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Permit • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT `r'! COMMUNITY DEVELOPMENT Permit #: ELR2012 -00017 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/01/2012 Parcel: 2S112DC00100 Jurisdiction: Tigard Site address: 15605 SW 72ND AVE Project: Consumer Cellular Subdivision: HERN PACIFIC TIGARD INDUSTRIAL I Lot: 1 -2 Project Description: CCTV system. Contractor: OMNI WIRE INC. Owner: PACTRUST 16521 SE MORRISON ST 15350 SW SEQUOIA PKWY #300 PORTLAND, OR 97233 PORTLAND, OR 97224 PHONE: 503 - 516 -6262 PHONE: 503 - 624 -6300 FAX: 503 - 906 -6353 FEES Description Date Amount Specifics: Restricted Energy Permit 02/01/2012 $75.00 12% State Surcharge - Electrical 02/01/2012 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo: N Boiler Controls: N CCTV: Y Clock Systems: N Data & Telecommunications: N 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 ..� `ii 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 503:639.4175by 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. Jan 30 2012 11:00RM OMNI WIRE INC 5038066553 p.1 Electrical Permit A ilea l� I)K()I,I1(I USE O.►r Cit of "igard R.eeeivea l� J� PennilNo.: Ua1e /f3 • M " 13125 5 W 11211 Blvd,, Tigard, OR 97� � 3 1 2012 I° IAa Ravi W Other Permit, I C A ♦ t Phone 503.713,2439 Fax; 503,598. Pnto/B Inspection Line; 503,639.4175 Date Reedy /By' - 53 See Page 2 for P d 5upplomental Information I f r: A ti u •o I to /MIethnd: R Internet; www ttgard•or,gov 1 f TIGRR A t l Q „ !,;!5.:N:.. „ ,, '''• 1 . , � r a r' ' � r "t ” i d ' ^e . r.I-t„ r , : ' I•, . h 1 a r. ,y'" r r ' n,li'.�. a� �'w a "' tl.'� 'yd•ec•,, ' : ,r " l;a�f Y" Adtiit[onlalteration /re IaCCmont "loam check all tat h apply (rnbmit 1 sets Of plans w /iion+i checked hcluw): New Congtl'uCti0l1 ® p ❑ Sot (Jr foully 400 amps or more ❑ 13c.ilding over Oleo slurica. ❑ Demolition ❑ Other; whore ' the fault Meinas and boatya s. t available faut currant ❑ y. ' ' r etv 1CfoJ� . Sry " , 1 .i" 1 ` ' .J . exceed, 10,000 amps at 150 volts or ❑ Floatin lr buildings. ' ri lose la giuund, or exeoeda 14,000 ❑ Cotrmoiroiel.uaa ag °iculuu al ❑ 1- and 2- family dwelling Z Commercial /industrial ❑ Accessory building amps for all other installations buildings, multi-family [ ] Master builder Q Other El fire pump. C in ■tallrtion of 75 KVA or Q Y p �+ ; p, „.,; „, © A crgency system. lnryer separately sha ved system, ;! (' ; ,;., ' P Ij�Q u�' ; �nr'�i ° i. � ipy$1 : 4 � t � JIQt�, �► �E�O..%t�' . . �' k6 f � I�;ii r ' ; ddition of new motor load of ❑ ^ ,. r, 2 . I -3', _ IDOHP or more. ocuupartey. ,lob no.: Job site address; 8 5(/ LD5 j ' Ave.. Recreational vohicic Pal As, No ve E, Six or morn rosidcnttnl unite 5 1Ad ( ( ❑ Health -care fauilitios ❑ Supply voitabo for more than City/State/ZIP; ► ��” 9 "� ,G ❑ Haxardaus Itwntion$ 600 volts nominal. Suite /bldg, /apt, no : Project name: ti ❑ 5atv or I slot 600 amps or more, n �} q'• (J-� w°r ,: r , .'I � •.' :. It i:, 'I r rr �'�> ' Cross street /directions to fob site; err °rtr +uen o h. 1 er I l' tel New residential sink- or multi- famtly dwelling unit. Includ attache garage. Lot n t .; 1,000 sq. t1, or less 168,54 4 Subdivision; Es. add'I 500 sq, R. or portion 33.92 I Tax snap /parcel no.; Limited energy, residential • 75 2 < • ..