Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT • • , . COMMUNITY DEVELOPMENT Permit #: ELR2011 -00174
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/27/2011
Parcel: 2S101AD03100
Jurisdiction: Tigard
Site address: 6950 SW HAMPTON ST 340
Project: Energy Connect Subdivision: Lot:
Project Description: Low voltage for data.
Contractor: HENKELS & MCCOY INC Owner: WESTON INVESTMENT CO
5031 NE 148TH 2154 NE BROADWAY
PORTLAND, OR 97230 PORTLAND, OR 97232
PHONE: 503 - 205 -1720 PHONE: 503 - 284 -2147
FAX: 503 - 205 -1712
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/27/2011 $75.00
12% State Surcharge - Electrical 07/27/2011 $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 _ . •r•ance 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: Oregon law r r you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -01 -0010 through OAR 952 -01 -0090 0 ay obtain a copy of the rules or direct questions to OUNC by calling 51 32.1987 or 1.800.332.234
I / /
I -ued By: Permittee Sign.
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.
, • -Jul. 22. 2011 6:33P4 - HArina . No. 0961 P. 2
Electrical Permit Applicato ! LULA( FOR OFFICE USE ONLY
11111
City of Tigard ',JUL 2 1 2011 Received IIIIIMMI Pennit blo.: EAR_ pea- ea/ 7 A
Dategl t
11 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review -
I a Phone: 503.718.2439 Fax: 503.59460 Dale/13 . Other Permit; tup , e9/ -t./ TIGAR
Ir4ection Lino: 503.639.4175 '
,,,i '1 Y' OF TIGAHD Date Ready/By: Avis: lif S'ee Page 2 for
D
. . Internet: www,tigard-or.gov P i .j ILDING DIVISION N°1`fiedimethm: s‘ hirommion
-• • :-.•., • - "-:•.'::: , -:::••• , :• , :::::': ,,, ' , 1'.. , ,•'' , •:,:•••••;; ,, .iy; ..4* • ;•;• .',1 ,s..',•:'•:. ::;':',''.. ,.,,,„:::. ..,.
D New VAddition/alteration/replacement Please check all that apply (submit 2 sets of plans Miming checked below):
U
1=1 Service or feeder 400 amps or more CI Building over three stories.
0 Demolition . El Other: . where the available fault current 0 Marinas and balnYagla- •
" • :.s.'; .: '. -'-;- -• ••••`:': :'..: 4vx .:, exceeds 10,000 amps at 150 volts or 1:1Floating buildings.
..:.: : ,.. '7: ; ',":".' '-, '''':::.:. • - .' ', `'''' ' ''''.-. '''' ' ''''. • ''•'''''' ' ''''''*:" '''. ' ...' less to ground, or exceeds 14,000 I:Commercial-use agricultural
171 1 - and 2-family dwelling Commercial/industrial 0 Accessory building - amps for all other installations. buildings.
CI Multi-family , ID Master builder CI Other: Prim pump. Ellnstallation of 75 KVA or
. 0 Emergency system. larger separably derived system.
: .... 1 ::.:1,41.pog,:lopoolop.'1:‘ : ..i , - 0 Addition of new motor load of 1:1"A"."B","1
Job no.: I J - ..,.. ot f•_• ,,,. A „ c ,. 100HP or more. occupancy.
• Site allures& . (p - I'D u H ruk.) ...)r •T'e stir, 0 Six or more residential units. CI Recreational vehicle parks,
1
City/State/ZIP: 4, c 1
0 BealilKare Aciliiies. ID Supply voltage for more than
11 0 0 k i .. ..3
['Hazardous locations. 600 volts nominal.
• Suite/bldg./apt. no.: S 40 1 Project name: (2_6 e _use ,tyke amps or more,
:::::...: ,:'.. . . ;:" , 'LZ - '::: :''':::'•-•':?'': -•:.-:.::
Cross Street/directions to job site: 6 La - DJ- , 0 p_06 Deicri . don .. Fee. Total •
New residential single- or multi-family dwelling unit. .
. . Includes Attached ga rage. ,
Subdivision: . 1 Lot no.: 1,000 54. 11. or less 168.54 - 4
Ea. addl 50014. ft. or portion 33.92 ' 1
Tax map/parcel no,: • , . Limited energy, residential
75.00 2
• --.:"- " - • ' '-,' '. ''''' ' '' : `..:""':. '.."• ' . ' t ook.„ i ko t i: ; •:::;,. , (with above sq. ft.)
