Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
-• COMMUNITY DEVELOPMENT Permit #: ELR2009 -00184
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/13/2009
Parcel: 25101 DCO3900
Jurisdiction: Tigard
Site address: 7150 SW SANDBURG ST
Subdivision: Lot: 0
Project: Progressive Insurance
Project Description: Voice & Data Cable Install
FEES
Owner:
PROGRESSIVE CASUALTY Description Date Amount
INSURANCE COMPANY, REAL ESTATE Restricted Energy Permit 07/13/2009 $75.00
NOTIFICATIONS, PO BOX 89429 12% State Surcharge - Electrical 07/13/2009 $9.00
PHONE:
Contractor:
PTSC
8025 SE TELFORD RD
GRESHAM, OR 97080
PHONE: 503 - 665 -4900
FAX: 503 - 665 -4830
•
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 Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
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 OA 01 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: (9,1-
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 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.
•
„07/x,9/2009 TIC 15 :57 FAX 5036654830 cEl\TED IJ002 /002
Electrical Permit Application .N\-- 0 9 2 0 •' : •' • FOR OFFICE USE ONLY • •
II City of Tigalyd Vr(`1G ciao( L� �� Permit No.: �L i2Z�g - Qv /�� •
13125 5W HuII Blvd., Tigard, OR 9727.3 r `'� 0 l lv i •: ' �icx.
- Phone: 503.639.4171 Fax: 503.598.1960 r 3DI _Date: C)iher l'ermi4:
TIGARD
Inspection Line: 503.639 -4175 BulL Dote Rmnly nv: ..iris: el Sec Page 2 for
lntcrnnt: www.tigard- or.gov Nolitied,Methnd; Supplemental information
........ :iOF'WORK • . ... . .. EW. •
0 New construction Addition /altcratioll/replaCemerll Please cheek all that apply (submit plans bmit 2, sets of pla w /items checked below):
❑ Service or feeder 400 amp8 Or nsrre ❑ Building over three slur icy.
❑ Demolition ❑ Other: - where the available fault current ❑ Marinas and boatyards.
CATEGORY <OF,. CONSTRIICI'IOIV ' . ' . • . .. .000 amps a 150 or ❑ Floating buildings.
exceeds 10 50 volts o
less to ground. or exceeds 14.0(0 ❑ (:a -use agricultural
0 1- and 2- family dwelling X Comtncrcia] /industrial 0 Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: . ❑ Fite puap. ❑ lusiallalion of 75 KVA or
' $IT,E iNF.ORMATION AND LO(:ATION. , ., l larger separately derived system.
JOB
Emergency system laar
❑ Addition of new motor load of ❑ "A ", " '. " ", "1-3",
•
Job 116.7 ] Ab site r llldrays; mom- or Dorn. job �� 5 � ��� b ❑Six or more residential traits. ❑ Iteeruational vehicle parks.
Lily /Stslte/Z1P h� d QO C 7 ? 3 ❑ Health-esic facilities. ❑ Supply voltage for more than •
• JJ 1 h ° l . _ ❑ H:nenlnuv hicalians. 600 volts nominal.
Suite/bldg. /apt. no.: Projcct namRreg9 r I mo . L u - _f Cm/ ____O Service or feeder 600 amps or mote,
7",;:t.......;....;';'.:.::4: ' FLE,;:SC;iIEbULE'.. 7.:
Cross street/directions to'obsite:
. _ ] ,D rsertp dao ..- .._ _ _._ I 0: I. .!:tt:_....1. �t'otol._ �._,�,..
New residential suigle- or multi - family dwell unit.
Includes attached garage.
Subdivision: -- Lot nn,: 1,1100 sq. It. or less 145.15 4
Ea. add'l 500 sq. ft. or puniun 33.40 I
1'ax rnaplp;lrccl no.: Limited energy, residential
75.00 2
• DESCRIPTION pF worm (with ab ove sq�
energy, multi- family 75.00 2
�p -r-, ��..{..^ /� �, r,, - f ^,� .�-/� ,c, p L
tic, e-g- - .Data •• 4�( -
. b C vrr a � '• raidential (with above sq. ti.)
