Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00016
Date Issued: 01/27/2012
T.[ G A R. 0 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S102AD03100
Jurisdiction: Tigard
Site address: 9045 SW BURNHAM ST
Project: Pacific Log Scaling Subdivision: 1998 -032 PARTITION PLAT Lot: 1
Project Description: Data Cabling
Contractor: TRITON COMMUNICATIONS, LLC Owner: DEANGELO, STEPHEN T &
PO BOX 1091 BOSLEY, BECKI A
HILLSBORO, OR 97123 13215 SW 124TH AVE
PORTLAND, OR 97223
PHONE: 503 - 615 -5800 PHONE:
FAX: 503 - 628 -5689
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/27/2012 $75.00
12% State Surcharge - Electrical 01/27/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
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. 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 952-001-0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: flJ V Permittee Signature: (» -T �� " ? CMS
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.
01/25/2012 21:54 5036285689 TRITON COMMUNICATION PAGE 01/03
Electrical Permit Application RECEIVEr ' FOR Ohl;lcl: IJ L ON L\
City of Tigard /received
Il k --- R
Plan :
e 13125 SW Hall BIvd., Tigard, OR 97223 JAN 2 6 2012 Plan Review Pecedi o., b._? —. I a. -cm
e: Phone: 503.718.2439 Fax: 503,598.1960 Date/By: Other Permit
- l ( :i A k i ) Inspection Litre 503,639.4175 CITY OF TIGAF D Date ReadyBy: runs: . la See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
ElUILDING DIVISIOR " .
PLAN ,. REVIEW.. ':: :..:;:::::' :;:.,. .::
Ej ® Addition/alteration/replacement
New construction
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
exceeds 10,0 amps of 150 vo lts or ❑ Float' buildings.
CATEGORY' OF CON `: ... ;.': , . .. P ut8
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I - and 2- Family dwelling ® Corutziercial /industrial ❑ Accessory building $ amps for all other installations. buildings.
D Multi - family ❑ Master builder ❑ Other: ❑ Fire pip. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB • SITB `IN : ANDAOCATION:':-:'`: motor load of 2 1
.. ... . . . . .... . . .. 0 of new m
Job no.: 3994 Job site address: 9045 SW Burnham tool>P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
0 Hazardous locations. 600 volts itotntnal•
Suite/bldg. /apt. no.: Project name: Pacific Log Scaling ❑ Service or feeder 600 amps or more.
` : 'kit . SCHEDULt
Cross street/directions to job site: n etcri,pti on I Q ty. [ Fes I Total ' I .
New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax ma p /steel no.: Ea. add'1 S00 sq. ft. or portion 33.92 1
p , Limited energy, residential
75.00 2
'.•. 'DESCRIPTION OI?.: wci4 :.,, ;: •• ..;; ; ; :. , '' •. (with above sq. ft)
' Limited energy, multi- family 75.00 2
Data cabling residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER" ... 201 amps to 400 amps Q.7r11NAivT ps p 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder ee,
. M. APPOCANT • , ; ' : : El. � $480• : I 12SON : :. 742 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
_
Each add'/ branch circuit 7.42 2
-.
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67,84 2
dwelling, service and/or feeder
Phone: ( ) . F :: ( ) Reconnect only 67.84 2
E-mail: - -- - Pump or irrigation circle 67,84 2
Sigri or outline lighting 67,84 2
CON t R 4CTOR .... ... .. Signal circuit(s) or limited- energy
Business name: Triton Communications, LLC panel, alteration, or extension. l Page 2 75 2
Each additional inspection over allowable in any of the above
Address: PO Box 1091 Additional inspection (1 hr min) 66.25/11r
Investigation (I hr min) 66.25/ hr
City /State /ZIP: Hillsboro, OR 97123 Industrial plant (1 hr min) 78.18! hr
Phone: (503) 615 -5800 Fax: (503) 6285689 Inspections for which no fee is 90.00 / hr
specifically listed (%r hr min)
CCB Lic.: 154665 Electrical Lic.: 34648CLE Suprv. Lic.: 2826LEA . • .. ELECTRIC;AJ .PERT'/ T -FEES': ;. :'" '
Subtotal: 75
Suprv. Electrician signature, required: �/_ t Plan review (25 %ofpermit fee):
Print name: Aaron Van Fleet � � Date: 185/12 State surcharge (12% of permit fee); 9
Authorized signatur
TOTAL, PERMIT FEE: 84
/y _ _ Thia permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Aaron Van Fleet Date: 1/25/12
Number of inspections allowed per permit.
I: 113uilding \r'ermitaTLC- PwmitApp.doc 07/01/10 440 -4G I5T(l I /OS /COM/WEB
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01/25/2012 21:54 5036285689 TRITON COMMUNICATION PAGE 02/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES;
RESIDENTIAL WORK, ONLY: '• .
Fee for a residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Dvot Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WO ONLk:' . •,
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
U Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVA,C
LI Instrumentation
❑ Intercom andPagizg Systems
❑ Landscape Irrigation Control*
•
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
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