•,,,,'::.s.,",;rt'::,:;l, y i ,1 ��y��I'�'� yeti' ��� ,.. :'t;'. ` • . F '' ':Y.', � :� "I ., ri.-- 1�!•Cl'' : '1;' � , (with above AQ Limited energy, multi•f 75.00 2 / residential (with shove sq. fl) , Se �1 _ rvices or feeders installation, alteratlon /or relocation 200 amps or less 1 00.70 2 p,,� t�'�� 01 am l0 400 saps 1 33,56 2 r.A i ',. gy,, R ' � tiY :�i . : .:0; ::, l/ ' ', j: } ''':ralti'i kY N;.! ..' :.y: . - .:. 1 ,,, p� ;uTla r✓ R ' 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 'Temporary services or feeders installation, alteration. and /or Cit '(State/ZIP: relo — 200 amps or lead 39,36 I Phone; ( ) Fax: ( I25.08 2 20 1 amps t� 400 gimpy Owner Installation: T _ his installation is being made on properly that I own which is not 401 amps to 599 amps 148,54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, Branch eircults - new, Alteration, or extension, ps penal Owner signature: Date: or c uita w it h .., . 7.42 2 .,::,,,.: 0ni= , ebpve sctVICO � ' ' t. �' "� "A� ? �kl�:�� each branch circuit i3, Pee for branch circuits WlthOUt Business name: service of feeder tee, ti at 56.18 2 branch circuit contact name: - Each add'I branch circuit 7,42 2 Address: Miscellaneous (service or feeder not Included) — •'° bash manulactimed or modular 67.84 2 City /State /ZIP: dwone servieeandloi feeder _. R Phone, ( ) Pax: ( ) econnect 67,84 2 - primp Sr Irrigation circle 67,84 2 E - mail: Sign or outline lighting 67.84 156.?., 2 ,'r ., ,'' `''';;''1 , ,II .opP.N1 I. Q.. , '�' 1.', Si eircult(s)orlimlted• energy panel, alteration, or eztension. t Pa 2 2 Business name: Ofv I O , rt( •. Erich additional inspection over allowable in any of the above Additional inspection (1 hr min) 66.25/ hr Address: 11(.(, 1' Investigation (1 hr min) 66.25/ hr City /State /ZIP: • 1 JI, r 2 . . . Industrial plant (d hr min) 78.18/ hr Phones ) r'( ie • Fax: (5 3 ) v C _ 5 2 Inspectlolts for which no foe is '90,00/ hr' t s spccincally hated rh hr min CC8 Lie.: gleutrical tic„ - . 'uprv, Lic. � EL@ '3�''f,C 11S`PE i a;Ir L Subtotal' '��' Suprv. Iilectriciar>'s g r c, required, ° l y c Q r � Plan teview (25 % of permit fee): Print name: i a , ' u G� Date: State surcharge (12% of permit fee): C) il, A .f • 1 .. "TOTAL PERM FEE fiY q -- . J Authorized signature: _ „ " ' / - -_- - . i - - - - This permitplrplleation explros-if a - permit is obtalnod v'ithln - 180 - /� . day's after it has burn .loeopted as eemplatc. Print name: -- butte: )/?c ZOI 7. r Numbcl or Inspections al:owed per permit. toBuild mi\Porm ltrtt3t,C- Perin1t App Ann 07 /0U10 440.4615'r(I 1/05/c0M/w13t • Jan 30 2012 11:00RM OMNI WIRE INC 5039066553 p. 2 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for residential systems combined........ $75,00 Check Type of Work Involved; ❑ Audio and Stereo Systems* n Burglar Alarm ❑ G -arage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* E Vacuum Systems* E Other: lc for each commercial $75.00 sys tem (SE., OAR 918 309 - 0000) Cheek Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems 2] Data "Telecommunication Installation ❑ Fire Alarm Installation ❑ I -IVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling • ❑ Other dd Total number of commercial systems: *No -- licenses are - required. Lieenses_are_required fot all other installations 1: Suftding %Pa,mitaBLC- Panni:App.d00 7101/10