Permit '// gap r)N/ i► , hlC Icco< - �� trM 5$ f r) ,
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT •
11111 �, COMMUNITY DEVELOPMENT Permit #: ELR2011 -00126
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/07/2011
Parcel: 2S113AB00500
Jurisdiction: TIGARD
Site address: 16083 SW UPPER BOONES FERRY RD 105
Project: Metro Multifamily Housing Association Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37, F
Project Description: Data /telecommunications for TI. 6/7/11, reprinted permit to include fire alarm.
Contractor: LEAR ELECTRIC CO INC Owner: G &S FC LLC
5140 SE CIRCLE AVE 16083 SW UPPER BOONES FERRY RD,
PORTLAND, OR 97236 STE
TIGARD, OR 97224
PHONE: 503 - 849 -4723 PHONE:
FAX: 503 - 661 -6389
FEES
Description Date Amount
•
Specifics: Restricted Energy Permit 06/07/2011 $75.00
12% State Surcharge - Electrical 06/07/2011 $9.00
Type of Use: COM Restricted Energy Permit 06/07/2011 $75.00
Class of Work: ALT 12% State Surcharge - Electrical 06/07/2011 $9.00
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 $168.00
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 OAR 952 - 001 -0090. You may obtain a copy offt or direct questions to OUNC by calling 503.232.1987 or 1.800.332.23444.
Issued By: Permittee Signature: _ d ✓/
J
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.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00126
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/07/2011
Parcel: 2S113AB00500
Jurisdiction: TIGARD
Site address: 16083 SW UPPER BOONES FERRY RD 105
Project: Metro Multifamily Housing Association Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37, F
Project Description: Data /telecommunications for TI
Contractor: LEAR ELECTRIC CO INC Owner: G &S FC LLC
5140 SE CIRCLE AVE 16083 SW UPPER BOONES FERRY RD,
PORTLAND, OR 97236 STE
TIGARD, OR 97224
PHONE: 503 - 849 -4723 PHONE:
FAX: 503 - 661 -6389
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/07/2011 $75.00
12% State Surcharge - Electrical 06/07/2011 $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 OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: �/ /G /6
111 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.
elk,
Electrical Permit Application s FOR OFFICE USE ONLY
City of Tigard E j � Date /B : Permit No.: �ea / / /.._ 10
11 1111 q 13125 SW Hall Blvd., Tigard, OR , 97223 C �
w \ Elan R ev i ew Other Permit:
Phone: 503.718.2439 Fax: 503.598.1 �\V � (� �pateB
T 1 G A It Inspection Line: 503.639.4175 , t � ', \� Date Ready /By: See Page 2 for
Internet: www.tigard or.gov `J Notified/Method: Supplemental Information
.w \tir
TYPE OF WORK \ ®. �' PLAN REVIEW
❑ New construction ❑ Addition /alteration /replaWnent
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: where 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 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergenc system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.: Job site address: J 100HP or more. occupancy.
1.6 L/0 ice' ` 1,5 r! Ct `i —S ❑ Six or more residential units. P
❑ Recreational vehicle parks.
City /State /ZIP: El Health -care facilities. ❑ Supply voltage for more than
El Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Z ° --1 Project name: m fi 7:211 7 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description I Qty. 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. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
_
Limited energy, multi - family
C�l�e� - it) E. L Pap I l — C,Y_ " Y ' residential (with above sq. ft.) 75.00 2
Y Services or feeders installation, alteration, and /or relocation
°- re _ 4 tc err\ S t " S-7&fv s 200 amps or less 100.70 2
❑ PROPERTY OWNER T ❑ 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 7.42 2
each branch circuit
Business name: J c r Dc ,1 B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Le r_ l , � � panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed ('7 hr min)
CCB Lic.: Electrical Lie.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
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.
