "
Cross street/directions to job site: r Description 1 Qty. I Fen. Total 1 � , . *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 2
.�.�. � � ,,�� >,,:... �.,. �,•. 75.00
, 't- "a' 9'' =' '; s m , r . '. ,, i .; .,, :'��rq ".,.,:.: ° v,: ( with above s . ft.
�,;�: ,�: ,� :� : �:���D'E GR T IION O � W(3RK ,� , ., ..�,. < ( q )
'� � ^,�- n..• „,.�.;,, .� ; ; .F ; � a y �.� . ...., moo. <.. ,,. ,. , ; ... z:
Limited energy, multi - family
CAS (, pu S residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' ❑` %'PRO,I'ERT�YyOWNER, .. �. =T.Ez�I`�' 5F 201 4
� amps to 00 amps < <: .:. .. ..:: .. . ... . ., . �... .�„ �� P 106.85 2
Name: 401 amps to 600 amps 160.60 - 2
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
:: ?'fi�A..Y ,t:R , ,,:a_ S.,>� -an • ;a�•�',Ce�'n•a % w.x�.�: ;. ,., above service or feeder fee,
w ( , a „ „; %',” PPI , .''ANT:;:' , li ?5,e .. „ � 4,}54
i', , ®A IC °''? =; ❑ UNTAGI`PEItS4 ;s:
n_ _. �',.� I(�, €��;,��,�,�: -ux.a ..� 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'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
- - A;:r�f -'• - :fry - y
;
-„- Sign or outline lighting '�: CU1VT'RAG"I'OI� . s��,;,,,�. 2
fi .,.; ,"��:, <5.,,,�, -„ - ,.. ,':;;'' -. ,. - -. '�.- ,.,.,� <.,. - ....,,..., ,,.... , «z %, � , ,��i.......,... may . . ..::
Business name: .044... Signal circuit(s) or limited -
w i'1 Z 7 C � O ener panel, alteration, or ``
Page 2 2
e f
Address: /L900 N wr 61 S yiC P g o ext ension. Describe:
City /State /ZIP: HI LL $ be de-) Oil_ l i / 2 'f Each additional inspection over allowable in any of the above
) 2 - o 7 2 Fax: (S� ) t i'( - C p Per inspection 62.50
Phone: ( 5 0 3,
5? Jy / 0 Investigation per hour (1 hr min) 62.50
CCB Lic.: / 6 s ? - 0 Electrical Lic.3y'QQC(E Suprv. Lic.:'OQ f 4 (A Industrial plant per hour 73.75
„a < EL JBt?TR1 SAL FEE
s. .
do.'
'uprv. ectrician signature, required: �. _- PERM Subtotal:
Print name: , I (Nie‘ t LE 2 Date: el — 21_0/ Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 84 -00
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I \ Building \Permits \ELC- PermitApp.doc 05/23/06 440 4615T(1 I /05 /COM /WEB