Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
•
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00048
• 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2012
TIGARD Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16195 SW 72ND AVE
Project: Option Care Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 30
Project Description: Data telecommunications system.
4/25/2012: REPRINTED for additional fees collected for additional inspections for Phase II.
Contractor: COCHRAN INC Owner: PACIFIC REALTY ASSOCIATES LP
7550 SW TECH CENTER DR. #220 ATTN: N PIVEN
TIGARD, OR 97223 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/14/2012 $75.00
12% State Surcharge - Electrical 03/14/2012 $9.00
Type of Use: COM . Restricted Energy Permit 04/25/2012 $75.00
Class of Work: ALT 12% State Surcharge - Electrical 04/25/2012 $9.00
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N S �O� e ��
�
Data & Telecommunications: Y Fire Alarm: N C �i(/ !/ 0 L % � /N
C-1 L &- 'y / Ze/ /
HVAC: N Instrumentation: N L � 3 - 7/f --c26/42_., Inn Landscape/Irrigation: N Landscapp e //Irrigation: N 4.) /777
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $168.00
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 -0 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Y Signature: B : Permittee SI nature: oft /5/ G / (9772
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 603.639.4176 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.
•
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• m COMMUNITY DEVELOPMENT Permit #: ELR2012 -00048
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2012
Parcel: 2S113AB00600
. Jurisdiction: Tigard
Site address: 16195 SW 72ND AVE
Project: Option Care Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 30
Project Description: Data telecommunications system.
Contractor: COCHRAN INC Owner: PACIFIC REALTY ASSOCIATES LP
7550 SW TECH CENTER DR. #220 ATTN: N PIVEN
TIGARD, OR 97223 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/14/2012 $75.00
12% State Surcharge - Electrical 03/14/2012 $9.00
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
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: _._��� • 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 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 *(51 08:55:58 03-14-2012 1 /3
Electrical Permit A lica • IQ 1.0R ()HA(• usi.: ()NI.,
10
'1 1 II 4 City of Tigard
13125 SW Hall Blvd., Tigard. OR 97223 vq. N ' 61. Received Review izimirmi Permit No.: a ,e , •
..4
r ._tz,1`01 ,Itlan
' Phone: 503.639.4171 Fax: 503.598.1960 v. if'V%‘.' , "\
Other Permit: v &
• T RiAli I) i 13._ at
Inspection Line: 503.639.4175 . 0 r‘ ..A\''0 Date Ready/By: .1oris: . 65 See Page 2 for
Internet: www.tigard CO \,C V Notified/Method: • 7 .-- (..0 Supplemental Information
!. .■ ■•7)1110 . f ! ::' : ; . *:-7 . ::; ..../.... '::;:" ; . ... : titt.:0:#.1*tt) l .M:i1::-!:;:;:14:3■:!;::' , :;7:!.iW.:■.*;,1:'Zi 1.Fig.41C•A?Akg:::1(.,140:14fOgYekl.11.t.i:::.I.:.::);;Ci...),.':1':
El New construction gAddition/alteratiordreplacernent Please check all that apply (submit 2 sets of plans w/itenis checked below):
ID Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
::'• y:•: ototio#joidi exceeds 10,000 arias at 150 volts or 0 Mating buildings.
less to pound, or exceeds 14.000 1:1 Commercial-use agricultural
0 1- and 2-family dwelling ACommercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: ['Fire pump. 0 Installation of 75 KVA or
larger separately derived system.
. '; • . •• ; .• • • • ; .. 4 9P , WgTI A . ... , : ...., ,. .. ....:.: , 0 Addition of new motor load of 0 "A“, "E". "1-2". "1-3",
Job no.:/i/M I Job site address:/4r/$/ 77/c, gm__ 100HP or more.
C3 s ix or more residential units. occupancy.
CI Recreational vehicle parka.
City/State/ZIP: 77p 0 Health-care facilities.
ie. 97 Zz.. op onl Cetre ,_. 0 H dous locations. °Supply lts voltage for more than
600 vo nominal.
Suite/bldg./apt. no.: Project name: //2 , 1 r z pi ,. .... ..... ['Service or feeder 600 amps or more.
if.l.:':SY,Ett.00
Cross street/directions to job site: /0 7 4 cy-- Description 1 " Dry I Pee I Total 1
g •
0 PPL-i l'•
L i
New residential single- or multi-family dwelling unit.
