Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR201 1 -001 04
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2011
Parcel: 2S110DCO2300
Jurisdiction: Tigard
Site address: 11535 SW DURHAM RD C -2
Project: Edward Jones Subdivision: Lot: 0
Project Description: Low voltage for voice and data.
Contractor: CACHE VALLEY ELECTRIC COMPANY Owner: HIP WILLOWBROOK LLC
6200 SW ARCTIC DR. BY TAX DEPARTMENT
BEAVERTON, OR 97005 PO BOX 2708
PORTLAND, OR 97208
PHONE: 503 - 431 -6600 PHONE:
FAX: 503 - 624 -1436
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 05/11/2011 $75.00
12% State Surcharge - Electrical 05/11/2011 $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 $84.001
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. ATTEN % . •r -.o. law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 r through OAR 952 =001 -• . • r • u may obtain a copy of the rules or direct questions to OUNC b - ' or 1.800.332.2344.
!
Issued =y: = _/ .p/x)1 l j Permittee Signa : / �L�fl�'��'
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.
05/10/2011 12:11 FAX 425 424 9966 CACHE VALLEY ELECTRIC RI 0 0 2
Electrical Permit Application 1 FOR- OFFICE USE ONLY
City of Tigard 06
.. 13 k Received
V Date/E : 5 1/111/ 11 71 ,.-ee
1111 - .125 SW Hall Blvd., Tigard, OR 97223 , % ' L Permit N°. (4111-7ey A
:.
14 Phone: 503.718.2439 Fax: 503.598.1960 ,,.;* \- ,,Alairl Other Permit:
TIGARD Inspection Line: 503.639.4175 \ :O ,c N . ■11 - • eady/By: lurk: fa See Page 2 for
Internet: www.tigard c0 vO,' otified/Method: Supplemental Information
New construction D Addition/alteration/re ment Please check alt that apply (submit 2 sets of plans w/items checked below):
El O
0 Service or feeder 400 amps or more El Building over three stories.
El Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
f',Oirboif=4Coisi§iiitiefi■A: ill.;.nA..-1:.•. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1- and 2-family dwelling [E] Commercial/industrial El Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 12 Fire pump. 0 Installation of 75 KVA or
- • 0Emergency system. larger separately derived system.
,, .. 1.2 .,:•.- .,;.:?','-‘,,,,'!'' .4911:-SITE -,',.,, El Addition of new motor load of
Job no.: 43799-20 Job site address:„1.4.8 Durham Road 100HP or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard, Oil 97244 0 Health-care facilities. 0 Supply voltage for more than
El Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: C-2 Project name: Edward Jones 0 Service or feeder 600 amps or more.
' ;;;-,'`: p,:tc scitovi*
Cross street/directions to job site: . ii_Lpi tion I Qtr. i Fee. I Total I •
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'i 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
75.00 2
tiEgeititi.-fidiSrrei":4i3iR,:: ':' ''.: ' '):.7 (with above sq. ft.) .
Limited energy, multi-family
voice & data installation residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
tj:':iftoptitiv,]1*vi : .:: -,7 ', : 1::;; - , '.!;',;'';': - -*
. .1.AN*:,::::;::',.r„.:..:.;,.:-,-,i...,; 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
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 .nstallation 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
—,-,., above service or feeder fee,
,- '.1Z.-APPLICANT.';',. --":'-,:' -:' '-. ':,. - .' ,. : .''' 0 'CONTACT: PERSON: -:--.:,., .'..,:.' 7.42 2
each branch circuit
Business name: Cache Valley Electric B. Fee for branch circuits without
service or feeder fee, first
56 18 2
Contact name: Vanessa Martin branch circuit
Each addl branch circuit 7.42 2
Address: 6200 SW Arctic Drive Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: Beaverton, OR 97005 67.84 2
dwelling, service and/or feeder
Phone: (503) 431 Fax: : (503) 624 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E vanessam@cve.com Sign or outline lighting 67.84 2
--:'. - -- :,:..: :-.,_ :-, Signal circuit(s) or limited
Business name: same as above 1
panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr mm) 66.25/ hr
City/State/ZIP: Investigation (1 hr mm) 66.25/ hr
Industrial plant (1 hr min) 78.18/ lir
Phone: ( ) Fax: ( ) inspections for which no fee is
specifically listed (1/4 hr mm) 90.00/ hr
CCB Lic.: 148222 Electrical ' 37-976 Suprv. Lie.: 5000S :::'A
Suprv. Electrician signative, require,. Subtotal: 75.00
Plan review (25% of pennit fee):
Print name: Jody Jenkins 7 "'I Date: 5/10/11 State surcharge (12% of permit fee): 9.00
TOTAL PERMIT FEE: 84.00
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
D.Building \ Permits 1 ELC-PermitApp.doc 07/01/10 440-46157(11/05/COMAVEB
05/10/2011 12:11 FAX 425 424 9966 CACHE VALLEY ELECTRIC 003
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work ]involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Clpener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:,• = ..• ,, `1 +,.'.:: ": ;; - ; ,•',:
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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentatioa
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landi;cape Lighting*
❑ Protective Sign aling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 Building \Permits\ELC- PermitApp d c 07/01/10