Permit { r. R
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00124
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/04/2009
Parcel: 2S 101 CB00500
Jurisdiction:
Site address: 12670 SW HALL BLVD BLDG 1
Subdivision: Lot: 0
Project: APEX INDUSTRIES
Project Description: TI - install low voltage for voice and data.
Owner: FEES
TCTPI LLC Description Date Amount
25977 SW CANYON CREEK RD #J Restricted Energy Permit 05/04/2009 $75.00
WILSONVILLE, OR 97070 12% State Surcharge - Restricted Energy 05/04/2009 $9.00
PHONE:
Contractor:
APEX INDUSTRIES
12670 SW HALL BLVD
TIGARD, OR 97223
PHONE: 503 - 235 -8324
FAX: 503 - 235 -1363
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Y Fire Alarm:
HVAC: Instrumentation: Total $84.00
Intercom /Paging: Landscape /Irrigation:
Required Items and Reports (Conditions)
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other:
Other Desc:
This permit is ' . -• ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be • • e in accordance th approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 1: • days. ATTENTION' Oreg. - <? es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules a set forth in OAR
952 -101 -0010 thr ugh OAR 952 - 001 -1100. You m obtain a,copy of the rules or direct questions to OUNC by calling 503.2 99 or 1.80 3 .2344.
Is ued By: • Permittee Signature:
t \
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'N 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.
` " Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Date /B : .5 7 0 Permit No.: ""-4W 9' - e / 2-5
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C • Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready /By: J 0 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 116 Supplemental Information
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.
where the available fault current ❑ Marinas 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 ® 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 ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 12670 SW Hall Blvd 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97223 ❑ I Iealth - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Apex Industries ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. i Total 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'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 ' 75.00 2
Limited energy, multi - family 75.00 2
Voice and 'data cabling for interior office and warehouse residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
SC° f 200 amps or less 80.30 2
® PROPERTY OWNER • F l y TENANT 201 amps to 400 amps 106.85 2
Name: Apex Industries \ \ \\ 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 12670 SW Hall Blvd Over 1,000 amps or volts 454.65 2
City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)235 -8324 Fax: (503)235 -1363 200 amps or less 66.85 1
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, rent, 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
❑ APPLICANT ® CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: Steve Layton without service or feeder fee 46.85 2
first branch circuit
Address: 33295 SW Evergreen Way Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Scapposse, OR 97056 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (971) 275 -4139 Fax: : ( )
Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
-
Business name: Apex Industries Signal circuit(s) or limited -
energy panel, alteration, or
Address: 12670 SW Hall Blvd extension. Describe: Page 2 2
City/State /ZIP: Tigard, OR 97223 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 235 -8324 Fax: (503) 235 -1363 Investigation per hour (1 hr min) 62.50
141 ; KCB Lie.: 132183 Electrical Lie.. 931LEI�3'j Suprv. Lie.: 931LED3 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ; j� ,.� . - . A 011 / Subtotal: 75.00
Print name: Z Plan review (25% of permit fee): 18.75
State surcharge (12% of permit fee): 9.00
Authorized signature: TOTAL PERMIT FEE: '^^-44445—
i This permit application expires if a permit is not obtained within 180
Print name: r r, - �,r, D a t e: (
lfv , r 7 ;; ; �\ 1 -_J r =;, ; Y % r, t — _.- , 7
` days after it has been accepted as complete.
* Number of inspections allowed per permit. 00
I:\ Building \Permits\ELC- PermilApp.doc 05/23/06 440 -461 I /05 /COM/WEB X