Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00120
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05!25/2011
TIGARD. 9 Parcel: 2S101DD00702
Jurisdiction: Tigard
Site address: 6900 SW SANDBURG ST
Project: Thrifty Supply Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: data /telecommunications
Contractor: TECHNOCOM INC Owner: J & K PROPERTIES CORP
7929 SW BURNS WAY STE. F 6900 SW SANDBURG RD
WILSONVILLE, OR 97070 TIGARD, OR 97223
PHONE: 503 -682 -4195 PHONE:
FAX: 503 - 682 -2781
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 05/25/2011 $75.00
12% State Surcharge - Electrical 05/25/2011 $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 $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 through 952- 001 -00.0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
min
Issued By: r Permittee Signature: '1/ P6 /&5
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7 :00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
El Permit Application,
S''' FOR OFFICE USE ONl.i'
' Received
City of Tigard Permilhto.:
1111
131 SW Hatl1 131vd.,'l'i ud, OR 97223 i Dutc /t5y', . 7 , - _ Z17 y- Oa /z4
�1 Plan ue
Oilier Perrin',
Phone: 503.718.2439 Fax; 503,598.196(, � � � Dotdlly;
'I'tG•a1RD InsoectionLine: 503.639,4175 � (�P`� A I9itt¢Ready /ey: auri 1E1 Sec Page 2 for
Internet: www.tigard- ot'.guv \V` %Nolifted /Method:
..e ' t Supplemental information information '(,�n .nee it v
T OF W ORK. ur N°ri ,''
PLAN—REVIEW
\ ` Plee ohnol: all that :p�ply (Rubin:, 2 noes or plans w /items checked below):
(J New construction �ACltl;tion /alterati onhcplac �tcnt
"
� ❑ Service or feeder 400 amps or more ❑ liuildiug over three stories
❑ Demolition 0 Other: _ where the available fault current ❑ Marinas and boatyard$.
CATEGORY 'OF CONSTRAl C"1'ION exceeds 10.000 amps at 150 voles or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commereial -use agriculru;al
❑ I- and 2- family dwelling XCommerciai /industrial E] Accessory building. amps for all other installations. buildings.
0 Multi-family 121 Master builder ❑ Other: CI Fire pump. ❑ Installation o1'7S KVAor
JOB SITE INFORMATION AND LOCATION ❑ atnergtlttcy YyYlwn. 1,,;gor separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1. ", "1 -3 ",
,L / _ g `u ) .�
Job no.: It Y ,4 100141 or morn Reese oct:upattcy,
Q 1 I Job site. ntldress: (� r
0 Six or mare residential units. ❑ fteur:alional vehicle parks.
Cif /Suite /Zi : ■ ' ❑ Health - care facilities. ❑ Supply voltage for more than
y : ttSri+3 ... a ,. ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. n,t' Pmjt-.rl.name: ❑Service or feeder 600 amps or more,
tl r .I / ., / . ' FEE SCk1E1)ULE Ili
Cross street /directions to job Site; UCbcrl uteri qtr, kcc. r'eml
New residential single- or multi- family dwelling unit.
includes attached garage.
Subdivision: LLot no.; 1,000 sq. I2 o r less 168.54 4
drat. add') 500 sit. lc or portion 33.92 I
Tax map/parcel 00.: Luna- energy, residential
DESCRIPTION �QF WORK (with above sq. tt J 75,00 1111 2
-^^ Limited energy, multi- family 7500 2
° /P1r /, I 1 I - rueidonrial (with ahoy. sc. it.l
Services or feeders installation, alteration, and /o • relocation
200 amps or less 100.70 2
1']t(jl'til2TY OWNER 201 u rip. w 100 amps 133.SR 2
❑ I'CNANT
401 amps to 600 amps 200.34 2
Name:
_. ,,, 601 amps CO 1,000 amps 301.04
Address; Over 1,000 amps or volts 35226 2
°'
Temporary services or feeders installation, alteration, and /or
C'ily /Stale /"ell': relocation
—
Phone; ( ) I 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 401 amps to 599 amps 168, 2
intended tilt' Sale, lease, rent, or exchange, n'cording to ORS 447, 449, 670, and 701.
