Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
r a Permit #: ELR2010 -00256
2 COMMUNITY DEVELOPMENT
_ �=
13125 SW H Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2010
,TIGARD , Parcel: 2S101 BB01500
Jurisdiction: TIGARD
Site address: 12254 SW GARDEN PL, BLDG# 1
Project: CTA Labs Subdivision: PARK 217 Lot: 0
Project Description: Installation of (2) systems: Access Controls and Security.
Contractor: CONVERGINTTECHNOLOGIES Owner: WALTON CWOR PARK BC 8 LLC
16575 SW 72ND AVE BY TTA/EPROPERTYTAX DEPT 325
PORTLAND, OR 97224 PO BOX 4900
SCOTTSDALE, AZ 85261
PHONE: 503 - 228 -8522 PHONE:
FAX: 503 - 228 -8521
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 11/16/2010 $150.00
12% State Surcharge - Electrical 11/16/2010 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: Y Other: Y Total $168.00
Other Desc: Required Items and Reports (Conditions)
This permit is i d 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 accordance 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. TENTION: Oregon -w • ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 through OAR 952 -% 1 -00.0. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu d By: � ' iv 4 a'A2 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' 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 Fo OI F1CF USE ()NIA
City of Tigard �r ��� j jJ D Received DateB / /4, /61 / PermitNo.: •_1 fa ��
/O - 61 ,
1 �t
lig
13125 SW Hall Blvd., Tigard, OR 9722 3KVrJ Plan Review
Phone: 503.639.4171 Fax: 503 DateB : Other Permit:
I I t'. n R I>' Inspection Line: 503.639.4175 NO v 1 6 7 3 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
= '' ,.'l..*' - , . , : - - TYPE 'OE `WO OFfIG N :, , -, ,PAN. ; REVIEW, - -' �
VLSI Please check all that a p pl y (submit 2 se ts of plans w /items checked below :
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ New construction � Ad / a ltera i ; L1 e '���� ii e�t l )
❑ Demo 0 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 (xj Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi -family ❑ Master builder ❑ Other: ❑Fire pump. ❑ Installation of 75 KVA or
. JOB SIT AND LOCATION ['Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
100HP or more. occupancy.
Job no.: Job site address: /;?;? �l L� f �/ / , p / l'/ � ❑Six or more residential units. parks.
❑ Recreational vehicle
City/State /ZIP: 'j ,r a /�� 7 ID Health-care facilities.
0 locations. ❑ Supply voltage for more than
/ / 600 volts nominal.
LI Suite/bldg. /apt. no.: Project name: C TT4 iiiio'
❑ Service or feeder 600 amps or more
y �
L w , FEE SCHEDULE r'
' 't ` ' -
Cross street/directions to job site: t�'' / ( 1. , / 7 4 , / , , ,f /e - //fry) Description 1 • Qty. 1 Fee. 1 Total 1 '
New residential single- or multi - family dwelling unit.
.A` /e j/ IA / el`'`f//,s . _ v / Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
• DESCRIPTION W
TION OF ORK , (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
A/ i'. y A ///j.1 (?2,147,/ f/i " " Je7iy",'ry /
f ,Pz--.4 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
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: 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: ❑, above service or feeder fee,
CONTACT' PERSON each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Email
Sign or outline lighting 67.84 2
CONTRACTOR , ' "' - ,r . - Signal circuit(s) or limited - energy 7�,pd
/ % t ��� /� /� �` z `�� panel, alteration, or extension. _ Page 2 /5 2
Business name:
�� 47/,� / !� / S Each additional inspection over allowable in any of the above
Address: /65'75 SW ./ 2' - ' ^‘/ / 1 Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: &Ti / /X / 9/;-7 4 j Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) 7 7_ Fax: ( ) � / Inspections for which no fee is
� b � < <' specifically listed (Vz hr min) 90.00/ hr
CCB Lic.: /J Electrical Lic.: ` - Suprv. Lic.: (ELECT ' PERMIT�FE Es
Subtotal: /5 r
Suprv. Electrician signature, required: �
`� s/"" Plan review (25% of permit fee): 4-----
Print name: r� . ivy % �'T�� / Date: //// C hp State surcharge (12% of permit fee): / S% //////������
TOTAL PERMIT FEE: /Le T. pU
Authorized signature: .,<7. 4 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: �,� 7 i.rezrf-, Date: ) / /5/ * Number of inspections allowed per permit.
Y
I:\ Building \ Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK -QNLY ,
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n 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
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \Building\Permits\ELC- PermitApp.doc 07/01/10