Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
011!!
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00257
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/17/2010
Parcel: 2S101 DB00100
Jurisdiction: Tigard
Site address: 7320 SW HUNZIKER RD 320
Project: Golsan Scruggs Subdivision: Lot: 0
Project Description: Data telecommunications system.
Contractor: AF TECHNOLOGIES Owner: HILLTOP BUSINESS CENTER LLC &
1418 HEMLOCK ST. NW HUNZIKER LLC
SALEM, OR 97304 9430 NW KAISER RD
PORTLAND, OR 97231
PHONE: 503 - 362 -2364 PHONE:
FAX: 503 - 362 -2382
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/17/2010 $75.00
12% State Surcharge - Electrical 11/17/2010 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: 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 -0090. You may obtain - .. • - direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By z.----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' 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.
•
NOV. 16. 2010 2:13PM 503 608 -7198 N0. 0802 P. 2
Electrical Permit Application .1� / 1A/111,M 1�Oir_C EFIc : r1SE ONLY '
City of Tigard C Received r ///
'� 13125 SW Flail ;31vd,, 'Tigard, OR I O 1\4 Date /Bv: �lJ • `w
Plan Review •
1 Phone: 503.718.2439 Fax: 503.598.1960,i Z 6 Datelp ; Other Per � A f _ d/ 5p
I I c, al.t1 Inspection Line: 503.639.4175 �� Date Ready /E1y: 0 Sec Page 2 for
Internet: vww.tigard- or.gov � G ls rifie
No _ Supplemental Information
4 New construction Q Addition/alter r � r placement Please check all that apply (submit 2 sets of plans w /items checked below):
[] Service or feeder 400 amps or more ❑ Building over time stories,
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards
, l " n . j�t "s a tS?aW` 'w
t k a n ih IV r m , a a ; l ; : 11 ii N exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
... , • Q : m �ta nu a1 r ; I la, a r ^ i' 1 less to ground, or exceeds 14,000 9 Commercial -use agricultural
E 1- and 2- family dwelling ! Connlinercial /industrial ❑ Accessory building amps tar all other installations, buildings,
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ lustallalion of 75 KVA or
rr l t 1: { . " t p ❑ Emergency system. larger separately derived system,
( � t�
E IMI T id o i s,I l t. ' ' 1 �trPRlb au u a E "l�, i� l
r �r
i !`�. �t�K' ^ tft ' etc ❑ Add ition Of ■ m01pr 108(1 of ❑
Job no.: Job site address: 23) W k7 Ke r 1001-1:P or more. occupancy.
❑ Six or more residential units. 0 Recreation td vehicle parks.
City /State/ZIP: O r'- 0 11=3 -it. SW ❑ Health -care facilities. ❑ Supply voltage for more than • t 1 / ❑ Hazardous locations, 600 volts nominal.
Suite/bldg./apt. no.: Project name: 0) c . Ct ga C • f ❑ Service or feeder 600 amps or mart. r �t }� kill II,,
- . ~ �SIY�S i �E i41il1If� 11S�Yj IN r�y, 1 ild6, � li, ' ;r ��,illXfliSillt
Cross street/direolions 10 job site: D, cr „ti °n Qty. P. rota) •
New residential single- or multi - family dwelling unit.
InCllydc,s attached garage.
