Permit w CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II
°-- 1 • - COMMUNITY DEVELOPMENT Permit #: ELR2011 -00037
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/16/2011
Parcel: 1S 134AD06200
Jurisdiction: Tigard
Site address: 10565 SW NIMBUS AVE 100
Project: TSE Subdivision: Lot: 0
Project Description: Low voltage for telecom cabling.
Contractor: COCHRAN INC Owner: ROBINSON, CONSTANCE A &
7550 SW TECH CENTER DR. #220 ROBINSON, LYNN ET AL
TIGARD, OR 97223 BY KG INVESTMENT MGMT
10240 SW NIMBUS AVE #L3
PORTLAND, OR 97223
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/16/2011 $75.00
12% State Surcharge - Electrical 02/16/2011 $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 - - • - - 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: Ore. •n - re• -' es you to follow the rules adopted by the Oregon Utili No .' - ion enter. Those rules are set forth OAR
952 -00 0010 through OAR • 2 -001 r r • r You may obtain a copy of the rules or direct questions to O- ■ or 1.800.33 .2344.
� t
Iss ed By: Permittee Signa r �� `i:' 2 /
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.
01 10:48:42 02 -16 -2011 1 /3
�n n
Electrical Permit Application. ' - FOR OFFICE USE ONLY
City of Tigard FEB Received tey / , ^ ? �
`'y g 2 tJ 11
Date /By- �(� a ;% Permit No.: [ a 0 (
t� _ 'r 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review 503.639.4171 Fax: 5034 98.1960 .r'r Date /By: Other Permit
TIGARD Inspection Line: 503.639.4175 t/l I v U 1 Its Date Ready /By: luris' El See Page 2 for
Internet: www.tigard or.gov BUILDING DIVISION Notified /Method: Supplemental Information
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r ''TYPE OF WORK PLAN REVIEW ..
-
❑ New construction ddition /alteration /replacemeltl Please check all that apply (submit 2 sets of plans whims checked below): 1
❑ Service or feeder 400 amps or more ❑ Building over three stories. + 1
❑ Demolition El Other: and boatyards.
Other: where the available fault current v
- CATEGORY OF CONSTRUCTION : •': exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14.000 ❑ Com mercial• use agricultural F
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder - I> ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or -
JOB SITE INFORRIATION AND. LOCATION ❑ Emergency system. larger separately derived system Q
•
• - • ❑ Addition anew motor load of ❑' p C" ° I.2^ •• 1.3•• zv
IOOtIP or more. occupancy,
Job no.: G 1 Job site address: , d ( 1,...1 014 `4 10 L ) V 11 P
�
['Six or more residential units. ❑ Recreational vehicle par ks.
City /State /ZIP: • - 1 L � v W, 9 - [ 2:2__Z ❑ Health-care facilities. 0 Supply voltage for more than i Zo
`1 9 I + ❑ Hazardous locations. 600 volts nominal. 1
Suite /bldg. /apt. no.: `0 0 Project name: * - 7 — S \ v, L ❑ Service or feeder 600 snaps or more. j1
FEE,SCHEDULE 0
Cross street /directions to job site: Description 14a'- I pee. I Total I
New residential single- or multi - fancily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fi. or less 168.54 4
Ea. add'I 500 sq. ti. or portion 33.92 1 A
Tax map /parcel no.: • Limited energy, residential
2
DESCRIPTION OF WORK (wills above sq. f[.) 75.00
/ 25 ` Limited energy, multi- famil 75.00 2
lt2 b , 25 4 \ c0 Jv/. �� \. f residential (with above sq. ft.)
-3 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 '
Name: 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: ( ) 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' . ` • .CONTACT PERSON, above service or feeder fee,
eac branch circuit 7.42 2
Business name: a'0^e. 'GCS C 1f'\"t a. ,• 0 „ B. Fce for branch circuits without -� e service or feeder fee, fleet
Contact name: ll branch circuit
56.18 2
��/ �O ri y -O 7.42 2
— t T Each add'I blanch circuit
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service andlor feeder 67.84 2
Phone: &\ 1) 2 - L2L5 Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: k <It_ c ( Cpl(. At trA..'1 l vl C t LC) 110
Sign or outline lighting 67.84 2
CONTRACTOR Signal circwt(s) or limited- energy
Business name: h can panel, alteration, or extension. Page 2 5 + O O 2
Each additional inspection over allowable in any of the above_
Address: 1 5 50 5 (e-c-V■ e rt_K 4@22 V ?1 Additional inspection (I hr fain) 66.25/ hr
City /State/ZIP: � OK c s 72 Z'3 Investigation (I Innis) 66.25/ hr
Industrial plant (I hr min) 78.18 / hr
_3`T
Phone: 603 � ` / ' &,5-6 `, F ax: ().3 ) 7 3a - ,. p 9 '' Inspections for which no fcc is
90.00/ hr
specifically listed (94 hr min)
CCB Lie.: 72 c.i Electrical Lie.: u754/9 Suprv. Lic.:3447 . ' ELECTRICAL PERMIT•FEES
Suprv. Electrician signature, required: / Subtotal:. , 0 � �
P lan review a
(_5 /o of permit fee):
Print name: KP rno._,.}� " D ate: 2C\ fit `` State surcharge (12 %ofpeonit fee): 9, 0 Q
Authorized signature: ` \ TOTAL PERMIT FEE: H a 0
This permit application expires if a permit is not obtained within 180 -
days after it has been accepted as complete. (��Q�J
Prim name: Date: ' Number of inspections allowed per permit.
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I:t Bpi lding •Permits•L' LC-Per ailApp.dar 0701.10 4404615T(f I'55•COM'WED
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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:
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
L EI / 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 requited
for all other installations
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