Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
C' COMMUNITY DEVELOPMENT Permit #: ELR2011 -00006
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/06/2011
Parcel: 2S112DB00200
Jurisdiction: TIGARD
Site address: 15255 SW 72ND AVE
Project: Pittman & Brooks Subdivision: FANNO CREEK ACRE TRACTS Lot: 45
Project Description: Low voltage for voice & date in second floor addition.
Contractor: PROCOM COMMUNICATIONS INC Owner: BROOKS & PITTMAN RENTALS
PO BOX 22288 15255 SW 72ND AVE
PORTLAND, OR 97269 PORTLAND, OR 97224
PHONE: 503 - 233 -8037 PHONE:
FAX: 503 - 233 -8052
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/06/2011 $75.00
12% State Surcharge - Electrical 01/06/2011 $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. A NTION: o - gon la . •quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 0010 through OA' 95 001 -00• •. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344,
Issu r j �� 4/ ,,/ __i i Permittee Signature: Z_ r 4P 4--
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 Applica ACEIVVED FOR OFFICE USE ONLY
Received ni�� / � e n 0 �� / —era*
City of Tigard IpnI ✓ Permrit No.: L /L p � J ! ��c C/
n 13125 SW Hall Blvd., Tigard, OR 97g3N 0 6 2011
Plan B lew
S Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: 6c A 0 0. 7 90 /
T I G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: firms: 8 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK 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: we 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 KV A 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.: Job site address: 15255 SW 72od Ave. 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: Portland/Oregon/97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locutions. 600 volts nominal.
Suite/bldg. /apt no.: Project name: Pittman & Brooks ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I 00'. I Fee. I Total
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. R or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. R)
•
Limited energy, multi- family
Voice and data t ' 1►L� j } " residential (with above sq. R) 75.00 2
� r Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Pittman & Brooks 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City / State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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 599 amps 168.54 2
Branch circuits - new, alteration, or extension, p er panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: ProCom B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Shawn Giles branch circuit
Each add'I branch circuit 7.42 2
Address: 2310 SE Clatsop Miscellaneous (service or feeder not included)
City/State/ZIP: Portland/OR/97202 ddweelllrssia
ervc or modular 67.84 2
Phone: (503) 233 - 8037 I Fax: : (503) 233-8052 Reconnect only 67.84 2
Pump or rogation circle 67.84 2
E - mail: shawng@procomcommunications.com
Sign or outline fighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: Same as above panel, alteration, or extension 1 Page 2 75.00 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City / State/LIP: Investigation (1 hr min) 66.25/ br
Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) I Fax: ( ) Inspections for which no fee is
90.00/ hr
specifically listed (34 hr min)
CCB Lic.: 109929 I Electrical Lic.: 3- 397CLE Suprv. Lic.: 1172LEA ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: _ ,e. Subtotal: 75
c _ Plan review (25% of permit fee):
Print name: Shawn Giles Date: 1/07/11 State surcharge (12% of permit fee): 9
le / TOTAL PERMIT FEE: 84
Authorized signature: ' — ` i This permit application expires if a permit is not obtained within 180
Print name: Shawn Giles Date: 1/07/11 days after it has been accepted as complete.
• Number of inspections allowed per permit.
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