Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00199
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/24/2011
Parcel: 25101 DB00103
Jurisdiction: Tigard
Site address: 7360 SW HUNZIKER RD 106
Project: Dale Carnegie Training Subdivision: Lot:
Project Description: Low voltage for data.
Contractor: AF TECHNOLOGIES Owner: HILLTOP BUSINESS CENTER LLC
PO BOX 6551 HUNZIKER LLC
BEAVERTON, OR 97005 9430 NW KAISER RD
PORTLAND, OR 97231
PHONE: 503 - 466 -2900 PHONE:
FAX: 503 - 466 -2922
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/24/2011 $75.00
12% State Surcharge - Electrical 08/24/2011 $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 acco • - • -- ith 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. ATT ION: Orego law re•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -r 11 0 through OAR 952 10 1090 may obtain a copy of the rules or direct questions to OUNC by calling ;)932.1987 or 1.800.332.2344.
Iss .• d By: � PermitteeSignature- / d' .
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.
AUG, 23. 2011 4:05PM 503 608 -7198 NO. 0922 P. 2/4
Electrical Permit Applicatio 1 PCP' FOR ()PFI('E USE ONLY
City of Tigard l t� L ; !r
>� g Received Dnte/B : Sl�� PermitNo.: e4 ���0 /9.
13125 SW Mall Blvd., Tigard, OR 97223
n Platt Review
Phone; 503.718.2439 Pax: 503.598.19 U G 2 3 2 0 � Ocher Permit; f/ -- /76
D atc/Ay;
- t; A p T) Inspection tine: 503.639.4175 Date Rcady/By; kris: la Sec Page 2 for
Internet: www,tigard-or.gov CITY OF TIGA D Notifiedll\Qethod; Supplemental Information
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7 ' 4 Ncw construction El AdditionIaIteration/replacement Please check all that apply (submit 2 acts of plans w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault current
!,Y � + Ar 7 r r; ,r (>;`'{t s •,rr ---- r , c o , ! 1 r } \,a , ," , r ; a , ,,, k � ❑ Marinas and boatyards.
+ hy � t'. ,,,, 6 ,. r� , l " If' h ;,;2 fS''tJ1 E r t ^ p,..tr at 11 } � i 1„ U�vMJ(t f ar...:,,,jtEr?r,t�a'�i),Yu r�r \..( exceeds 10,000 amps 150 vOltS Or g g
� ts , SC q V 1 f ,,{{ trF F P ❑ Floating n s.
f { ,nr y h .. ,. i l, � .k1± n h V ,., 1 { 11;1 1 ., c A , AN r I A,aa.4n • .. U - {: r'ri..aFJS 1 'u^ F -n ,ulU}.tt)wrY :,;ru., 1, Wit,,;,; > r 1 ,1 . , .lvli /S�,:r, r� N ut �,i�51 legs t0 1.7 id. or exceeds 14,000 ❑ ( • u$e at,C' tou lt u TA1
❑ I- and 2- family dwelling P ommercial /industrial ❑ Accessory building amps for 11V n Al other installations. buildings.
❑ Multi -family ■Master budder ❑ Othel ❑ i . ❑ Installation of 75 KVA or
;:!'+T'"f '7 fir ( ? /4,.�n, ubr S t 4 . i { { ' -0(�iltill d {l I�i+� ( i 1. �1gt11`� v (S N1StJt' ?+ i l eyl ^ 1 1 7 1 v v I G4 M +J "`( l � �r } rtlt,7 rF + lil,..l ! + Ir ❑Lmerbrency system. larger separately derived system.
1\d .. a,, .,:,'S,utu.; :k.:,t.ddsl+rutwZ, � ..ti.:;: sot ` :.; , v.S90,sdbr.ane_,w.i, P i:s, , : , , e„:, : — } r, vlJ..i„dwa.,W y r, r ,, i ❑Additionofnewnwtorloadof A ,
Job no.: ,, 41 ' a, Job site address: 7 IS\A f om , w 'AI, f o or mare, R e Cre a¢oy.
