Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 00182
I G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
-r
Parcel: 1S136DC04400
Jurisdiction: Tigard
Site address: 11945 SW 70TH AVE
Subdivision: DARTMOUTH SQUARE Lot: 30
Project: TVF &R Command Center
Project Description: Data telecommunication and audio systems.
FEES
Owner:
TUALATIN VALLEY FIRE & RESCUE Description Date Amount
20665 SW BLANTON ST Restricted Energy Permit 09/14/2010 $150.00
ALOHA, OR 97007 12% State Surcharge - Electrical 09/14/2010 $18.00
PHONE: 503 - 649 -8577
Contractor:
ROSS ELECTRIC INC
2870 SE 75TH AVE #203
HILLSBORO, OR 97123
PHONE: 503 - 642 -2800
FAX: 503 - 642 -5815
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: Y Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $168.00
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 • - : 952- 001 -0100. You ma 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:
Air
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 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.
09/10/2010 15:51 5036425815 RECEIVED ELECTRIC INC PAGE 01/03
Electrical Permit Application RECEIVED roll oFFI(-I; ticr: uNi.v rimpuilm City of Tigard Receiwd G Permit No.;
13125 SW Hall Blvd„ Tigard, OR 97223 S E P 10 2010 Pimlt ��-n(�—C�a.4B�—
Phone: 503.639.4171 Fax 503.598.196 ( /g : OthtrPermit / ,' — P X
Inspection Line: 503.639.4175 ` .
- 1 . „., „I) CITY OF TIGARD Read 7 ��
. Internet; www,ti and -or. ov n t Information
g g � otrfi
I ormanon
� Supplemental
N'New construction ❑ Addition /alteration/replaeelnent Please check all that apply (suhmit 2 seta of plans wfitema checked below):
❑ Demolition ❑ Other. 0 Service or feeder 400 amps or mom 0 Building over three stories .
where the available fault current O marinas eadtioatyards.
�"�'i!..f` 17 .r. .., , ' • . ' .' ' i '-`,. -- •“ - :- •'`• : .; °; exceeds I 0,000 amps 87 150 volts or ❑ Floating buildings.
leas tp Btotlad. ar exceeds 14,°°°
❑ I - and 2- family dwelling �4C Commercial /industrial ❑ Accessory building ❑ Com in one agrlenhural
F rall otltermsWllau °ffi bwldgs.
• ❑ Multi-family ❑ Master builder irepump. la
t • .. v . . _ E vA or
�.. C� Jti Y : .� k , I , '� „y 0 Y ;pad � Sa+ % 'ately derived s r.. .,.,. o f new ot � of O "p ti -2- °1.3,
1r.+ 0 q 1o°HP or mote. .
• Job no.: Job site address: � � �J occnpaaor.
13 Si or more residential units. 0 Recreational vehicle parks.
City / State/ZIP: '.; ,C GQ• (� Q Re ?off► 3 . . 17 Health -care facilities. ❑ Supply voltage for more than
V r CI El locations. 6 0° volts nominal.
Suite/bidgJapt. no.; Project name: . ; V. P o .r< 4 0 Service or
m axder 600 amps or mots
• Cross street/directions to job site:
New rcatdentlal single- or multi-family dwelling snit.
Includes attached ga :: e.
Subdivision: I Lotno.: 1,000 sq. 1 or less M.• i. 4
Tax map /parcel no 1500 sq. ft. or 3192 1
'� . "• l i map/parcel
` energy; redder[ 2
Lim 1111 67 84
with R
i)0\p- 1 /- -} Limited energy, multi - family �� 2 ,., t 1 1" 1rr� 1 '1 G.r� �1\r1 f�� t .. e Ltr 1 residential with above : a.
Servlcea or feeders Installation alteration and/or relocation
200 amps or less 1.1 100.70 2
"3' ?1':+'n , ar r i , , 1 i 3 -i 201 oultio to 400 :
Name: 401 amps to 600 amps _ 200.34 NM 2
Address: 601 aims to 1,000 amps Mill 301.04 MI 2
Over 1,000 ,,.s or volts 1111. 552.26 Mil 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less MN 5936 MEI f
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 1111. 125.08 -- 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps M1112131.1111 2
Owner signature: Date Branch circuits - new alteration or extension , er , anel
A Fee for branch circuits r ; .. i ,,
' w . . above servi or feeder the,
7.42 with z
Business name: • � �
each branch circuit
B. Fee for branch curt
Contact name; w/rlroat service feeedd
er fee, 56.18
first branch Circuit III
Address: Each add'[ branch circuit .111 4
Ciry / State/ZIP:
Miscellaneous service feeder not inclad
dovellur:, service and/or Pbeder �� ill
Phone: ( ) Fax:: ( ) Reconnect only 67.84
E-mail circl _ 67,84 Ell
,. ,, r r
Si •4 or outline lighting
Business name: Ross Electric, Inc
Signal circuit(s) or limited -
energy panel, alteration, or i�
—
Address: 2870 SE 75 Ave, # 203 extension. Describe: Page 2 4. , - 2
Ciry /State /ZIP: Hillsboro, Or 97123 ta,s,r,rli,n1,1. ,ti
: tm+, oftheabo
Per inspection
ve
Phone: (503) 642 -2800 1 Fax: (503) 642 -5815 66.25 -
Investigation per hour (1 hr min) 66.25 25
NMI. it 78.18 r
CCD Lic.: 157891 Electrical Lic.: 34 - 436C Suprv. Lic.: 4232S ' Industrial plant per hour l�
Suprv. Electrician signature, required: �Z r " " <. , '-i".•,_1. : , . ' ';r .' -,..: �
Subtotal: ���� . ,
Print name: Stephen Ross Date: 2/8/2010 Plan review (25% of . r't fa):
State surcharge (12% of penult fee): ‘,.),,S /, ,
Authorized Signature: TOTAL PERMIT FEE: / , - . - '. k
Print name: I Date: Thk permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: lBuirdinglP Petmmlt PermilApp.doc 1(W1/09 440461ST(IIF05/COMIWEB
1, (/t 1—I S fr" /r)ter
09/10/2010 15:51 5036425815 ROSS ELECTRIC INC PAGE 02/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�r�^r� ,. re= , a.c�-.-'y' ^. .. , ti.fc, �_rc.S..ar� �: � (. -r 4 •'.
Fee for all residential systems combined........ $67.84
Check Type of Work Involved:
• ❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial $67.84
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
IN Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
- tgl Data Telecommunication Installation
- ❑ Fire Alarm Installation
❑ HVAC
❑ Instrumcntanon
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medico]
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required •
for all other installations
B ineloa.moiELC- PormuApp. clot 10/O r/OD