Permit , CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 ' -! ', COMMUNITY DEVELOPMENT Permit #: ELR2011 -00250
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/14/2011
... •Hi`Ril Parcel: 2S101AA02900
Jurisdiction: Tigard
Site address: 12123 SW 69TH AVE
Project: Tigard Corporate Center - Bldg A Subdivision: WEST PORTLAND HEIGHTS Lot: B
Project Description: Low voltage for fire alarm.
Contractor: CAPITOL ELECTRIC CO INC Owner: TIGARD CORPORATE CENTER LP
11401 NE MARX STREET 15325 SW BEAVERTON CREEK CT
PORTLAND, OR 97220 BEAVERTON, OR 97006
PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 - 7121
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/14/2011 $75.00
12% State Surcharge - Electrical 12/14/2011 $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 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. ATT • N: Ore.. - law re. ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-s I10 through OAR 952-101 . Y ay obtain a copy of the rules or direct questions to OUNC by calling 503.232lior 1.800.332.2344.
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Issu By: N. /l Permittee Signature: ............---1
i
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 R
FOR OFFICE USE ONLY
Received
III C y r DEC % D ate /By: / // Permit no.: f�a����Q v,/.50 v,/.50 'r 13 126 it S of Tiga k3 Blvd. , Tigard, OR 97223 U 1 4 2011 Plan Review
' Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit: f - /) — ��s�
TIGARD Ins Line 503 CITY OF TIGARD Date Ready /By: iuris: ❑ see Paget for
Internet: www;tigard- or.gov BUI DIVISION
Notified/Method: Supplemental Inlbnnation
TYPE OF WORK - PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories
CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
U I- and 2- family dwelling U Commercial /industrial ❑ Accessory building exceeds 10,000 amps at 150 volts or Floating buildings
❑ Multi - family ❑ Master Builder ❑ Other less to ground, or exceeds 14,000 Commercial -use agricultural
JOB SITE INFORMATION AND'LOCATtON amps for all other installations. ❑ buildings
Job no 120115 Job site address: 12123 SW 69th Avenue ❑ Fire Pump El Installation of 75 KVA or
❑ Emergency system larger separately derived system.
City /State /ZIP: Tigard, OR 97223 El Addition of new motor load of ❑ "A ", "E ", "1 - 2 ", "1 - 3 ",
100HP or more. ❑ occupancy
Suite /bldg. /apt. no.: Bldb A Project name: TCC - FA Strobe Updates ❑ Six or more residential units El Recreational vehicle parks.
❑ Health -care facilities ❑ Supply voltage for more than
Cross Street/Directions to job site: ❑ Hazardous locations ❑ 600 volts nominal.
• ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Subdivision: Lot no.:
Description I Qty. I Fee. I Total I „
Tax map /parcel no.: New residential - single or multi - family dwelling unit.
DESCRIPTION OF WORK Includes attached garage.
INSTALL FIRE ALARM CIRCUIT 1000 sq. ft. or less $ 168.54 4
Ea. Add 500 sq. ft or portion S 33.92 1
H PROPERTY'OWNER I ❑ TENANT Limited energy residential
(with above sq. ft.) $ 67.84 2
Name:
Specht Properties Limited energy, multi- family
Address: 15325 SW Beaverton Creek Court residential (with above sq. ft.) $ 67.84 2
Service or feeders installation, alteration, and /or relocation
City /State /ZIP: Beaverton, OR 97006 200 amps or less S 100.70 2
201 amps to 400 amps S 133.56 2
Phone: (503) 646 - 2202 Fax: (503) 626 - 8903 401 amps to 600 amps $ 200.34 2
601 amps to 1000 amps S 301.04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts $ 552.26 2
intended for sale, lease, reot or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders installation, alteration, and /or
Owner signature: Date: relocation
200 amps or less S 59.36 1
❑ APPLICANT 1 ❑ CONTACT PERSON 201 amps to 400 amps 5 125.08 2
Business Name: 401 amps to 599 amps $ 168.54 2
Branch circuits - new, alteration, or extension, per panel
Contact name: A. Fee for branch circuits with
service or feeder fee, each
Address:
branch circuit $ 7.42 2
B. Fee for branch circuits
City /State /7_I P: without service or feeder fee,
first branch circuit 5 56.18 2
Phone: Fax: Each additional branch circuit: S 7.42 2
Miscellaneous (service or feeder not included)
E -mail: Each manufactured or modular
CONTRACTOR dwelling, service and or feeder $ 67.84 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only S 67.84 2
Pump or irrigation circle $ 67.84 2
Contact name: DAN WILSON 503.262.0411 DIRECT Sign or outline lighting $ 67.84 2
Signal circuit(s) or limited-
Address. 11401 NE MARX ST. energy panel, alterations, or
extension. Describe: Fire Alarm 1 Page 2 S 75.00 2
City /State /ZIP: PORTLAND, OR 97220 -1041
Each additional inspection over allowable in any of the above
Phone: 503 - 255 -9488 Fax: 503- 257 -7121 Per inspection $ 66.25
Investigation per hour (I hr min) $ 66.25
CCB Lie.: 48748 lElectrical Lie.: 26 - 496C ISuprv. Lie.: 3132 -S Industrial plant per hour _ $ 78.18
Z I EL total AL,PERMIT'FEES*
� Suprv. Electrician signature, required//1 Subtotal $ 75.00
Print Name: DARR€L - Date: 12/13/11 Plan review (25% of permit fee)
� ii,-$ ) A At/ State surcharge ( 12% of permit fee) $ 9.00
Authorized signature: TOTAL PERMIT FEE $ 84.00
Print Name: DARRELL MCNEEL This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections per permit allowed.