Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
°'�': COMMUNITY DEVELOPMENT Permit #: ELR2011 -00196
TLGARL7 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/17/2011
Parcel: 2S112DC00100
Jurisdiction: Tigard
Site address: 15605 SW 72ND AVE
Project: Progressive Subdivision: PACIFIC TIGARD INDUSTRIAL I Lot: 1 -2
Project Description: Low voltage for access control system.
Contractor: JOHNSON CONTROLS INC Owner: UNION PACIFIC RAILROAD CO
4011 SE INTERNATIONAL WY 1700 FARNAM ST, 10TH FL SOUTH
STE 605 OMAHA, NE 68102
MILWAUKIE, OR 97222
PHONE: 503 - 305 -2000 PHONE:
FAX: 503 -654 -1158
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/17/2011 $75.00
12% State Surcharge - Electrical 08/17/2011 $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: N 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: Y 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 • •ugh OAR 9 ! -00 • 8 . 1. Y• may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 r 1.800.332.2344
{ L
Issued =y: ,1�1�� ' Permittee Signature: //;(
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 A hcatl0 C EIVED FOR OFFICE USE ONLY
R eceived
City of Tigard DateB Permit No.: c
p 13125 SW Hall Blvd., Tigard, OR 97223 nn Plan Review i G �� O � I DO ���
Pho ne: 503.718.2439 Fax: 503.598.1980U G 1 7 2 O Date/B : Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
i y a wj„
� .... , TYPE 'OF , 1N DIMIS �. �� � z � `� ... �.�� � PIaAN RE NEW Er
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ® Addition/alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
x „ i , C ATE GORI OF C exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
''" " - • z ' ' '° ° '' " ° ` less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial 111 Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
71 ❑ Emergency system. larger separately derived system.
JOBz SITEriFORIVIATION ,AND ;tiOCATIOFi f a ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 371 - 200079 Job site address: 15605 SW 72 AVE IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Portland, Or 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Progressive - House couns ❑ Service or feeder 600 amps or more.
' t t !.�! EE SCHEllUILE ' ''
Cross street/directions to job site: Description I Qt I Fee. r 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
G DESCRIPT1lON OF�WORI{ 4 75.00 2
r l R, -, rR � ,".\. �, .. � ,..... � _, ., ,-` .tea � 'u'. (with above sq. ft.)
Limited energy, multi - family 75.00 2
Install 3 cardreaders in new House Counseling area residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
lit PROPERTY= OWNER a l/ TE 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
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
Fan: 200 amps or less 59.36 1
Phone: ( ) ( )
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
above service or feeder fee
r APPL5ICANT' ❑CONTACT PERSONS 7.42 2
.. ...., ,.gym_ ,.., each bra circuit
Business name: Johnson Controls Inc B. Fee for branch circuits without
service or feeder fee, first
Contact name: Steven J. Beachner branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Ci City/State/ZIP: Each manufactured or modular
ty dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
g ligh ing
T t*" masteeparosraTgOok is I Signal circuit(s) or limited - energy
Business name: Johnson Controls Inc panel, alteration, or extension. I Page 2 75.00 2
Each additional inspection over allowable in any of the above
Address: 4011 SE International Way, Suite 605 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Milwaukie, Or 97222 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 305 - 2000 , Fax: (503) 654 - 1158 Inspections for which no fee is 90.00/ hr
7�/ t�/ specifically listed (Y: hr min)
CCB Lic.: 65320 54743 Electrical Lic.: 26 216CLOE Suprv. Lie.: 97/3 AM" ,i e „ ELECTRIGxtuERMITfFEES Iii
Suprv. Electrician signature, required - /0///// Subtotal: 77'
`'�� Plan review (25% of permit fee):
Print name: Steven Beachner 4713LEA Date: 8/17/2011 State surcharge (12% of permit fee): g• 70
TOTAL PERMIT FEE: gq'. 00
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: • Date: * days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doe 07/01/10 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
WORKONLY
Fee for all 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:
COWMEItCYAI• WCORK ONLY: '
Fee for each commercial $75.00
system
(SEE OAR. 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ B oiler Controls
❑ C lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ H VAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
• Other Access Control System
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 07/01/10