Branch circuits -- new, alteration, or extension, per panel
Owner *.nature: _ Date; A. Fee for branch circuits with
. �--..k l'LI CAN'1' 2<:ONTACT PERSON above service or feeder fen, 7.42 2
vuoi Liu dl ci R:4,4
I inc::� name: 13. Pei r0, branch circuits
�j'.'� ' service or feeder lee, first 56.1$ 2
Contact name: ! -')� , branch Circuit
���- � b :acti add'1 brunch circuit 7.42 2
Asters s/ ♦ i j — Ma
Miscellaneous {service or feeder not included)
` ir Each manufactured or modular 2
City /S(1107W: ♦41 • 1 �. t� 0 dwcllin , service and/or feeder lin
r+� 0 0 I hid u2.,_ ^ f��' Reconnect only 67.84 - 2
e: °� , I Fns:: ad
Pump or irrigation circle 67.84 2
I „111: • E_. . l n r R 4. 'A■ - - 4 . a 't r!i .' Sign o r outline lighting 67.84 2
0 ` - RA 1 r It Signal circuit(s) or limited - energy 2
panel, alteration, or extension. { Page 2
lltISineSS 11dI1W, • Each additional ins ection over allowable in an of the above
t \Iklress: A dditional inspection (1 hr min) 66,25/ hr
t 1 r s Investigation (1 hr min) 66.25/ hr
I I t (ti1;Ila /LI I': Industrial plant (I h mitt) 1111 78,1 hr
•- Fax: ( ) Inspections for which no fee is ■ 90.001 hr
( _ specifically listed (V5 hr min)
d'('l( Lie.' r lectrical Lie, 0 C • . Lie.; bail 1 C ` ELECTRICAL PERMIT FN;LS. '•
_ + . :• � Subtotal: ai
/J g
in l pry. I�luoi tic ,ill c n6 urn, re'rlu it'N //
ti' ' ' ' I 1V I t r - plan review (25% of permit fee);
• Date: , Slate surcharge (12 of permit fee):
I' III n;inii' (� � — TOTAL PERMIT FEE: g
loft/Qt.-1 $iIlalure: 4 Thi win application expires if a permit is not obtained WI nt inn
a4
___ . days after It has been accepted as complete.
II seal • r .�� 4 -' . Date; • ,..6 r Number of inspections allowed per permit.
5a0 1e1M1 trim:ur /m:11
1 ^I<,i■dre P , -,min ■ra.t'- rrss 0
•
Elec trical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITIIID ENERGY PERMIT FEES: '
. RESIDENTIAL WORK ONLY:
Fee fur all residential systems combined $75.00
Check Type of Work Involved:
n , \tldjo mid Stereo Syysfems*
El 1 r,2
❑ C-i;ii;ii;L Douf OYcilei. `
n Heatin Ventilation s Air Conditioning System*
❑ Vacuuffl Systems*
r ti l,[,, r:
COMM E KC I AL WORK ONLY:
Fee for each commercial $75.00
system
(S OAR 918- 309- 0000)
Cheek "I'V l,e of Work Involved:
❑ _ \it, Ii(t,tI RI , Lt-'L Ot"
l:i der Controls
n t i 'ck Sy'slenls
j(1);t::t 'I't:lecomrfluni(; adon Installation
❑ I iit: _1l:trn7 1nt;tall:tti.,rl
❑ 1 ivy.. .
E Ii,s,, :u,alenration
• I.,,s. ret,m and Paging Systems
❑ I ..!iichl,.:1-w T,riE,atioiI Control*
71 i`.Ii•Llic,,l
Ej Ni ,r;r l.;lllti
❑ l I,., .1t,ot l.andscapL I ,i;.:,hting
n 1 1 ,tective Signaling
To ;11 t .lnslxcr of cofrunel:cistl sytcnls: —
*No licel;tii'i are requic:J. Licenses are required ,
for all , tlhe I . installations
,
INSuiiai,l uitnup 00007!01 /I(I