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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 1111 COMMUNITY DEVELOPMENT Permit #: ELR2010 00259 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2010 TIGARD Parcel: 2S113AB00500 Jurisdiction: Tigard Site address: 16083 SW UPPER BOONES FERRY RD 130 Project: State Farm Subdivision: Lot: 0 Project Description: Data telecommunications system. Contractor: HENKELS & MCCOY INC Owner: G &S FC LLC 3366 NW 264TH ST 16850 SW UPPER BOONES FERRY RD HILLSBORO, OR 97124 SUITE A PORTLAND, OR 97224 PHONE: 503 - 205 -1720 PHONE: 503 - 639 -0108 FAX: 503 -615 -8610 FEES Description Date Amount Specifics: Restricted Energy Permit 11/18/2010 $75.00 12% State Surcharge - Electrical 11/18/2010 $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 OA: 952- 001 -0090. Yo .. - obtain a copy • s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. •�, Issued B i 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 CE : cli: Oi r Ic E „ 1lSI opt RdL iv � � IN Ctty f Tigard NOV 7 2010 D M PermitNo.: O.- 13125 SW Hall BlvdTigard, OR 972 ® Phone: 503.718.2439 Fag: 503.598.1960 1�akaB : y Othe Permit: an 10 — 00 In r . l i • A x l,x Inspection Line: 503.!39.4175 err OF TIGARD Date Ready /By: Juries See Page 2 for Internet; www.tigard- or,gov , ! G DIVISION NotifiaH/ivlethgd: Supplemental Information W �17 .1 inw��r dl un I� q '1� i . y 01 1 - r l 1,1k � C I II x', +,,v, ■ I ���I� 1 , 19 [711 V CII II191 -.4,M 7 I � ^ I. s tl 111 l l 41 I�.;IYri 'i 1 t' ,6 a i 1 3 1 A Nr S Ni IuP I`1 1 III ,N 1 17 n ,i4 1 2I ''LL6'� d8R � ti `? }a1' l . ' Ill : 4 : r � 1 'ir4'�i I 6 111111 1 > ll 1� 1 .LI �' 'hll , ® New construction ❑ Addition /alteration /replacement Please check all that apply (submit z gets of pleas w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: ' where the available fault current ©Marines and boatyards. p 011 1 '" 1. I II ' ' , 7 uul Ius M < 2 WAIF, u�u�a 11 y ryt I " I � ,.'1' k 111 10,000 amps at 150 volts or ❑ Floating buildings. I � �' "rL r q h � " i • , , d' •.. N' i.�' 111l 'ISM A IT, , • 'I'iIgl ratio I iNNII 3Ft(kl. Po� � , i L... • 1 , " ,1 p $ less to ground, or exceeds 14,040 co Commercial-use agricultural ❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings, ❑ Multi - family ❑ Master builder 0 Other: ['Fire pump. © Installation of 75 KVA or 1 �� ,I, o�i „ P I 111d11 '"11 IW rv;11 : ,,a r it ' e Nr * 1 , ©1 ~RlergettC system �I pplII�Im � I . l l Q i r I- I` ll ” . 0 I a �R R , I', j 1 1 Y Y larger separately derived system. IN ry I I V� III�J d MI ' r . 1 ' I I ❑ Addition of new motor load o£ .. Job no.: 45FISFC1L10 Job site address: 16083 SW UPPER BOONES FERRY RD 100HParmore. occupancy. 0 Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: TIGARD OR 97244 DHealth - care facilities. ❑ Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: ; a Project name: STATE FARM ❑ Service or feeder 600 attnts or snore. � 1 3 t r rT a 1I Me d�ll'Ii y ir. :035 a0 ir,l �IPh I I� A Ili 1 1' „ Cross street/directions to job site: n New residential single- or multi - family dwelling unit. Llcludes attached garage. Subdivision: Lot no.; 1,000 sq. ft. or less - 168.54 4 ~ ira, add'1500 sq. R. or portion 11111 33.92 - D Tax map /parcel no Limited energy, residential 7 �h�kN����li ",'1k�gjjj�g 75.00 75.00 MI 1p W� VOLT � A I GE tl1 I N S I TA[ I ! lel�c ,.,wulm rr,j!I q i:' jM1 l�uN 916�� 1i ���'pl'tld wi,mt Limited fl energy, multi-family 75,00 ATION VO10E AND DATA residential with above ti. . ft. III Services or feeders installation alteration acid /or relocation 200 amps or less - 100,70 "WI!i I7vl'I� r��� : *'�'NRd' i�0' I 1 a p ' �' r w9, <ml"ulnil�mu '; :JI UU�I� 1 "� ,11'r;I; � i k' ��'IIII��IIVi' f V1 18Pt�1m?