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Permit y CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2009 -00299 -TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/02/2009 Parcel: 2S101AC01300 Jurisdiction: Tigard Site address: 7105 SW HAMPTON ST Subdivision: Lot: 0 Project: Kaiser Tigard Dental Project Description: Install restricted energy for voice /data. Owner: FEES KAISER FOUNDATION HEALTH Description Date Amount PLAN OF THE NORTHWEST #838, ATTN: Restricted Energy Permit 10/02/2009 $75.00 GENERAL ACCCOUNTING 11TH F, 500 NE 12% State Surcharge - Electrical 10/02/2009 $9.00 PHONE: Contractor: COCHRAN INC 626 SE MAIN ST PORTLAND, OR 97214 PHONE: 503 - 234 -6564 FAX: 503 - 238 -2098 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: Y Fire Alarm: N HVAC: N Instrumentation: N Total $84.00 Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions) Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Other Desc: 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 OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: () n k.u W I WO 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 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. ' FROM COCHRAN— BROADWAY (MON >SEP 28 2009 14:38,ST. 14:37/No. 7500000808 P 1 Electrical Permit Applica lis ECEg ED FOR OFFICE USE ONLY - City of Tigard Received (12-2 Date/By: '/ Permit No.: E' O 0 nl - en 2 y 13125 SW Hall Blvd., Tigard, OR 9P 2 9 2009 Plan Review , G Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 Date/By: TI G A RD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: a: i B See Page 2 for Internet: www.tigard or.gov LNG DIVISION Notified/Method: G Supplemental Information TYPE OF WORK . • PLAN REVIEW . . BUILD ❑ New construction ❑ Addition/alteration/replacement Please check all hat apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: 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 ❑ I - 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 ", "I -2 "I -3 lob no.: J ob site address: C 100HP or more. occupancy. al 7L ©� , v ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: `( O ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: lex `� "'' r ,) ❑ Service i feeder 600 amps or more. „ �� ,� i n ervce or FEE SCHEDULE Cross Street /dlreCh OnS to job site: �J upetipuae l Qsy. I Fee. I Ton, 1 • 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 75.00 2 . DESCRIPTION OF WORK. • : . .. . (with above sq. ft.) Limited energy, multi family L. C r A , l L 75.00 2 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less' 80.30 2 ❑ PROPERTY OWNER - • ❑ TENANT :', ' ,' . . 201 amps to 400 amps 106.85 2 Tame: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: . Over 1,000 amps or volts 454.65 2 Ciri /State /ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 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, r er 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 I i Contact name: C ,(/) �1 c I /Ct., >.c 7�1 fi rs t b rt n chv i or feeder fee, 46.85 2 l/° lL�l lam( { -1 l first branch circuit Address: Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular • dwelling, service and/or feeder 90.90 2 Phone: ) 34 i gJ 3 j 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: /_ �, ^- ` � Signal circuit(s) or limited - �� a)V\ -TVY i,� -L ` Jl )X:z J o-yty C� tee t y l Cenergy panel, alteration, or Address: tfi Z `1 ti b-�- � , extension. Describe: / Page 2 7 .1-1 2 City/State/ZIP: K o� C1 7 2i 4 Each additional inspection over allowable in any of the above C Per inspection 62.50 . Phone: ( = m) G 3u -(p5 L Fax: (5o;3) 2.. 3c( - 2,0%" )S Investigation per hour (1 hr min) 62.50 CCB Lie.: 7, Electrical Lie.:31- RoC) Suprv. Lic.: (4`e_� Industrial plant per hour 73.75 / , . ELECTRICAL PERMIT. FEES '. Suprv. Electrician signature, required: ` ` Subtotal: 7g7 , , Print name: �L_e_ Date: V 9 Plan review (25% of permit fee): _ \c_ 9 1 L '' `� State surcharge (12% of permit fee): e t Authorized signature: TOTAL PERMIT FEE: $ Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. * Number of inspections allowed per permit. I l Bwldine \PermitalELC- PermitApp.doc 05/23/06 440- 4615T(11 /0S /COM/WEB In c - C- ---e A 0- Lka,n..e._