Permit 71 ' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
" `- COMMUNITY DEVELOPMENT Permit #: ELR2009-00190
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2009
Parcel: 2S113AC00103
Jurisdiction: Tigard
Site address: 7216 SW DURHAM RD, BLDG# P200
Subdivision: Lot: 0
Project: Wellpartner
Project Description: Installing two limited energyircuits for camera and network systems.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 07/21/2009 $150.00
#300 12% State Surcharge - Electrical 07/21/2009 $18.00
PHONE:
Contractor:
TRITON COMMUNICTATIONS, LLC
PO BOX 1091
HILLSBORO, OR 97123
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PHONE: 503 - 615 -5800
FAX: 503 - 628 -5689
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: y Fire Alarm: N
HVAC: N Instrumentation: N Total $168.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: /AA J Ski-- Permittee Signature: 5 - A P PLC c A r- -x-a
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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 an inspection that business day.
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.
07/16/2009 12:22 5036285689 TRITON COMMUNICATION PAGE 01/03
Electrical Permit A 11CAt' i�Oli 111.11(.1-. l Nr (:►\1.1 , :
' . City of Ti and ,� R °�i"Qd
131 SW Hall Blvd., Ti gar 7223 Dare/B : , s
' ' i
n Phone: 503.639.417I Fax: 503.5 16 6 009 Plan , Review
bate/B : Other Permit
Ti Cj A R I? Inspection Line: 503.639.4175 D Date ady/B5: r�i+ to See Page 2 for
o tified/Method Supple Information
v os
TYPE o Of D ` ® � :. :,:: �: . . ',..,. .: ;
g
Internet: www.tl ar -o r. ov No
El New construction El Addition 1 ttoaJreplaceme]It Please check an 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 OP COI\'ST1it1CTYON " . .. exceeds 10,000 amps at 150 volts or ❑ Floating bandin .
less to ground. or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- 8rtd 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Insmilation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger se derived systet r,
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• ❑ Addition of new motor load of ❑ "A ", "E" "1 - 2" "13 ",
Job no - : 3320/3323 Job site address: 7216 SW Durham 100HP 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/bidg. /apt_ no.: Project name: WeilPar'tner ❑ Service or fboder 600 amps or more.
Cross street/directions to job site: Deseripoon F O t . I Fee I i Totai ` I • .
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145 :15 4
Ea. add'I 500 sq. ft. or portion 33.40 . 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK ' .' • • ' ' ' with abcsva sq. Et.) 75.00 2
Limited energy, multi- family 75.00 2
Install camera system and network wiring. residential (with above sq. ft.)
Services or feeders Installation, alteration, and/or relocation
• 200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT. . . ' 201 amps to 400 turps 106.85 , 2
Name: 401 atnps to 600 amps 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 t 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 10030 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, per panel
Owner signature: Date: A. Pee for branch circuits with
❑ APPLICANT 1 ' ❑ CONTACT PERSON • ' above service or feeder fee, 6,65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder prof included)
City /State /ZIP: Each manufactured or modular 90.90 2
Phone: ( ) Fax:: ( ) dwelling, service and/or feeder
Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR F .. • �' Sign or outline lighting 53.40 2
Business name: Triton Communications, LLC
Signal circuit(s) or limited -
energy panel, alteration, or
Address: PO 130x 1091 extension. Describe: 2 Page' 1 2
City/ State/ZIP: Hilsboro, OR 97123 Each additional inspection over allowable in any of the above
Per inspection 62.50 •
Phone: (503) 615 -5800 Fax: (503) 628 -5689 '
Investigation per hour(i hr min) ..62.50
CCB Lic.: 154665 Electrical Lic.: 34648CLE Suprv. Lic.: 2826LEA Industrial plant per hour • , . - • 73.75 '
E GAS(. EixoNo . FEES; :! _ 1: ` ;. .
Suprv. Electrician signature, required: / ' r1� Subtotal: 150
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Print name: Aaron Van Fleet f / Date: 7/16/09 Plan review (25% of permit fee):
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'r r� <-------- State surcharge (12% of permit fee): 18
/ d
Authorized signature: (
f� J TOTAL PERMIT FEE: 168
Print name: Aaron Van Fleet This permit application expires if a permit is not obtained
Date: 7/16/09 deyh atter it has been accepted as complete.
• Number of inspections allowed per permit.
1:5Bulidin \PumiL, \EI -C-Po vi Arp.dv" 05/23(05 440'4615T(11/05 /COM/WEB ' ' '
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• • 07/16/2009 12:22 5036285689 TRITON COMMUNICATION PAGE 02/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL L WORK ONLY
Fee for all residential systems combined $75.00
Check Type of Work Involved: •
1 1 Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fcc for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boi Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
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® Other Camera Systems
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Total number of commercial systems: 2 •
*No licenses are required. Licenses are required
for all other installations
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