Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° `- COMMUNITY DEVELOPMENT Permit #: ELR2009 00120
TI GA)? D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/28/2009
Parcel: 25101 DB00103
Jurisdiction: Tigard
Site address: 7360 SW HUNZIKER RD 105
Subdivision: Lot: 0
Project: Surplus Line Association of Oregon
Project Description: Install limited energy for voice /data.
Owner: FEES
HILLTOP BUSINESS CENTER LLC & Description Date Amount
HUNZIKER LLC, 9430 NW KAISER RD Restricted Energy Permit 04/28/2009 $75.00
PORTLAND, OR 97231 12% State Surcharge - Restricted Energy 04/28/2009 $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: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Y Fire Alarm:
HVAC: Instrumentation: Total $84.00
Intercom /Paging: Landscape /Irrigation:
Landscape Lighting: Medical: Required Items and Reports (Conditions)
Nurse Calls: Protective Signal:
Security Alarm: Other:
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 •AR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 or 1.800 332.2344.
Issued By: � V � _1_ 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'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.
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Elect Ical Permit Application zt { X fi j•d 3 }y'i FP's Y z F . ,. 4" k 5, • :7 f' 3_:
='�" ` _.� ' � '� �- F OR OFFICE USE ONLY � �' �> z'�s:! � � � ��
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CI of Ti and APR 2 4 21 I'' ceived ( 1
`J g I ateBy: ii. Permit No.: t LA.r ' Q 4 a
H j I" 9 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review .(� v (�-� L te` "�
Phone. 503.639 4171 Fax: 503.598 1960 CITY OF TIG iF' /By: Other Permit: }�I ,1 P )05
AILD
Ins ection Line: 503 639.4175 , . a ead vi ethod. -/B �—+ See Page 2 for
TIG Internet: www.tigard- or.gov
BUILDING DIVA e {r�fi d L Supplemental Information
,, , TYPE OF WORK ' , ° _ .- - -. . PLAN REVIEW -. ;'
Please check all that apply (submit 2 sets of plans se /items checked below):
❑ New construction ❑ Addition /alteration /replacement
❑ 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
❑ 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 L OCATION • ' ❑Emergency system. larger separately derived system.
. El Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3' ,
Job n o.: ( 2, Job site address: 36c i- Layz j c,i 100 HP or more. occupancy.
❑
❑ Six or more resisi dential units. Recreational vehicle parks
City /State /ZIP: 9223 DI-lealth -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg, /apt. no.: 103 Project name:Sp Y ✓ 0L ❑ 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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK " " (with above sq. ft.)
V D Limited energy, multi - family
�/ /
D C Q 6I, 1 � residential (with above sq. ft.) 75.00 2
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
Name: 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
City /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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
Cf. APPLICANT -. :'" ;' ° , above service or feeder fee,
❑ CONTACT PERS _ " 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: si tlhout service or feeder fee, 46.85 2
/ first branch circuit
Address: Each add l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ("S13)7 ) 0 C(51) Fax: : ( ) Reconnect only . 66.85 2
E -mail: Pump or irrigation circle 53.40 2
' ` CONTRACTOR. > - : '.:1_. Sign or outline lighting 53.40 2
Business name: ( ( Signal circuit(s) or limited -
l� L 7 U�v`��M . _4 y C.; . I �C:t C� _ � �ner panel, alteration, or
Address: p '� extension. Describe: 1 Page 2 7 - 2
City/State/ZIP: � 1= ' roi,tck O C 7 Z( 4 Each additional inspection over allowable in any of the above
7 n Fax: _ Per inspection 62.50
Phone:
(5 ) L 3 �{ ( _ V ( ( 51=-3) 3:.s/ - �ci g Investigation per hour (1 br ms) 62.50
CCB Lie.: 7 C' Electrical Lie.: 3f1- 3`-lh -)C; Suprv. Lie.: -3 (ALf _ _ Industrial plant per hour 73.75
l .. ELECTRICAL PERMIT. FEES":
Suprv. Electrician signature, required: \____ . I Subtotal: — 1 5 ‘---
Print name: \L . Date: qt I Plan review (25% of permit fee):
`� " State surcharge (12% of permit fee)
Authorized signature: 'TOTAL PERMIT FEE: g `I "—
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 pennit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T( I I /05 /COM /WEB