Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00067
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/11/2012
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 460
Project: State Farm Subdivision: VARNS ACRES Lot: 9
Project Description: Fire Alarm.
Contractor: T & L COMMUNICATIONS INC Owner: GK TRIANGLE CORPORATE PARK III L
PO BOX 87387 BY THOMSON REUTERS INC
VANCOUVER, WA 98687 -7387 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD, CA 92013
PHONE: 360 - 737 -9725 PHONE: 503 - 221 -1900
FAX: 360 - 737 -9648
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04 /11/2012 $75.00
12% State Surcharge - Electrical 04 /11/2012 $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: N Fire Alarm: Y
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 rule • • • uestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B ��� Permittee Signature: ` - -4
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.
Electrical Permit Application ..‘, Fok OFFICE USE ONLY
of and
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City Ti R "` d
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City Tigard
O�l. Date/B: % i 1ri ' / • . .
13125 SW Ha11 Blvd., Tigart + z. ' r k, Plan Review -
C Phone: 503.639.4171 Fax.ti 160 N �® Date/B : Other Permit: 1,
T I G A R D Inspection Line: 503.639.417 . O� Date ReadyBy: 13 See Page 2 far
Internet: www.tigard or.gov QQ ® t_ '`e • P •CiN Notified/Method: H �/ Supplemental Information
TYPE OF WO' .� PLAN REVIEW
El New construction ®Addition/alterau. -t: cement P lease check all that apply (submit 2 sets of plans w/items checked below):
❑ Demolition ID Other: V
n ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling El 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', "1 - ", "1 - ",
Job no.: I Job site address: 13221 SW 68th Parkway IOOor more residential Recreational y ❑ Six or more residential units. ❑Recreational vehicle parks.
City /State/ZIP: Tigard, OR ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Ste 460 I Project name: State Farm ❑ 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: I Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. R)
Limited energy, multi - family
75.00 2
Fire alarm tenant improvement residential (with above sq. ft.)
Services or feeders installation,alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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: ( ) I Fax: ( ) 200 amps or less - § 6 - 5 , 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, Qer panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: T &L Communications, Inc. B. Fee for branch circuits
without service or feeder fee, 46 85 2
Contact name: Ross Bushaw first branch circuit
Address: PO Box 87387 Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Vancouver, WA 98687 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( 360 ) 737 -9725 I Fax: : ( 360) 737 -9648 Reconnect only 66.85 2
E -mail: office @tl- communications.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: T &L Communications, Inc.
r energy panel, alteration, or
Address: PO Box 87387 extension. Describe: 1 Page 2 ■",t t�.f�`2
City /State/ZIP: Vancouver, WA 98687 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( 360 ) 737 -9725 I Fax: ( 360 ) 737 -9648 Investigation per hour (1 hr min) 62.50
CCB Lic.: 67787 I Electrical Lic.: 7- 428CLE I Suprv. Lic.: 684LEA Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: L Bushaw Date: 03/23/2012 Plan review (25% of permit fee):
Larry State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE: C � .4. This permit application expires if a permit is not obtained within 180
Print name: Larry Busha Date: 03/23/2012 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits5E1.C.PermitApp.doc 05/23/06 440.4615T(11 /05/COM/WEB