Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'! COMMUNITY DEVELOPMENT Permit #: ELR2011 -00202
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/07/2011
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997 -016 PARTITION PLAT Lot: 2
Project Description: Data telecommunications system.
Contractor: STONER ELECTRIC Owner: TRC MM LLC
1904 SE OCHOCO 5973 AVENIDA ENCINAS STE 300
MILWAUKIE, OR 97222 CARLSBAD, CA 92008
PHONE: 503 - 462 -6500 PHONE:
FAX: 503 - 659 -4968
FEES
Description Date Amount
Specifics:
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 $0.00
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 •52- 001 -0090. You may obtain a c. • of the ies or direct questions to OUNC by calling 503 232.1987 or 1.800.332 2344.
Issued By: - 7 / Permittee Signature: j — _ : a te = All•
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.
Sep. 7. 2011 7: 25AM Storer El ect r c Group No. 9618 P. 1
eiS) -
Electrical Permit Application i\,4,- FOR OFFICE I ISE ONLY
City of Tigard tr-W- \ 0 ,
enr
(..‘
xe ) Received
Date/13 ; Misliimm
1 13125 SW Hall Blvd., Tigard , i Plan Review
- 7
i 4 Phone: 503.639.4171 Fax: 504;541196N f" .t* ■. <1`" r .t...
40, A i^...i ,,,, P"°/ • Other Permit:
RD
Inspection Line: 503.639.4175 Cjv Iti Date Ready/By: f/J Sec Due 2 for
I WA
Internet; www.ligard-orgov CNC)N Nonhed/Ntelhoo: IIM Supplemental Information
•W 'VV.VPB '01? W0110:s 7 f,.'::::,:; : f . .:;' ,.,.*...MA ri!ga PLAi!ligini,V,MI:VM: ' : • :
0 New construction Please check all that apply (submit 7, sets of punt o w/items checked below):
Addition/alteration/replacement
V 0 Service or feeder 400 amps or more ID Building over three tiories.
El Demolition Ill Other: wheee the available fault current ID Marinas end booWerda.
, ., IR lig°,7:;',, : :! , 54: - W - ; ; .7A , :::: exceeds 10.000 amps at 150 YON or ID Floating buildings.
t -C - 7- grlgitir: -:-;• ;' :'6,0- . •.0 00( or ' ippf4.14.4ww-.1 ,.,;;?;:. :-' - 1 ' 2 .- ...:: .?) 0 c „,.,,c..,„„„,
k
lo. Lo ground, or exceeds 14,000
IA 1- and -family dwelling Commercial/industrial I=1 Accessory building amps for all other ins iallations. buildings,
El Ml'ati-finily 0 Master builder El Other: 0 Fire pump. El Insiallation of 75 KVA or
. . 0 Emergency system. larger separately derived system.
JOB - SOB iiiiFtiOlaerAt tailek■Ill' ':', :: . . :. El Addition ofnew motor load of 0 w. "r "1-r. "1-3".
. -,,-- ,
100HP or more. occupancy.
Job no.: 138.42v _ Job site addresa: I 5‘70 t !4<i ,
"/ 0 Si x Drown-a residatural units. 0 Recreational vehicle parks.
for more isa
1:I 1-1 c al h - carb fetilitie s D Supply voltage ii
Cily/Slate/Z1P..R p d 07 722-0 D litatudons locations. 600 volts nominal,
Suite/bldg./apt. no.: Project name: 54r 1(17g. 0 SCMCC Or fCCder 600 amps or more.
0at ' SCHEDULE ' :.: .:;, ...:°4;M:=
Cross street/directions to jai site: Description I Qtr. I Fee. I Tend I .
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. II. or less 168.54 4
En. ',dal 500 sq. ft, or portion 33.92 I
Tax map/parcel no.: Limited energy, residential
75.00 2
: : :,1 N.,1).4.0747.Wa011k : ' ' . • . : : ' . (with above Ect. II) .
Limited energy, multi-family
75.00 2
V;T/C-lt.74-77,4 ee 1-/X)‘' residential (with above sq. ft.)
Services or feeders Installation, alteration, and/or relocation
._
200 amps or loss 100.70 2
. • " , , ,,, ,Fe.45 w.i.,:.w...:::::f,. In ...r-ii,; , : ' ' , 201 amps to 400=0 133.56 2
0:PROPERTY ONYIN4 i:],SSE;= 7 A c` :
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
Ciry/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59,36 I
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 circuila with
above service or feeder fee,
M • . '''', .:' '], . % each branch circuil 742 2
Business name: B. Pee for branch circuits without
service or feeder fee, first 56.1B 2
Comsat name; branch circuit
Each addl 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
Phone: ( ) F i ax: : ( ) Reconnect only 67,84 2
Pump or irrigation circle 67.84 2
-mail:
, Sign or outline lighting 67.84 2
.CONt0i.Z. f.OVE.1. , Signal circuit(s) or limited-energy
panel. alteration, or extension. Page 2 75; OC 2
BUSines$ ilmiC: STONER ELECTRIC, INC. Each additional inspection over al owable in any of the above
Address: 1904 SE OCHOCO Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
CilY/StateZIP: MILWAUKIE, OR 97222 Industrial plant (1 hr min) . .
_ 78.13/ hr
Phone: ( 50a Fax: ( 503) 659-4968 Inspections for which no fee is
specifically listed ( hr m 90.00/ hr in)
CCB Lie.: 44823 Electrical Lic.: 26-122C Suprv. Lie.: 34965 W,?ir PERMIT REES::: ;T:.%4
Subtotal: 75; CO
Suprv. Electrician signature, required: tyi # L1 0 „,.......
Plan review (25% of permit fee);
Print name: MICHAEL FALCONER I Date: 9 / State surcharge (12% of permit ree):' 1 ,9, QV
TOTAL PERMIT FEE; 'el, ow)
Authorized signature: This permit applies don 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 permi I.
•
lAnuildinal.PermitalLC-Nrmiapp.doo 07/01/10 440-46157(11/07/CONUWEB
Sep. 7. 2011 7:26AM Stoner Electric Group No.9618 P. 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
P <'TT++'S 1I L 'OIR&,0111)17 :_ nr-: ,„ -- T _s +-, -r_- '1
Fee for ill residential systems combined........ $75.00
Cheek Type of Work Involved: .
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑] Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
Fl Vacuum Systems*
❑ Other:
Pee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
ti Data Telecommunication Installation
❑ Fire Alarm Installation
❑ FIVAC
❑ Instrumentation
❑ Intercom and Paging Systems
F7 L • andscape Irrigation Control*
❑ M edical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ O ther -
Total number of commercial systems: /
*No licenses are required, Licenses are required
for all other installations
LIDuilding\PemdlslELC- PenniIApp.doo 07101/10