Permit rt CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 14 „
,_'. COMMUNITY DEVELOPMENT Permit #: ELR2011 -00223
Date Issued: 10/18/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 500
Project: Plaza West Subdivision: ASHBROOK FARM Lot: PTS 5 &
Project Description: Low voltage for fire alarm
Contractor: FIRE SYSTEMS WEST INC Owner: SUN LIFE ASSURANCE CO OF CANADA
600 SE MARITIME AVE #300 BY NORRIS BEGGS & SIMPSON
VANCOUVER, WA 98661 121 SW MORRISON ST #200
PORTLAND, OR 97204
PHONE: 360- 693 -9906 PHONE
FAX 503 - 289 -2208
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/18/2011 $75 00
12% State Surcharge - Electrical 10/18/2011 $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 y
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 accordance ith a•proved 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 ATTENTI• • Oregon la requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -0010 ' rou. h OAR 952 -001 -• • s • ou•btain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
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Issued By: _ ` . ..0 y / Permittee Signatu W.- _, t LV�
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 Application 169 FOR OFFICE o use i Y
�
City of Tigard � Received
�� Date/B /O al_ / Permit No e��!J/ .. I/ 06 .2
° 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
'. Phone 503 718 2439 Fax • 503 598 196 • 1 '1Q1 Date/By Other Permit ��jap� /��� 1.20 T 1 G A R D Inspection Line' 503 639 4175 Date Ready/By runs 61 See Page 2 for
Internet www.tigard or.gov Z C y G k it V Notified/Method Supplemental Information
TYPE OF WORK el i o � � OA � �s‘ ® PLAN REVIEW
❑ New construction Addition /alteratton/�'1 PCnt Please check all that apply (submit 2 sets of plans whtems checked below)
❑ Service or feeder 400 amps or more dBu11dmg over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Mannas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling [d'Commercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
p p� `-. 100HP or more, occupancy.
Job no.: Job site address:
9(pob UK/ c/M Sr ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: --6/112h t 04 9/00-5 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name pi,„A. 0 5r-0 5?fD ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
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'l 500 sq ft or portion 33 92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft ) 75 00 2
Limited energy, multi- family 75 00 2
P i. IA �� residential (with above sq ft )
C� Services or feeders installation, alteration, and/or relocation
200 amps or less 100 70 2
❑ PROPERTY OWNER ❑ TENANT 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
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 Date: A Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name. 0.S / _ t B Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56 18 2
Each add'I branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included)
Cit /State /ZIP. Each manufactured or modular 67 84 2
Y dwelling, service and/or feeder
Phone: ( ) Fax: ( ) Reconnect only 67 84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited- energy
S
Business name: f'�i R - G ('. 5 ��.5.4 panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address: WJ M4124' -f j fite' Rile- 20,_40 Additional inspection (1 hr min) 66 25/ hr
investigation (1 hr min) 66 25/ hr
City/State /ZIP: goo v�.'32 /4} , 986o/ lndustnal plant (1 hr mm) 78 18/ hr
Phone: (26 ) 035 fgot, Fax: ( ) Inspections for which no fee is 90 00/ hr
specifically listed (' /s hr min)
CCB Lie.:6/2 (47 Electrical Lic.t&_ 3 Suprv. i,ic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal
Plan review (25% of permit fee).
Print name: Date: State surcharge (12% of permit fee). SQ(' oa
i /
TOTAL PERMIT FEE
Authorized signature. p This permit application expires if a permit is not obtained within 180
Print name: � � J L D ate: 0//e//1 days after it has been accepted as complete.
` * Number of inspections allowed per permit
I \Building\Permns\ELC- PermiiApp doe 07/01/10 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Building \Permlts\ELC -Perm tApp doc 07/0]/10