C\ Building \Permits\ELC- PermitApp.doc 07/01/10 440 -4615T(11 /05 /COM/WEB
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:
n Audio and Stereo Systems*
n Burglar Alarm
F - 7 Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
�] HVAC
❑ Instrumentation
F l Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \Building\Permits\ELC- PermitApp doc 07/01/10
06/06/2011 12:30 5036616389 LEAR ELECTRIC CO INC PAGE 01
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Electrical Pern A licat 1 � Q0 172 6,
i ; [ a wed / m `0 41:121111 'F — emut No.: L [ �. � r
City of Tigard .. e/B : ew (� i/� —1W I D
1 3125 SW Hall Blvd., Tigard, OR 97223 JU N 6 2 0 other Permit:
111 >, Date/8
I N 8 Phone: 5 2439 Sax: 503.598.1960
Line: IIate ReadylBy: . El See Page 2 for
inspection iine: 503.639.4175 r Supplemental information
1' I t... www.ti CITY i OF D No • Internet: g od - or.gov °q; r .
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,” °s ('rab a„ .,, ,,, •,, a : ' ° v Please check all that apply (submit ? sets of plans w /items checked ):
' ffi yr ".* ,t lit i4V& , n, Ftiy +� t it's x. En;:r.
❑ New construction ® Addition /alteration /replacement Q Service or feeder 400 amps or more Q Building over three stories.
where the available fault current ❑ Marinas and boatyards.
0 ,;. 150 volts or ❑ Floating buildings.
Demolition ,'u � �; • ,r� =y'u } exceeds 10,000 amps at
" ∎'W1'i 'i' "• %. ,, s ) 4, Commercial -use agricultural
n 1 ` 4; 3r� "6' » f ; c t k i ,e r; l;r k l `" ', ......,',•',,' Al.i , a �3 ., .S o i'S 1 :f ' r „1 :, e; ., exceeds 14,000 ❑
�4��6rN l ��ratZ? '��d7�'= `J��r'LW3S {srx�ipr�r ,..-.,1,•.;$1 r. wvw a a c. •H51.�Im W.. ue�o;v + . , 4 x ti � o ,u i � less to ground, or excee
❑ 1- and 2- family dwelling S Commercial/industrial ❑ Accessory building amps for all other installations. ❑ Installation uiings.
❑ Multi- family 0 Master builder of 75 KVA or
Other: ❑ Fire pump.
dder ❑ ❑ Emergency system. larger separately derived system.
"Y w , , �r7 ,� h h �' . 5 u 49 tf.a'' ��N , .' g? 46:ii 4744 + t} "A 'td 1 " r -'' �) " '. • ❑ Addition of new motor load of ❑
44t 'n a w " ; ,.:
, ,. .,rr ,r o• occupancy.
14 � � �;. , nr Jiro,. s„ �,, I00HP ormoro.
Job no.: 11 -314 i Job site address: 16083 SW Upper Booties Ferry Ro CI Six or more residential Recreational vehicle parks.
units. 0 for more than
Supply voltage o
Health -care facilities. 600 volts v voltage nominal.
City/State/ZIP: Tigard, OR 97224 0 Hazardous locations
Q Service or feeder 600 amps or more.
Project name: M MIIA TI ; r Y . l °i `li., "A" ;. ri
Suite/bldg./apt. no.i.0.2 , 4 .- -
/� ,° �.` lj��C�` t�' � 'F,�1 +a'w�'S „'.��.�,r ,,r� y t'1T,Py��Su F �
J 11CCL TJ/� 9e -f / aaS/A/6 _Deac3iptlon 9N• l Fee, l Total
Cross street/directions to job site: ! ' New residential single- or multi - family dwelling unit.
AS-Co ' - ( O Includes attached garage.
1,000 sq. ft. or less 168.54 4
Subdivision: Lot no.:
Ea add'1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: , energy, residential 75.00 2
, .. ,• v -�.;: t10 a4;°3iNi `;�,r -.,�:, , xf "r'°"+' ;� . e),. = '34,. (with above sq. ft,)
d }t Cl (,'tr W s; r ;.i.;. „rar,:,: energy, multi - family 2
i- fce 1 75
��l l �J31'. �ryv. , e./ , �k '�� � K. ) � �I 1
J� 1� , . VA,IT ' S.