■ ❑ Six or more residential units. ❑ Rcr¢stional veh parks,
City /Statc/ZIP: Y 2.2- • +` ❑ Healtla•oare f acilities. ❑ Supply voltage for more than
❑ hazard locano,„ 600 volts nominal
Suite/bldg. /apt. no.: Project,lame: o\ «-. ❑ S ery t : or > ! feeder 600 amps or more.
t V i G r ?�I : ,," r Sr r 4 ,ir v E ,:fil tyylr, n�7�lljll� -,ll; :+x�Ir�S\�����t�)�' :i;::f<'1��ut,� �{Stil;
Cross street/directions to job site: , i v, i! S}1 " ,
n+")fhl,rl ,l " +,
J � � Ddcription
Qtv I Foo. Tolot R
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. It or less 168.54 4
Tax map/parcel no.: Ea, add'I 500 sq. ft. or portion 33,92 1
rr ^ ^r ^.^r , ry r , r �+ v r y;� ^� 9- •t1SC4w 4 f r , i r ' „i r yy� rr , , u r Limited energy, residential
i, 4n Sl(1. Y,.,.i,l \; f) 4 l+ v t 7 r W� r l,yi '%{' �,.�' ` ,7 1 I tf 7 r.zr.Nar 4 ,tt, t r)r with ft. 75.00 2
ld + V} Y1rIO �rI Mr,. GI 6: t 1 t hi s YS 1„1 1(1�+ ,� �} it li:C r " :i M _ ( )
, r..,:.. r..• .- •; r,.s,s a r :5 ..... � �. t . . w v u.oa;x .�,uau�A..x;x<,. .�y'�„�'l Iz�,a..,,'4,s���, r�s i, r�.. r. a.. �t.,.. ..�.,�iim,v,tv..v.,,,w.twlYl }t_i:�l�,',. JGj,
th Limited energy, multi- fatltily 75.00 2
V t Ca, '4-- 01.'1 .01 residential (with above sgft.) _
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
;r') ) S,1nY 'v yl y s r " t � .' "' 7 1 , s {\ id[ , v n , r
' 'ir ) t )�s� rtf mit �I � 7z n}a a , , If�ICpY „r0 � a i {, r �� r, 4 , r� ,j e l � f � J> t t f, ,, q, 201 am to 400 ¢m s 133.56 2
lV.,',.. 1Stvie.irg; tAgro
: �:,r :
,: a.: 1,1 t \.WInza . i- J J.. , w..:.,,,,,, , ,,y, v ., ....4„„ r0:'! ? ru� a) S 110 (Id!t { 1 ,i! ur:�, ?Ar,. rY p —
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
Temporary services or feeders installation, alteration, and/or
City /Stare /ZIP: 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: r Date: A. Fee for branch circuits with
'f ''�1' I t M1r S� ,' {, {l - ,f i \X11 3 5 8 1 �iI nwy iv ',{, "yd r ? > 111 h 7Ey t1� {,!'l } F� tl > rl, . 6, vi 1 , 1., 4, l h�'y, 1 e_ +r ,,A , �;'?'p3,15, !�, abo service or feeder fee, A
J'lr:F 1 "a'.rtll�.,!'lr �Vj,';;:i. },114 12 1 3i: ::;lit. 1 1 : 4 4,, l (!. I. L16� . V ,.. . :,.tgo,4o4. :.Se.;,:,s ;., 9,,,,,,a k{i. , 1 {l ,d t l , l "I��F� Fe e l f branch 7.Y2 2
B. Fe for branch circuits without
Business name:
service or feeder fee, first 5618 2
Contact name: branch circuit Contact
Each add'1 branch circuit _ 7.42 2
Address: Miscellaneous (service or feeder not included)
Y.ach manufactured or modular
City/Slate/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect Only 67.84 2
Pump or irrigation circle 67,84 2 '
E -mail:
'CS,' '''''''''''';'9.2,, ra r { t , l.tF 18SPAa t, 1 +Fir "1 "fu,,;l o- < v�C ii.' °,re_, S wt* rf r- t7 { u r! ',1 her t. vs { l +r y HM t, i c ; r +, } r(? ^ . Sim or outline lighting 67, 84 2
