Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
If ; :,. COM MUNITY DEVELOPMENT Permit #: ELR2011 -00125
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/07/2011
Parcel: 25101 DC04601
Jurisdiction: Tigard
Site address: 7409 SW TECH CENTER DR 100
Project: Solutions Yes Subdivision: TECH CENTER BUSINESS PARK Lot: 2
Project Description: Low voltage for data.
Contractor: AZIMUTH COMMUNICATIONS INC Owner: NORRIS & STEVENS
P.O. BOX 508 621 SW MORRISON
WILSONVILLE, OR 97070 PORTLAND, OR 97205
PHONE: 503 - 639 -0110 PHONE: 503 - 223 -3171
FAX: 503 - 639 -0115
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. • " TION: • - •on law re.uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -O8 -0010 through OAR 9 2 -00 .890 ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss • d By: ,k 4' � e �/l in Permittee Signature: juhJLCS
• 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 Application FOROFFICE•USE ONLY :
Received ��� h
City of Tigard Date/By: 7 �( A Permit No.: �G /�� /�
V 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 Date Ready /By: orris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN' REVIEW
171 New construction VI- 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: 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 vi, Commercial /industrial ❑ Accessory building amps forall other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
.JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
0 of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
(�� /� f 1 �� r r ,�i 100HP or more. occupancy.
Job no.: Job site address:
/ Jl W (CS �� cC 1�,7` '/ �- ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: - 12.-T-1}0.30 V ; ❑ Health -care facilities. ❑ Supply voltage for more than
ZZ ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: ( Project name: Lli ,, �on)j y ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 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 145.15 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential
DE CRIPTION OF WORK (with above sq. ft.) 75.00 2
S
Limited energy, multi - family
1/Di C t6 rUAT a residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ' ❑ TENANT. • 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 am 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, Rer panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CON TRACTOR Sign or outline lighting 53.40 2
Business name: f - Z_-( l 1 o� 0 �' C AT ( 01\6 Signal panel, t o n , or
� �� energy panel, alteration, or
Address: c) w �o,� -�� 1 �(61e_��v extension. Describe: ( Page 2 2
City /State /ZIP: -- uA1 e-.1 c,(12_ i? 0 (z, Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: ( .57) ( 3 ^0((,U Fax: (5 C 3 - 0 ((S Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: " Suprv. Lic.: Industrial plant per hour 73.75
1 `�� X32 D v 3� 9�t�C p �co (,�
�_ � ELECTRICAL L PERMIT, .FEES
Suprv. Electrician signature, required: �- 11� Subtotal: f ".
Print name: Gj 1 --r— Date: 6/' /6 (2,01/ Plan review (25% of permit fee): , `' �° t4 State surcharge (12% of permit fee): g, 00
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete. 0, / pa
* Number of inspections allowed per permit O -•'
P\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(1 I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r RE,SIDENTIAL-WORK`ONLY:. `
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
. COMMERCIAL'WORK ONLY: .
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
t D ata Telecommunication Installation
❑. Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
I. \Building\Permits\ELC- PermitApp doc 03/23/06