Permit • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Permit #: ELR2011 -00251
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/14/2011
,TIGARD Parcel: 2S101AA03800
Jurisdiction: Tigard
Site address: 12259 SW 69TH AVE
Project: Tigard Corporate Center - Bldg B 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 acc. - - h 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 ION: Oregon aw re• es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0e 0 thr. gh OAR 952 -001 -•.90. Y• • ay obtain a copy of the rules or direct questions to OUNC by calling 503.23 87 or 1.800.332.2344.
/,
Issue. By: / � Permittee Signature:
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 l FOR OFFICE USE ONLY
Date/By: V/
City of Tigard
1 Y r aj � � ' - ermit no.: j a /.
Q� ��
a 13125 SW Hall Blvd., Tigard, OR 972 s G[� Plan Review
. C - Phone: 503.639.4171 Fax: 503.598. J �iI Date /By: Other Permit: �� % , 15s
TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juris• Li See Page 2 for
Internet: www.tigard- or.gov
DEC c E /yE 4 Notified /Method: Supplemental In fin fin 20
� '� TYPE OF WORK CI PLAN'REVIEW
❑ New construction IA Addition /alteration /rep ` h ' vF 1 /GARD • Please check all that apply (submit 2 sets of plans w /items checked below):
CI Demolition ID Other: �d((�� SUING DIVISI ❑ Service or feeder 400 amps or more ❑ Building over three stories
CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
❑ t - and 2 family dwelling H Commercial /industrial Li 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 LOCATION amps for all other installations. ❑ buildings
Job no 120115 Job site address: 12259 SW 69th Avenue ❑Fire Pump El Installation of 75 KVA or
❑ Emergency system larger separately derived system.
City /State /ZIP: Tigard, OR 97223 CI Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
100HP or more. ❑ occupancy
Suite /bldg. /apt. no.: Bldg - Project name: TCC - FA Strobe Updates 17 Six or more residential units ❑ 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
Subdivision: Lot no.: FEE SCHEDULE
Description I Qty. I Fee. I Total '
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'I 500 sq. ft or portion $ 33.92 I
U PROPERTY OWNER I ❑ TENANT Limited energy residential
Name: (with above sq. ft.) $ 67.84 2
Specht Properties Limited energy, multi- family
Address: 15325 SW Beaverton Creek Court residential (with above sq. ft.) S 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 S 200.34 2
601 amps to 1000 amps $ 301.04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts 5 552.26 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders installation, alteration, and /or
Owner signature: Date: relocation
200 snips or less S 59.36 1
❑ APPLICANT I ❑ CONTACT'PERSON 201 amps to 400 amps S 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 S 7.42 2
B. Fee for branch circuits
City /State /ZIP: without service or feeder fee,
first branch circuit S 56.18 2
Phone: Fax: Each additional branch circuit: $ 7.42 2
Miscellaneous (service or feeder not included)
E -mail: Each manufactured or modular
CONTRACTOR dwelling, service and or feeder S 67.84 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only S 67.84 2
Pump or irrigation circle 5 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 $ 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 S 66.25
Investigation per hour (1 hr min) S 66.25
CCB Lie.: 48748 'Electrical Lie.: 26 -496C ISuprv. Lie.: 3132 -S Industrial plant per hour $ 78.18
Suprv. Electrician signature requir _ ELECTRICAL PERMIT FEES*
���/cc 1/tt�'" l Subtotal $ 75.00
Print Name: DARRELL MGM Date: 12/13/11 Plan review (25% of permit fee)
CCC State surcharge ( 12% of permit fee) $ ' 9.00
Authorized signature: / �� � �� j�1 9
' J /'r I- ` TOTAL PERMIT FEE $ 84.00
Print Name: DARRELL CNEEL This permit application expires if a permit is not obtained within 1811
days after it has been accepted as complete.
* Number of inspections per permit allowed.