Permit r CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00240
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2011
Parcel: 1S136CD00401
Jurisdiction: Tigard
Site address: 8020 SW PFAFFLE ST, STE# 200
Project: The Marshall Group Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: Data telecommunications system and audio stereo system.
NOTE: Ste. 200 panel access through Ste. 150
Contractor: ANDERCOM Owner: E &S HOLDINGS LLC
8560 SW 151ST PL 8020 SW PFAFFLE ST
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503 - 886 -9045 PHONE:
FAX: 503 - 644 -5273
FEES
Quantity Description Date Amount
Specifics:
2 ea Restricted Energy Permit 11/18/2011 $150.00
1 ea 12% State Surcharge - 11/18/2011 $18.00
Electrical
Type of Use:
Class of Work:
Type of Const:
Occupancy Grp:
Total $168.00
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 • R • .- 001 -1090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: • / / OW e
Permittee Signature: 7 /C' 7-7 ,r(1
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.
Nov 18 2011 10:13AM HP LRSERJET FAX page 1
Electrical Permit Application ,\�� I -'l)I i11'1.►('I. t ;i: (1\1,1
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City of Tigard � �' Received � � z:: /l /� :; ::,.:
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- 13125 SW Hall Blvd., Tigard, OR 9 Plan Review • P hone: 503,718.2439 Fax: 503 0 �% O DateB OtherPennitQ�� f/ -Bt,
l , r -., „li inspection Line: 503.639.4175 _ \ ��� Date Ready/By: Pi See Page 2 for
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Internet: wwtigard -or.gov ,:;`• ' �� �N''' Notified/Method: Supplemental Information •
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❑ New construction f: Addition/alterationlil3p P ease cheek all that apply (submit 2 s
tat appy (suets plans w /items checked below):
p )
❑ Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑ Other: CZI where the available fault current ❑ Marinas and boatyards.
i s ) sl i � t tyyrj.j , v r i , ys s.r jt r,r i 7 ( T i t g x 1 1 yt' , � r u;r 7;∎ exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
t,i� /1:I `/K ureti4: it iiiiiiittlirusi's.khr TalrlA
ii lt.� Y s ,i • 'r tra"•lE 3t fl
less to ground, or „cads 14,000 ❑ tVommeroial -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
t rr , ri 6 " t , P i I , F rl �r fy . , , v I k l i 13 Emer system. larger separately derived system.
u r.1' iii rir rw, I , ii' 4,4 t lis1=4A 3 d iu' ar t .. s , 1 -`. i � ttl t § & t —
akid n. ,rs K ' ' 95 ❑ Addition ofnewmotorloadof ❑.. " " -3 „
Job no.: Job site address: p x-p ?t, p e- p L>E S lool>P a more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
Cit /state/ZIP: 1 t q� - ( " of— t 12. Z. 3 ./, f / El acalth -care faciluies. ❑ Supply voltage for more than
/ (�r� ❑ Hazardous locations 600 volts nominal.
9uite/bld ! no.' ' ect name: % 1:1 Service or feeder 600 amps or more.
. ./ ro '. , i, ' al M.` l s :iY j rsxr yyuin .,u ',,.�+3s i r t q
7 �Y� uu: .�. �C:s3".�a�.�c�.��,w��,. ,. w� qi #��i a
Cross street/di - 1,41 - : rt e: %+pro- Description Q. Fee. Total °
3 r �F> �1 -F New residential single- or multi - family dwelling unit.
a'C Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 16854 4
` F& add' 1 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: 5/—?‘ ,� Q 70� Limited energy, residential
ra g itli l r E C 't: : l` i f �a ` 3o ' ,3: `.. n —:i Iki v Y, a� v -'4 ,,` ' :Y :. °. ,? j (with above al' ft.) 75.00 2
Limited energy, multi - family 75.00 2
fk t agolk residential (with above sq. ft.)
f ���} Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
I 'f ml 3 tt ::; N1A s i ',. "iI r Y w +lit 1 i p it "' s � WFIY•lP r t ; ,;�v " 201 amps 400 s to ant
nFr,r,i:Ak Y01:R. t �c.�:via„aiuuwtisu i.."u 4... Kria /iii. •111 .ai ` stliwu ,i+im. l,r i,l` „_ p P s 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
City/State/ZIP: lState,7m Temporary services or feeders installation, alteration, and/or
tY relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
p
it a t ° 1 4 3 r hiilici Su l ., duali i hill nt rt7 lgl l a ' ar �i t Vale above service each brume circuit der fee, 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, that 56.18 2
Contact name: branch circuit
Each add'1 branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: State/ZIP: Each manufactured or modular 67.84 2
t3 dwelling, service and/or feeder ,
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E r it u t Sign or outline lighting 67.84 , C 0 • 0 2
J �lt �l'e It`d {' � r - �4 H .Sf' ltF �N31dT t .�t �{iS' r' � pt'r l
E i fEE1 ,� :r li t'r, 1 J i ��,$)�! �"'s �..�:.�,t -� lE��. ,Q7. Ar, ,.0 ta )f ' sip.' cirsuit(s)orlimited- m„ f iii �
Business name: � m�� panel, alteration, or extension. , Page 2 J” 2
Each additional inspection over allowable in any of the above
Address: g U0, 5 W (y l sr F (� e- A ce. Additional inspection (I hr min) I, 66.25/ hr
City /State/ZIP: 13 dr'n—�lJ 0(!r Q ? 0 5- Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
P. • se: ( 503) Site, RO t.45" I Fax: ( 503) 6 SZ 7 3 Inspections for which no fee is 90.00 / hr
■ s • - iftcall listed 4 hr min
l CCB Lic.: (7 K i ( Electrical Lie. G/.6- - S , y . Lie.: 33(3 i ll I .,tom..- ,i,1„ , a y a p " ' .„� ! t int;,
M. l4auf.wn Yi u�5 ?,� x1 : c,
Subtotal: ,
i Suprv. Electrician _ , required /( �� o ,�
Plan review (25% of permit fee):
Print name: N't c.. L ui . F „ � �
Date: t1 � g i I State surcharge (12% of permit fee): ' /t
or)
TOTAL PERMIT FEE: y
Authorized signature: ! T his perm appl expires if a permit is not obtained within 180 ,.V
Print name: M G (AAA v Date; t 11151/I a dupe after it has been accepted as complete.
1 Number of inspections allowed per permit /6 i i U �/
,
y �%
7:Ynll1IdIA$`.FetMItBY�1.C-pe}t p / / 04 - / 4-.0 76( 2/�t aaaaals'rtrtros/coMnvse r-
Nov 18 2011 10:13AM HP LASERJET FAX page 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
3r aAa.eaie .t4 } G.32L1acar' u'vc ..S �'�4 t. 5 '..'xi.tti Pa {A •r
Fee for All residential systems combined. ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
WL�NAry �M� .
n�17 � " o A -t 4
, 9'. -�R."i x .
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
n
Check Type of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
.RI Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other �1 ►1
Total number of commercial systems: 1. -
*No licenses are required. Licenses are required
for all other installations
Mituiloing1PetmasVILC- Pemat App.doc a 7!01110