Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 . COMMUNITY DEVELOPMENT Permit #: ELR2012 -00155
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/25/2012
TIGA . Parcel: 25101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY, STE# 230
Project: Spec Space Subdivision: VARNS ACRES Lot: 9
Project Description: (1)signal circuit for Low voltage Data /Communications
Contractor: TECHNOCOM INC Owner: TRIANGLE POINTE LLC
7929 SW BURNS WAY SUITE F 901 NE GLISAN ST, #100
WILSONVILLE, OR 97070 PORTLAND, OR 97232
PHONE: 503 - 682 -4195 PHONE:
FAX: 503 - 682 -2781
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/25/2012 $75.00
12% State Surcharge - Electrical 07/25/2012 $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)
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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 160 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 • • " 952- 001 -'090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
wrA IA/ , /'ii Cf�-T1U�
Issued By: V � 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 603.639.4175 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.
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EIectrical Permit Application RECEIVED FOR OFFICE E USE ONLY -'
IN city of Tigard JUL 2 3 2012 Received -
g 1)ate/By: 1 14' II"' Permit No� seta - eh, ,
" 13125 SW Hall F31vd „'I Tigard, OR �O F TIGARD Plan Revie
Phone: 503.718,2439 Fax: 503. Other ter Permit: •
TIGARD Inspection Line: 503,ti39,41'/3
BUILDING Date Rcad I tutu El See Page lfor
Internet: www,tigard- or Nntified/Method: � il er Supplemental lnfnrmatinn .
i
TYPE .OF WORK I ' PLAN REVIEW _
_
ID New construct ddition /alteration /replaccmcnt Pleat chi all that apply (submit b sets of plans w/iicros cheeks l below): a
..I fccdcr 400 amps or more ❑ Building over three stories.
❑ ❑ Service
❑ Demolition Other: where iiie nvnilnhlr fault ntirrent ❑ Marinas and booiverdc.
exceeds 10,000 am et 150 volts or ❑ Floating buildings. CATEGORY OF CONSTRUCTION I Pa k t-.
' less to Around, or exceeds 14,000 ❑ Commercial-use atxicultural
❑ I - and 2- family dwelling FfCommercial /industrial ❑ Accessory building amps fol. ali other installations. hnildirtps,
❑ Multi-family 11 Master builder ❑ Other: ❑ Fire purbp. 1:1 Installation of 75 KVA or
.: JOW SITE tNFORMATION AND LOCATION ❑ Emcrgc cy system. larger separately derived systcni.
n ❑ Addido of new motor load of ❑ "A , "E " ' i -2 " "I -3 •
lob no.: Job site address: 13435 3 ' _6 � � , Y ..il Iooi II` occupnm t.
�I DD ❑ Six or Mnre residential units. ❑ Reere:1, mnnl vchicie parks,
City /State/ZIP: / , /� •"f �j / / H aza ddu.q fcaii n . ❑ Supply voltage for more than
V a / LIY� ❑ Hazardo�ua Incat 600 volts nominal.
Suite/bldg. /apt. no�� ire P ojcct name: ❑ Service br fccdcr 600 amps or more.
i • . FEE SCHEDULE
Cross street/directio lb tD • . site: oetenatioa I Qty. I Fee. I Tram
'' ' New resi single- or multi - family dwelling unit.
Includes .ttachcd garage.
Subdivision: I.ot no,: 1.000 so. iI. or less 168.54 4
Ea. add'! 5010 sq. ft. or portion 33.92 1
Tax map /parcel no.. Limited cnbrgy, residential
DESCRIPTION OF WORN (with atlovc sq, 0.)
__ _ 75 00 2
Limited energy. multi - tamely
75.00 2
�Q i Oa _ residential (with above sq. ft.) •
_ Services qtr feeders installation, alteration, and/or relocation .
:00 romps dr less 100.70
d PROPERTY OWNER : I TENANT ' 201 amps tb 400 amps 133,56 2
Name:
401 amps lb 600 amps 2(10.34 n.
601 amps tb 1,000 amps 301.04 2
Address: Over I,000lamps or volts 552.26 2'
City /Scare /!_1P: Temporafy services or feeders installation. alteration. and /or .
relocation
Phonc: ( ) Fax: ( ) 200 amps dr less 59.36 1
201 amps tit 400 amps 125.08 2
fwnrr installation: This installation is being made on property that I own which is not _ 11
intended for salt, lease, rent, or exchange_ according to ORS 447, 449. 670, and 701. 401 amps tb 599 amps 168.54
Branch cifcuits - new. alteration, or extension, urns ns ncl
Owner signature; Date: A. Fee for branch circuits with
.21PPLICANT I grc:ONTACT PERSON obnvc service or feeder fee, 7 42 2
each branch circuit
Business name: / , i ? 0 + n e� R. Fee for branch circuits without
service Jr fccdcr roc, first
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Contact name: r r i branch
circuit 56.18 2
1 - �' Each add'i branch circuit 7 2
Address: / / _ p `1$ -d i Miac�ItnndnuF (service or feeder not included)
Cary /Slate /71P: l� L / / Each manufactured or modular ""
in iv 0 dwelling, sd,rvice and/or feeder 67.84 2
Phone: ( ` Jl • / • - ta; Reconnect dnly 67.84
^
Pump or irrigation circle 67.84 2
E - mail: / ,/ . ,4 . /. ' • . t
itr '� � �� V Sign or outline lighting 67.84 2
• . CONTRA • a • ' Sienal ciretdt(s) nr lintitgtt energy
Business name: ~ / r (( IA m �1�I1 / panel, alterdtion, or extension. ` 7
r �� Each additional inspection over allowable in any of the above
Addresel / - 1 J , Additional ih5pection ( hr min) 66,25/ hr
city /SIatC/ZIP: �� � I Investigation (1 hr min) 66,25/ hr _Alf Industrial pliant (I hr min) ' 78.18 / hr
Phone: 2 . Z_ OM Fax: 0 7# i a Inspections for which no ree is
specificallYlisted (%: hr min) WAX)/ hr 1
./6 Lie, Q 2, Z. . a� J � i 1 ' 1 ELECTRICAL PERMIT FEES .
{ Subtotal'
I .__ �
A Suprv. Electrician signature, required:
�
I Plan review (25% of permit fee):
Print name: / Jr� ill
i , `, I Dale: 120 talc surcharge (12%ofpermit fix): L;
- � , TOTAL PERMIT FCG: 8
Authorized signature: ; la/
.. / This permit nppiicntion expires ifs permit is ant obtained with
• drys after it has been accepted as clmplcic.
Print name: , Dat w
.� �� , j ,0 • t•I..ntw, v looser nuns ulluwcd pct pcnaii.
1:\Building\Pcrmita ELC- PamitApp.doc 07 /01 /10 440.46151 IPo5/CQM/WER •
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESI1WNTIi .. WORK ONLY: .
Fee for Al residential systems combined $75.00
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Clueck Type of Work Involved:
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❑ Audio and Stereo Systetns*
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❑ Burglar Alarm
❑ Garage Door Opener*
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❑ .Heating, Ventilation and Ait. Conditioning System*
a Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY
Fee for sach commcrcial $75.00
system
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(SEE OAR 918 - 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler. Controls
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❑ Clock Systems
Data Telecommunication Installation
❑ 1-"ire Alarm Installation
fl I-IVAC
❑ Instrumentation •
❑ Intercom and Paging Systems
❑ Landscape krig,ti.ioiri Control* •
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
i :150diniWormilAELC•PermitApp.doc 07 /01 /i0