,- h �,a -. �,r. •, "1,.... �s �,tt?i;7e °�,� a'.' Limited .QO
.s,��;k�•,v.,�.�,�..��is�r,', 1,c�, ftµ., �.. . „,, , . , ..:; ,
Tenant Improvement residential (with above sq. ft.) .
• Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
e , t ..r. ,;, 1 3 , : :. n: 1
, r, ; :. ;';`; 1 201 amps to 400 amps 133.56 2
� u ,;, 2
5” i t4 4 fi rD r + rbk�s�r� ,� r 0 r
, ? rs� ;;F ,.,.,. E., 1 200.34 2 • fY -. 401 amps to 600 amps
Name: -
• 601 amps to 1 am 301.04 2
Over 1,000 amps or volts 552.26 2
Address: Temporary services or feeders installation, alteration, and/o
City /State/ZIP: relocation
200 amps or less 59.36 1
-
Phone: ( ) f Fax: ( ) 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 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
; . 3 above ser vice or feeder fee, 7 42 2
ns ,:,,, �.; ti ,., r, ,a - , F7.. r r } sad uA ie -.. : i ', V �;";g ;V:', branch circa
l ei ii; ti7. kl'' � r� 3 » t„ F 1 ,, , i '?14 � I-: r ` ' , , _ ' each bran it _
{ n rn,y „T �'1 d .. 1 �� a� rb/ i �r���C ` n ” , �NE ill; krfnl eltii� ,.ne r.c z °ra +r c ' snma. , . r ,. ,
�e�C'1�in�i_h!G'tS �, �� '�j'�:,. , .. �,fvt H 3 4.. ,k. t,.
B. Fee for branch circuits without
Business name: - service or feeder flee, first 56.18 2
branch circuit
Contact name: Each add'l branch circuit 7.42 2
Address: _ Miscellaneous ( service or feeder not included)
Each manufactured or modular 67.84 2
City /State/ZIP: dwelling, service and/or feeder
Reconnect only 67.84 _ 2
Phone: ( ) I Fax: ( ) Pump or irrigation circle 67.84 2
Sign or outline lighting 67,84 2
E , <., ev , A , z,0..7;d;S:0,s1•lj�i 44441 ? a 1, - 1 i 1 a� } ";' " %l "+ . 3 Or llmlted•CneC
{,,` 3 - �, :�Y' i : "•,1 4iybi�Wn ,, ,+. RS 1 ;e• A : ° i: } � , � n iQJ: ; 4,3 ;�i,��: , Sign e1TCnit {) �' 1
75.00
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!0.!; . �•I;Y, ilti,, ,, P �;, , 14ri,' 2
:k;�d��aA, �;,'��M;,l;+�;�;,, -t ��, � �:;.,; .s:,. i; � �� panel, alteration, or extension. Page 2
Business name: Lear Electric Co., Inc. Each additional inspection over allowable in any of the above
Address: PO Box 573
Additional inspection (1 he min) 66,25 /br 6625/ hr r
Investigation (1 hr min) ,
City/State/ZIP: Gresham, OR 97030
Industrial plant (1 hr min) 78.18/ hr
Fax: (503 - 661 - 6389 Inspections for which no fee is 90.00/ hr
Phone: (503) 665 specificall listed A br min
1 ,it!." oisa = '� 1'S'a�l t.. ... q r. ... 4.., ,gr�, ... ;'� i..'.
t�I 7 CCB Lic.: 52278 Electrical Lic.: 26 - 4110 Suprv. Lic.: 3786S Subtotal: 75.00
VV' Suprv. Electrician store, required: ,, 1 � _ //
Plan review (25% of permit fee):
Print name: Devi Mumford
ate: 6 /6 /11 State surcharge (12% of permit fee): 9.
TOTAL PERMIT FEE: 84.00
Authori signature: . / This permit application expires if a permit Is not obtained within IN ��, /� •"�- days after it has been accepted ns complete.
Print dame: David Mumford _4 -'/ I Date: 6/6 /11 • Number of inspections allowed per permit
1:\ Bmit ding\Permita'Er.C- Pe 07401410 440- 4615T(t 1 /85 /COM/WE.B