Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00157
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/05/2009
TIGARD Parcel: 2S113AB01400
Jurisdiction: TIGARD
Site address: 7358 SW DURHAM RD
Subdivision: Lot: 0
Project: Coram - Apria
Project Description: Data telecommunications
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 06/05/2009 $75.00
#300 12% State Surcharge - Restricted Energy 06/05/2009 $9.00
PHONE:
Contractor:
CACHE VALLEY ELECTRIC COMPANY
6200 SW ARCTIC DR.
BEAVERTON, OR 97008
PHONE: 503 -431 -6600
FAX: 503 - 624 -1436
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 Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
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 503.2 . 6 6699 or 1.800.332.2344. ,,
Y
Issued By: Permittee Signature: d "' /7/4),Z/ e�lDw
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.
,_,d6 0 08:27 FAX 425 424 9966 CACHE VALLEY ELECTRIC RI 001
• ( FOR OFFICE USF.ONL ' ',. 1,1,,,,;.,: ' ' ) ` P N, 1 l
Electrical Permit A pp li ca ti on - � ,, , 414'iq : �,I : .. J ax"kt
City of Tigard DaieBy 0 � 5 09 .. /I PermitNo. G lr // 5
of 13125 SW Hall Blvd., Tigard, OR 9 PE 1 Plan Review t /� �'
p
Phone: 503.639.4171 Fax: 503.598.1960 (� Date /B : Other Permi �tfJ�gOOIJ p+ DOsie,
Inspection Line: 503.639.4175 JUN 0 4 2009 Date Ready/By: la See Page 2 for
TiGARD N otified/Method: ❑000000000 70000fo
- Internet: www tigard or.gov I+
..,.. ......... rmatinn
TYPE OF- W J I•ft':'1 3 a ..: .: PLAN. REVIEW
: # $rhJ_
I=1 New construction ® Addition /alte'r
r k t t n %rep �t e l'ace t .. t mtent t A i l 0'hti it Please check all (fiat apply (submit 2 sets of plans w /items checked below):
� �atlp ❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
t
: - exceeds 10,000 amps at 150 volts o' Floating buildings.
1' ATEGORY, OF _ CONSTRUCTION :
- less to ground, or exceeds 14,000 0 Comtnercial-use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
. Emergency system. larger separately derived system.
: .:: ' : :. :.. ' : ;:.:: JOB INF.ORb1ATION :'LOCATION:; ', ❑ Addition of new notorload of ❑"A" "E" "1 -2" "1 -3"
1001-I1' or more. occupancy.
Job no.: 43656 Job site address: 7358 SW Durham Road ❑ Six or more residential units. ❑ Recreational vehicle parks.
CI Health-care facilities. ❑ Supply voltage for more than
City/State /ZIP: Tigard, OR 97224 ❑ Hazardous locations. 600 volts nominal
Suite/bldg./apt. no.: Project name: Coram - Apria
❑ Service or feeder 600 amps or more.
FEE S
Cross street /directions to job site: Description I Qty. I Fee. I Totni 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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
: - (with above sq. ft.) 75.00 2
:
' ; 'DESCRII''I'101�':OF;VVORK. :,.�_'::' .;..., .:..!. ..: '.;.: - :::
r ..
Limited energy, multi- family 75.00 2
low voltage structured cabling residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
1=1_ PROPERTY DWNER 0 .TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: -
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
tY relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 l
Owner installation: This installation is being made on property that I own which is not
201 amps to 400 amps 100.30 2
intended for sale, lease, re it, 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. Fee for branch circuits with
APPLIC .NT ; : - - -, -. :; ,
= :>. . - .. ..:. feeder ❑':
. , ® CONTACT _; >,'.:;
above servi or ee fee, 6.65 2
each branch circuit
Business name: Cache Valley Electric B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: Vanessa Martin first branch circuit ,
Address: 6200 SW Arctic Drive Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Beaverton, OR 97005 Each manufactured or modular 90.90 2
- dwelling, service and/or feeder
Phone: (503) 431 -6600 Fax: : (503) 6 -1436 Reconnect only _ 66.85 2
E -mail: vanessam @cve.com Pump or irrigation circle 53.40 2
T . .. ,
RACTOR - , _ . . - Sign or outline lighting 53.40 nlley _CON
Electric Signal panel, or alteration, limited-
Business name: Cache Vy energy panel, alteration, or
Address: 6200 SW Arctic Drive ) extension. Describe: 1 1
Page 2 2
City/State /ZIP: Beaverton, OR 97005 } 1 i 1 Each additional inspection over allowable in any of the above
i !/ Per inspection 62.50
Phone: (503) 431 -6600 Fax:..-(503) 624-143 / nvestigation p hour (1 hr min) 62.50
CCB Lie.: 148222 Electrical Lic.: 26 -I 135CLE l Suprv. Lie.: 20134J Industrial plant per hour 73.75
`:. •ELECTRICAL': PERMIT :TEES '.', ::: ` : c
Suprv. Electrician signatt re, required: 9 ': Subtotal: 75.00
Date: 6/1/09 Plan review (25% of permit fee): 0
Print name: Brian Hama:on ,/
State surcharge (12% of permit fee): 9.00
Authorized signature: TOTAL PERMIT FEE: 84.00 V
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.
i-\ Building \Permits\ELC- PermicApp do: 05 /23/06 440- 4615T(1 I /05 /COM/WEB
• • 06Y04/2009 :27 FAX 425 424 • 08 X 4 96
CACHE VALLEY ELECTRIC a 002
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
, 'RE§it•ESit tikt
Fee for all residential systems combined $75.00
Check Type of Work Involved:
O Audio and Stereo Systems*
O Burglar Alarm
O Garage Door Opener*
D Heating, Venti]ation and Air Conditioning System*
CI Vacuum Systems*
O Other:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
LI Audio and Stereo Systems
L I Boiler Control:
D Clock Systems
El Data Telecommunication Installation
0 Fire Alarm Installation
O I-WAG
O Instrumentation
0 Intercom and Paging Systems
D Landscape Irrigation Control*
0 Medical
0 Nurse Calls
LI Outdoor Landscape Lighting*
LI Protective Signaling
O Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\BuildinsTentits\ELC-PcrolitApp oc 01/23/06