Subdivision: 1 Lot no.: 1,000 6q. ft, or 1c,ss _ 168.54 4
Tax map /parcel no.: Ea, add'I S00 sq, r3. or portion 33.92 1
1 ; alp j e l y: �t r p, Limited energy, residential
tJ �l?I li l I fit.”. taa�; i �� I/ . Sb i doc a �u ' il , di vi: t v ., ll: 0 1. /4S ilr' i izi (with about sq, ft,) 75.00 2
Limited energy, multi- family
Lou.) \/O L i e° cabrl ry residential (with above sq. ft.) 75.00 2
Services or feeders ins tallation, alteration, and /or relocation
• 200 amps or less 100.70 2
L QQ�� �qq �!' ft ����� �"�
. ' , rji r 4l. x ', 4u:I n Fa '6r,t� l di r� sl at ft i^.t ft ,1,t full l R ' � I�sli { rM tl �'{BI V a t t� r I' � l : . C; } i, l l�P' 201 amps to 400 amps 133.56 2
-
401 amps to 600 amps 200.34 2
Name:
- , . 4.5 _601 amps to 1,000 turps 301.04 2
Address: 2-0 SW "14U 1 Vler .t , 5Z0 _ Over 1,000 amps or volts 552.26 2
ty arks 1 se_ CI 1 Temporary services or feeders iustallariou, alteration, and/ox
/State
Ci /ZIP: ( � relocation
Phone_ ( 503) 4u . c icov I Fax: ( ) 200 amps or less 59.36 _ 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125,08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 594 amps 168.54 2
Branch circuits new, alteration, or extensiojper panel
Owncr signature: Date: A, Fee lbr branch circuits with
$ to ' "�}s s ' g�9j � "' �f � r ! t � �3 {� " { �u �" above service or feeler fee,
llil 4 ! r1 f.. . s izSF'llti . + r�i5m g11R11 ii, ll. d 1l, ,,11f31ltl,iiki:li l I m 1�, 43 Et ii itit h . t� cads branch circuit 7.42 2
Business name: B. Fee for branch circuits wirhonr
— service Or feeder fee, first 56.18 2
Contact narrle: branch circuit
Each add'I branch circuit 7.42 2
Address: Miseellaneoue (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone:( ) I Fax:;( )
Reconnect only 67.84 2
. Pump or irrigation circle 67.84 2
E-mail: �3y y4 y��{ (,� ��p�l
1 1 q l 1t ( +r r t l gia tt•• "w "t` rVar ili f illr r; 1i1;1&141k'(4f a1118E111 ff9 signal circuit(s) energy 67.84 2
��ll�J�lll9i�1�1� � ,, �l�tt�����n���i',4�1r� ,
u:w
Business name: fl F '��� G-15 _panel alteration, or extension. Pa c 2 75
7 2
Each additional inspection over allowable in any of Lhe above
Address; T) x, h J C \ Additional inspection (1 hr min) 6625/ hr
City/State/ZIP: 1D O q1 D0 Investigation (1 hr min) 6625/ In
ty /Sttlte /ZIP; 1 1 Industrial plant (1 hr min) 78.18/ hr
Phone: (1 '3) Fax: (� LJSpeotions for which no fee is
) la,* r.� • — r j rr� a ccrfically listed ( ht min, 90.00 / hr
Electrical Lie.: Su rv. L ic.: l ' i
lt l } , , " 0
CCB Lic.: a ^' a t i'' sia u l t
Ib bbl C.�E LO p 3�i22LE1, ^i ;llt��sit�,t. "Jl, owr,t;'�r k ;i�,,.�.4. 1�l "m�€��1�'1��llnig Ii,,
Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee ):
Print name: ittAcji S 0 _ , Date: IL_ It , r7 State surcharge (12% of permit fee): q --
Authorized signature: TOTAL PERMIT FEE: F.( L� �V This permit application expires if a permit is not obtained Within 160
days after It has been accepted Os complete.
Print name: Date: . Number of inspections allowed per permit.
1.\ nuiIding \Permits\ELC•PermiuApp.d°c 07/01/10 140- 4615T(11/05/CQM/\20
NOV. 16.2010 2:13PM 503- 608 -7198 NO. 0802 P. 3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
'�i�ab „ � ���� � � � � 7a.� e$� � �+➢ .. . �IPLi1YiY:A6Y��Yfltl f t�sl��ir .1 i; ik P:�'S � t w � GR �� �'' i ly' 4'�'��+
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
1 y 1 y ' l
.01, '„:0,°044”' yy Xl ii qv Cr](i . i N, r � rii ry 1 Y y
1 "�e �f IA AAY�i4il� �4�Yfh)%7�Yll�Yl ��,I ISr Qd � {. �' {�� �AY'�P. 1` `�:,
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved;
❑ Audio and Stereo Systems
❑ Boiler Controls
I. 1 Clock Systems
12r Data Telecointnunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I \Building\PcrmiiaLC- Pumi>App doo 07 /01/10