�° magi i 111 L iiysjll ll i ' ii [ '',y11„� i rt>>ila oar ii " I .' 201 amps to 400 amps M 133.56 WI II I. ' ' tv,.) Name! STATE FARM 401 amps to 600 amps 200.34 601 amps to 1,000 amps In 301.04 El Address: 16083 SW BOONES FERRY RD ` '%r' Over 1,000 amps or volts 552,26 2 City /State /ZIP TIGARD OR 97244 - Temporary services or feeder installation, alteration, and /or relocation Phone: (252)912 - 7547 Fax: ( ) 200 amps or less M 59.36 =11111 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701- 401 amps to 599 amps 168.54 - Branch circuits — new alteration or extension 1 er anel Owner signature: Date; A. Fee for branch circuits with 1. r M© 1 g p�u n f 1111 m 1 P 1 + 1 N rj � i , , 1 1 , u , above service or feeder fee, $.rt • ' I � PP� i+ r 1'I Il „! . i ' ; 7 1 11 i4141, rd � IA I � -. 1 „ ,, : ::„ •,, :; .x i 7,42 t. -+ n lo7�a ar'u11 1 w 1'. 7 t n1 1 x Iu .n. d :_ n each branch circuit Business name; HENKELS R MCCOY B. Fee for branch circuits without ` service or feeder fee, first 56.18 El Contact name: DAVID SALAZAR branch circuit - - Each add'l branch circuit MI 7.42 Address: 5031 NE 148TI Miscellaneous service or fccdcr not Included City/State/ZIP: PORTLAND OR 97230 tacit manufactured or modular 67.84 © dwellin_, service and/or feeder l Phone: (971) 645 -0754 Fax: : (503) 205-1712 R econnect only IIIII 67,84 - Pump or irrigation circle M 67.84 mop E I)SAX✓pZARQ17ENK>MI S COM Sign or outline lighting 67 - i dyl11 , j4 i1 1 �I,'��Ifmp 11, 0 a!' 4In '■I�&} 71 i q N' 1 14�. 1y" II 'w'±• x i ll "1r 2 111 1 1 11 :1111111 i� IV �: '.� ' IVY.. " 'll 111111111 v1aM 1 it arirr_frtJf11 l G Vi6 � 1 1 1 1 j1, r: I Signal circuit(s) or limited -energy Business name: BENKELS & MCCOY 'anal alteration or extension. AM -i 5:d2_ Ill Each additional his 'colon over al or/able in an of the above Address: 5031 NE 148 Additional inspection (I hr min) - 66,25/ hr M- Investigation (1 hr mi City /State /ZIP: PORTLAND OR 97230 min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr —. Phone: (503) 2054720 Fax (503) 205 -171.2 Inspections for which no fee is - S 90.00i hr ME CGB Li 5 „ 11 iii 951 listed 11 1R tl @II Lie.: 63699 Electrical Lie.. 26- 895C.I, ttprv. Lie.: .: ; � 1 4111 N. I: P➢ � '� r I � I l yll' or� :'- ..�?;9��1.��'i���'�;�I!�; :?�:�I Puitll Vl�ilims�.�1Hf�1N Suprv. Electrician signature, required: Subtotal: 75.00 .-- Print review (25% of permit fee): Print name: - m ate: State surcharge (12% of permit fee); 9.00 Authorized signal f � ' TOTAL PERMIT FEE: 584.00 This permit application expires It a permit is not obtained within 180 days after it has been accepted as complete. �„ ,�/� Date: 7 . Number of inspections allowed per permit. 1:i Building \lfertnR91ELC- PormitApp.doc 007/01/10 4404615T(11 /or /COM/wEti a Ca t i Z� 6, ice_ Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: for residential systems omin $75.00 Fee for y buried 00 Check Type of Work Involved: ❑ Audio and Stereo Systems* fl Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: r Y „��J7 "1 VIII fqi, �Y�! !' I��I I li 0 Fee fore c commercial opro�� ! lave Ala 7�°�t$ w 0 11 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: C❑ Audio and Stereo Systems Li Boiler Controls ri Clock Systems ® Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC [] Instrumentation ❑ Intercom and Paging Systems ❑ 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 1 Huildins \pertnits\ELCPettnttApp,doc Q7 /0I /10