Permit CITY OF TIGARD ELECTRICAL PERMIT
o COMMUNITY DEVELOPMENT Permit #: ELC2009 -00353
.T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/24/2009
Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Subdivision: FARMERS INSURANCE Lot: 0
Project: Triangle Pointe
Project Description: Add /alter (5) branch circuits, sign /outline lighting for (1) sign, and restricted energy for fire alarm
installation in lobby.
Owner: FEES
TRIANGLE POINTE LLC Quantity Description Date Amount
901 NE GLISAN ST #100
PORTLAND, OR 97232 5 crt Branch Circuits 07/24/2009 $73.45
wo /Purchase Service or
PHONE: Feeder
1 ea Sign or Outline Lighting 07/24/2009 $53.40
Contractor: • 1 ea Signal circuit or Limited 07/24/2009 $75.00
Energy Panel
ROSENDIN ELECTRIC INC 1 ea 12% State Surcharge - 07/24/2009 $24.22
2925 NW ALOCLEK DR #170 Electrical
HILLSBORO, OR 97124
PHONE: 503 - 615 -8189
FAX: 503 - 615 -0689
Type of Use: COM •
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $226.07
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 throu 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: - �� �yMM�" Permittee Signature: SQ
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.
16
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Electrical Permit Application RECEVE) Received FOR OFFICE USE ONLY
City of Tigard D ate/ B : i • Permit No.: Q al - : `1` 4 .P. 13125 SW Hall Blvd., Tigard, OR 97223 7 20 09 -
C JUL J U L Plan Review f
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Yl Other Permit: ` • 20 44 . , 4 . `
T 1 G A I: D Inspection Line: 503.639.4175 / � �/ TIGARD Date Ready/iy: hris See Page 2 for
Internet: www.tigard- or.gov
CITY 1 OF otifie d/M ethod: 74 a T/ Supplemental Information
TYPE OF WO R IC l���G DIVISIO ..Gv�Q, PLAN REVIEW
® New construction ❑ 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.
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 ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
' JOB SITE INFORMATION. AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E', "1 -2 ", "1 -3 ",
Job no.: 321523 Job site address: 13333 SW 68 Pkwy 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Triangle Pointe Lobby Rem ❑ Service or feeder 600 amps or more.
• • FEE SCHEDULE
Cross street/directions to job site: Sw Hampton St Description 1 Qty. 1 Fee. 1 Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: NA Lot no.: NA 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: NA Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Remodel lobby residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
El PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Deacon Development Group 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 901 NE Gliasn St. Suite 100 Over 1,000 amps or volts 454.65 2
City/State /ZIP: Portland, OR 97232 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)297 -8791 Fax: (503)297 -8997 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
® APPLICANT ❑ CONTACT PERSON • above service or feeder fee, 6.65 2
each branch circuit
Business name: Rosendin Electric, Inc. B. Fee for branch circuits .
Contact name: Steve Hogberg
without service or feeder fee, 1 46.85 46.85 2
first branch circuit
Address: 2925 NW Aloclek Dr., Suite 170 Each add'I branch circuit 4 6.65 26.60 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Hillsboro, OR 97124 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 793 -6613 Fax: : (503) 615 -0689 Reconnect only 66.85 2
E -mail: shogberg @rosendin.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 1 53.40 53.40 2
•
Signal panel, or limited -
Business name: Rosendin Electric, Inc
energy panel, alteration, or
Address: 2925 NW Aloclek Dr., Suite 170 extension. Describe: 1 Page 2 75.00 2
Fire System Alter
City/State /ZIP: Hillsboro, OR 97124 Each additional inspection over allowable in any of the above
• Per inspection 62.50
Phone: (503) 793 -6613 Fax: (503) 615 -0689 Investigation per hour (1 hr min) 62.50
CCB Lic.: 103939 Electrical Lic.: � • 2uprv. Lic.. i Y Q/ ; 5 Industrial plant per hour 73.75
�� ELECTRICAL PERMIT FEES
• Suprv. Electrician signature, required: ....` . \)--0-- ' Subtotal: 201.85 ■.
Print name: C � i ^/ Litvii d Date: , ;cal 72 7 Plan review (25% of permit fee): A
r ' State surcharge (12% of permit fee): .3112-?‘ P.1.
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 18
Print name: Date days after it has been accepted as complet d h
• Number of inspections allowed per permit. 0J
l:\ Building \Permits \ELC- PermitAppdoc 05/23/06 440- 4615T(1l /05 /CO,WWEB
•
. 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
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El 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: \ BuildinglPermits \ELC- PermitApp.doc 03/23/06