Limited energy, multi-family
75.00 2
residential (with above sq. ft.) . _
..,
Services or feeders Installation, alteration, and/or reloc ation l
- 200 amps or less 100.70 . 2
'iti: go. : ,:•.. , [::•.,: : :•: : ,: : .•: : ;:......KItt..4..4:4 , .:: : ::•:3::,:•i, : : . , .. :: - :. 201 amps to 400 amps 131.56 2
' 401 amps to 600 amps 200.34 2
Name: v 1 c 10A) 0 c... 71"
601 amps to 1,000 amps 301.04 2
Address: \ g,() t.-kap ST I D it 3 46 Over 1,000 amps or vORS 552.26 2
t Temporary services or feeders installation, alteration, attd/er
City/State/ZIP: -r t (ap__0 0 0_,_ et I?... ...3 relocation
• /
Phone: ( ) I Fax: ( ) 200 amps Or 1555 59.36 ' 1
201 amps to 400 amps 125.08 2
. Owner Installation: This installation isbeing 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 so 599 amps 168.54 2
Branch eireuits - new, alteration, Or exten,SiOn ' • ,
Owner SigtlatU re: . Date: A. Fee for branch eireuita with
4 :..'::: ' .: ' ''S[ ‘ ..: ; :::51 iq .i * t:A O :PE4°11‘:' ':..::.'.: . a e b e ° Ch va br S a e n r rCi ° rC r O r rt der "6' 7.42 - . 2
Business name: /..th,)1),,8 e POCC(9 6 i QC, B, Fcc for branch circuits 10/rhoirt •
. service or feeder fee. first
/ 56.18 . . ' 2
: Contact name: D ci, branch circuit
----z-------- Each addl branch circuit 7.42 2
Address: 6000 0 0 1 LVZ A 0 6-
Miscellaneous (service or feeder not included)
•
Each manufktured or modular
City/State/ZIP: Po Vrt-p . 0 (D cr-r D 0
dwelling. service and/or feeder 67.84 2
Phone: (q9) , LAI - 3i- 5; G --- Tii.,7 - CeT)cF6 - 71.-'7 . -L04-60 Reconnect only _ 67.84 - 2
Pump or irrigation circle 67.84 2
E-mail: .c'&0,0 1.--1—u, ti..5(--S . Com . . Sign or outline lighting 67.84 2
:.,' 7 ":.:::•‘::.'.„?:::: -:'( NT4t '.::. , . : • Signal circuit(s) or limited-energy
panel, alteration, or extension. I Page 2, 2
Business name: 6 A ryw 1-'■•• A (bp 0 G Each additional inspection over allowable In any of the above
Address: • , Additional inspection (1 hr min) 66,251 hr
City/State/ZIP: . Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
,
Phone; ( ) - , I Fax: ( ) Inspections for which no fee is
h
90,00/
specifically listed eh hr min) r .
Cal Lic.: t ( q 9 1 Electrical Lie A4- cf96 Suprv. Lie.:
,:::: ''...':''::'..' C 'rt oirt,Fm:•• .: .• :: • . ' :
Suprv. Electrician signature: required: fly Subtotal: (t'i, r)3
Plan review (25% of permit fee): : — ' •
•
Print name: . ,
Date: State surcharge (12% of permit fee): "--- •
. .
' TOTAL PERMIT FEE: .
.gt.f,.(,,-
) a
Authorized signature: ,... ) / 0 i .. /, 4 0, 4 • Thls permit application expires Ira permit is not obtained within 180
days atter It has been accepted
Print name:Z) . ifffigr Milli Date: a • Number of inspecdons allowed per pennit. as complete.
•
1 ;1 1 3ulidireermil 6 NELC - PerinitAPedoo 07/0i/l0 . 44o-4615T(11/05/COMAVtl) •
Jul. 21. 2011 2:35PM .Henkels & McCoy No. 0958 P. 4
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
•
R SIDENTIA WORK'QN I'':
Fee for a ll 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 •
❑ Cock Systems „ 1 �� t /D7Ge � ` d •t . e27- 6 Le4 ;mi-
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 required
•
for all other installations
•
•
1:13uil diggTermils\EL.C- PermitApp.doe 07/01/(0
Jul. 22. 2011 6:33AM Henkels & McCoy No. 0961 P. 1
2840 Ficus Si
PomonH- CA 91766
908- 548 -8450 Fax
Henkels & McCoy
i
Fax
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