5/),) 11.Prafit71.1
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add' I 500 sq. ft. or portion 33.92 . i
Tax map/parcel no.:
Limited energy, residential
75.00 2
•:•,.....:',: '::. ";:' , ••• 1. ' r '. : .• ' ". ' • ..' 'tioscimpro..00:*cog :,.,'...., : :, : . ; . , . (with above sq. ft.)
Limited energy, multi-family
a o ..19....g- 6R)))01--A6 6 4h//4 6-- 00.ertii residential (with above sq. ft.) 75.00 2
Services or feeders installatio alteration, and/or relocation
AMX-eh/S-4,3 V67 71C3, / 200 amps or less
100.70 2
-. : ....... :. O1,000it.tii.i.owiok,:::: , .: , :::;:.' , . - ..:f.' , ::::: , ...:; -, ',.'::,'"'e:::::,..- 1 .4 - :94.*Ariif,i - ..! . ::::...:;.:::;:,...;:,:.,,,:. 201 amps 10 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: tOh/6 /0/ 4 5 ,9P3/on °Ail 601 amps to 1,000 amps -
301.04 2
Address: ///qg „s h. ) 7 2A4afr
Over 1,000 amps or volts 552.26 2
City/State/ZIP: , 9 f___ 902z
porary services or feeders installation, alteration, and/or
- Ti fri971..n i relo Tem cation
Phone: 3 (p ,F9357 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. . ... : ...,..": ,.... ' ..:1:1;';4011*4140 ......;!.....-'.'.-:'.-t"....',;k::-::.F:1:11.00...r#4.0t4.''. . a fee 742 2
Business name: e... Qs czy-skrecd-o..<-- B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56.18 2
Each addl branch circuit 7.42 2
Address:
Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
r:::'::'.',:• ....:. ' .... .....'.. . ri. -.• ....: ! .c •••• • .• , ', ••• . : • • • '• .... ,. Signal circuit(s) or limited-energy , ,,,, ....-
panel, alteration, or extension. / .
Business name: ('/)-• ,- .a Page 2 7,... 2
n nc„..
Each additional inspection over allowable in any o the above
Address: 1 550 c sk i j ( c 4N- *2,2) Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: 7766, Ca OK 972 a 3 .
Industrial plant (1 hr min) 78.18/hr
Phone: 603 ) 2_3‘,./.— ip5e q I Fax: (5a3 )23g 2.09 8' inspections for which no fee is 90.00/ hr
specifically listed CA hr min)
CCB Lic.: — 12_9(42 . I Electrical Lic.: 3754/6,C„11 Suprv. Lic.: 34473 'ii
Suprv. Electrician signature, required: \(...1 4
\ c....
Plan review (25% of per 75-cid -
Print name: 4 nn -tit\ • i Datej—g State surcharge (12% of permit fee): y
g,0 TOTAL PERMIT FEE:
kv;
Authorized signature: i ze pdA1-
Ms permit application expires If a permit is not obtained within 180
days after It has been accepted as complete.
Print name: oin : ori Date: .....
• Number of inspections allowed per permit.
1:41loildingTermiirELC•PennitApp.doe 07101.10 440-46157(11,05,COMAVEB
01 08:56:27 03-14-2012 2 /3
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
iiksititivtik., WORK . • .
Fee for a residential systems combined $75.00
Check Type of Work Involved:
O Audio and Stereo Systems*
O Burglar Alarm
O Garage Door Opener*
O Heating, Ventilation and Air Conditioning System*
O Vacuum Systems*
El Other:
•COMMgItCIAL.WORIC,ONLY:
Fee for each commercial $75.00
system
(SRP. OAR 918-309-0000)
Check Type of Work Involved:
0 Audio and Stereo Systems
LI Boiler Controls
El Clock stems
Data Telecommunication Installation rr J 3/0/ 8 7 :
O Fire Alarm Installation
El HVAC
Ei Instrumentation
p Intercom and Paging Systems
O Landscape Irrigation Control*
• Medical
O Nurse Calls
p Outdoor Landscape Lighting*
▪ Protective Signaling
El • . er •, 0
•
•
Total number of commercial systems: _L
*No licenses are required. Licenses are required
for all other installations
1:111+1ildiagTermitiNELC-PermilApp.doe 07/01/10