4.��! ____, Iw .t.wda,:r 'r1 01+..9,434M1.'t∎00,,t,z, it m^ rnl n,,,,,,.Si;I,S.,,„,,, „L,, ..1r1 J,Fv,l,r r id�w r .3i� {� i2"r[iE�iult��� Signal C1telllf�S)Orlimited- energy
Business panic: A F` — .. , 4 ' e . 1- C panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address: 0 ging ollrMIMIINIMMIMIII Additional inspection (1 hr rain) 66.25/ hr
�'
City /Slate /ZIP: r1"y Investigation hr min) 66.25/ hr
Al ' tro r% ` D r // hldustrial plant (1 hr min) 78,18 /hr
Phone: ;O. , OP , • it r al Fax: 1:503 4 6 . 2? tnspcctions for which no fee is 90.001 hr
a t ct
1 ! tleall listed (r hr min
CCB Lie.: lbl 06 Electrical Lie.: CLE 1 CI S, Suprv_ Lie. : i f i Rs' . ,i`. ''� I<�Ii ;'r'rill,!� ,�:f t,,11�'; \t9'i()i�c1ll� r "iia ,
Subtotal; `
Suprv. Electrician signl re s ,� , r l � — plat, review (25% of strait fee):
p )'
Print name: • 1 t IW On. I . Date: 2 ?.r. IrA State surcharge (12% of permit fee): el
Authorized signature: TOTAL PERMIT FEE: '.
>tr��r This permit Application expires if a permit is not obtained wi ith 1SO '
Print name: ii1./l G. • N i N fi'.38 ,
• Dale: S--2-5-111 . days
Number of inspections er it
d per permit. a ed as complete_
1 1Boildin g\Pennite\ELC- ParmilAppdu; 07/01/10 4d0.4615T(11/05/COM/WPB •
•
AUG. 23.2011 4:06PM 503- 608 -7198 N0. 0922 P, 3/4
i
Application - City of Tigard
Pplemental Information
1,ED ENERGY PERMIT (FEES:
w , .
a ll
, for residential systems
combined,.., _
.;heck Type $75.00
ype of Work Involved:
0 Audio and Stereo Systems*
Burglar latin
0 Gara Door Opener*
pleating, Ventilation and Air Conditioning System*
Vacuum Sys tems*
Q Other:
766"
Fee for Ach commercial
t ti . ;: ' , r
system......,.... $75.40
(SEE OAR 918 - 309 -0000)
Check Typ of Work Involved:
Audio and Stereo Systems
Boiler Controls
a Clocl[ Systems
L'bata Telecommunication Installation
Pire Alarm Installation
❑HVAC
a I nstrumentatio n
0 Intercom and Paging System
[� Landscape Irrigation Control*
Medical
Nurse Calls
O Outdoor Landscape Lighti
Protective Signaling
Other
•
Total number of con nerCial systems:
i0 licenses are required. Licenses are
t all other installati required
aoermitakaC.pctmitAPD.dx 07/01/10
AUG. 23. 2011 4:05PM 503- 608 - 7198 NO, 0922 P. 1/4
Mr reCA170/0ffie. �'
503-466 -2900 Office • 503-466 -2922 Fax
PO Box 6551 • Beaverton, OR 97007
regIna@aftinc.biz
www.aftinc.biz
Fax
To: City of Tigard Frame Regina Vandecoevering
Fax Pages: 3 attached
Phone: Date: August 23, 2011
Re: cc:
❑ Urgent ❑ For Review ❑ Please Comment 0 Please Reply ❑ Please Recycle
• Comments:
Attached you will find our permit application and payment authorization form for our project at Dale
Carnegie. Can you please fax the permit to our office at 503-4662922? Thank youl