Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'•.,. COMMUNITY DEVELOPMENT Permit# ELR2012 00216
Date Issued 09/17/2012
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S101 DA01700
Jurisdiction Tigard
Site address 7130 SW FIR LP
Project FTDI Chip Subdivision 72ND BUSINESS CENTER Lot 7
Project Description Low voltage for data
Contractor BRY -COM Owner NELSON VIAL LLC
14244 SE BUSH 7000 SW VARNS
PORTLAND, OR 97236 PORTLAND, OR 97223
PHONE 503 - 761 -5156 PHONE
FAX 503 - 760 -7501
FEES
Description Date Amount
Specifics. Restricted Energy Permit 09/17/2012 $75 00
12% State Surcharge - Electrical 09/17/2012 $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 wit
be d in accordance wi - pproved plans This permit will expire if work is not started within 180 days of issuance or if work is suspen•- •r more •e 180
d ATTENTION Oregon la• r - •• •s you to follow the rules adopted by the Oregon Utility Notification Cent Those rules :r: •t fort OAR
2- 001 -0010 thr•ugh OAR 952 -00 . 090 'o may obtain a copy of the rules or direct questions to OUNC by calling 503 232 87 r 1 800 332 23•
ssued By '� Permrttee Signature k f
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 FOR OFFICE USE ONLY
City of Tigard Date/By Received 9 , 7 , Permit No f��4a.4
III q 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
II : Phone 503 718 2439 Fax 503 598 1960 Date/By Other Permit
Inspection Line 503 639 4175 Date Ready/By Juns ® See Page 2 for
T 1 G A R O Notifred/Method Supplemental www tigard -or go PP lemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction la Addition/alteration /replacement Please check all that apply (submit 2 sets of plans whtems checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling a 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 -2 ", "I -3 ",
Job no Job site address 7/ 30 S // f Six o r or o more residential l units ❑ Recreational vehicle parks
City/State /ZIP / - - /'> Okt. ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg /apt no Project name r-- -A _ -( /S ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site Dacnption I Qty I Fee I Total I
New residential single- or multi- family dwelling unit.
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 1
Tax map /parcel no Limited energy, residential
DESCRIPTION OF WORK (with above sq ) 75 00 2
ft
_ / I) " \ Limited energy, multi - family
O!A-
`L, 1- Eu 64-TA 0-A-eALE residential (with above sq ft) 75 00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100 70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
Name 401 amps to 600 amps 200 34 2
601 amps to 1,000 amps 301 04 2
Address Over 1,000 amps or volts 552 26 2
City/State/ZIP Temporary services or feeders installation, alteration, and/or
h relocation
Phone ( ) 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 401 amps to 599 amps 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701
Branch circuits - new, alteration, or extension, per panel
Owner signature Date A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name B Fee for branch circuits without
service or feeder fee, first 56 18 2
Contact name branch circuit
Each add'I branch circuit 7 42 2
Address Miscellaneous (service or feeder not included)
City/State/ZIP Each manufactured or modular 67 84 2
ty dwelling, service and/or feeder
Phone ( ) Fax ( ) Reconnect only 67 84 2
Pump or irrigation circle 67 84 2
E-mail Sign or outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited -energy (�
U co Business name p ^ panel, alteration, or extension ( Page 2'� 2
Each additional inspection over allowable in any of the above
Address / �2/L � T y S a. S Additional inspection (I hr min) 66 25/ hr
City/State /ZIP T O' L A o 7/ Investigation (I hr mm) 66 25/ hr
/ w _ Industrial plant (1 hr min) 78 18/ hr
Phone (J OD 76. I.- 5r (�j Fax C ) t7�6 33 9 Inspections for which no fee is 90 00/ hr
� 2,ifq I F r ovi L / EA-
specifically listed W. hr mm)
CCB Lic u �� Electrical Lie u p ry L. ELECTRICAL PERMIT FEES
Supry Electrician si na�ilYe, required t -. / �oli�/y (25% Subtotal - 7 5,..=%6
b AUVIS' J, � GF' /` � � 1 � L1 Plan review (25% of permit fee) . � Print name N /3 /Z A N 1 Date /7 � /2_ State surcharge (12% of permit fee)
TOTAL PERMIT FEE g eefi a b
Authorized signature -
This permit application expires if a permit is not obtained within 180
Print name Date days after it has been accepted as complete
Number of inspections allowed per permit
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
FRESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other
COMMERCIAL WORK ONLY: _ a
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems
*No licenses are required. Licenses are required
for all other installations
I lfmldmg\Permoos\ELC- PermrtApp doc 07/01/10
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