Services or feeders installation,,fthergtion, and/or relocation(
. - 200 (sups or less 80.30 2
0 PROPERTY OWNER , I' TENANT 201 amps to 400 amps 111(1.85 2
Nam • 401 amps to 600 amps 160.60 2
amps
-• _ °- • •• 601 to 1,000 amps 240.60 2
....._ 1
Address: gaze 4340 6h�. ci
'� Over 1,000 am is or volts 454.65 2
' C;ity /State/ZIP: -n ..rd i a e _ q 3 .1 Temporary services or feeders installation, alteration, and /or •
_..:
_relocation _
Ptiurto: Ste ) 4() r e�C�l 4 4 Fax: l ) ? 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 I00.30 2
intended for salc, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps __ 133.15 2
Branch circuits - new, alteration. or extension, per parlel
Owner signature: • , Hate; . ...... _. -- A. Fce for brlitch circuits with
.. . /A APPA,ACANT.. •. .. CONTACT PERSON.: . above service or feeder fee,
6.65 2
��,,�� i cla branch circuit
Business nyn �i}prt c vg..... Q. '� -k•yl{,p ci- Ld mVYL, B. Fee for bl circuits
Contact name: q_ - cs�' without n crvi i corfeeder 1 fee, - 46.85 _.
ti ..mach, circuit
2
Address:. r_ 6 Se- -r r•�, - d R L - Each add'l bt:meh cin:uit 6.65 .
Miscellaneous (service or feeder not included)
City /Statc/LIl': 6- k O cif DgQ Each manufactured ormodular
f 2 dwelling, service ;Uld /er feeder
90,90 2
Phone: 3) (e( r/ -lq I Fax:: (` ) L6 .. v 3z • Reconnect only 116.85 2
E - mail: ga4 - P2.‘i ..p C,G 0 + 9 C b l Pump or irrigation circle 53,40 2
• CONTRACTO . Sign or outline lighting 53.411 2
• -
Business mane :' `(� fg.gsof . (p� , -ls"�O -�•tw C�-- energy l:lltilllt(5) e r tion, o -
_... _........ enciRy panel, alteration, or
Address: SE12,5 e �.�d -j 4- - extension. Describe: I
re Page 2 2
City /Slate /7_IP:q. (.�- 5 :y,,_ n 2 ci'1 DR Each additional inspection over allowld,1c in any of the above
Per inspection 62.5(1
Phone: 3) ( j ( -t_q a Fax: (�Q�) � S : �8 •, Investigation per hour (1 Ilr min) 62.50
CC 13 Lic.: 150 11.5 Eli Li,Aill 9 /I L6 Supt'v. Lie.: ite3R LE industrial plant per hour 73.75
-- ELECTRICAL PERM)T FEES
Smpav, Electrician Sirinaturt:, required: 4,0,___ - � ---
Print / Plan review (25° of permil):
x /„ Subtotal:
1 rint nalriej6.111t_s '� i S ays, . Date: / D 02.07 - �-- --
......... .
-• • _._.... _ ... -. - Slate surcharge (12 /s of peniiit fee):
Authorized sigt X42 1 •. , ,ova, ✓ TOTAL P FEE: r •
complete-
G l. [n n ;permit is not
Print 11411)6: 0. �Q,�` Jh, 9 1 'Phis permit application rvpire if n permr nhtninad within 130
-. ®O7 d -UD q • dais after it has been accepted a.,
, __.. _. -.
• Nu iher or itulxcuoun allowed per pc: mil.
I K I1v l',' -rc Itnpp.ru,r, 01.7.1)p 4411-15111(I I 5FC'OM WED
7 .)
- f Yr21;3 tVQ.• (/1SI.44.-0.c.Q.-)