Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t: COMMUNITY DEVELOPMENT Permit #: ELR2012 -00233
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/09/2012
Parcel: 25101 DCO3800
Jurisdiction: Tigard
Site address: 7190 SW SANDBURG ST 5
Project: McCormack Properties TI Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: Low voltage for voice and data
Contractor: ORE COM TELECOMMUNICATIONS LLC Owner: MCCORMACK PROPERTIES LP
9828 E BURNSIDE ST STE 100 7190 SW SANDBURG ST
PORTLAND, OR 97216 TIGARD, OR 97223
PHONE 503 - 597 -3700 PHONE 503 - 624 -4649
FAX• 503 - 953 -8501
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/09/2012 $75 00
12% State Surcharge - Electrical 10/09/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo Y Boiler Controls. N
CCTV N Clock Systems: N
Data & Telecommunications: N 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 a d all other applicable law All work will
be done in rdance . approved plans This permit will expire if work is not started within 180 days of is ce, if work is suspended for more the 180
days ENTION Oregon I: , re•uires you to follow the rules adopted by the Oregon Utility Notificati n C to Those rules are set forth in OAR
952 -0 -0010 through OAR 952 -0f • '90. You may obtain a copy of the rules or direct questions to OUNC by calling 50 232 1 7 or 1 800 332 2344
Is ued By: i wA0C Permittee Signature:
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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.
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Electrical Permit A l icat ' ,IWED FOR OFFICE 11s1.: ONLY
City of Tigard Received io/ � /a? Permit No f�,e ao�a - D Oa .v
13125 SW Hall Blvd., Tigard, OR 97223 T 8 ? 3 1 2 Plan Review
C Phone: 503.718.2439 Fax: 503.598 0 Date/By Other Permit Page 2 for
II G A KID
Inspection Line. 503.639 4175 Date Juns ® S le
Inte www.tigard -or gov CITY 1 TIGARL p� Supplemental Information
TYPE KxGDNISION PLAN REVIEW
El New construction , Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below).
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ 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 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 denved system
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: 7) q 0 S 5 r. I Six or more a res Recreational occupancy
{ 0 or more residential units ❑Re vehicle parks
City/State /ZIP: � � i o ` & i 2 ? 70Z.1 ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: /A, C_04,24 .C1c ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: 5. f . cARAjb7t of Description I Qtv. I Fee. I Total I
New residential single- or multi - family dwelling unit.
<4. 1 j ( ‘ u i2( r 4,,v_ S.1.4 , N D . 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 75.00 2
DESCRIPTION OF WORK (with above sq ft.)
Limited energy, multi - family 75 00 2
Lt 11 i 6) — UN G .4.4,D 047 �I/ABl m/i, residential (with above sq ft )
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
401 amps to 600 amps 200 34 2
Name: 601 amps to 1,000 amps 301 04 2
Address: Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59 36 I
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 ❑ 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 ' � JS CO
panel, alteration, or extension Page 2 2
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Business name: Qii CO u
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C� / 16 - i = GD/I't V// CA 1 7a — AiS Each additional inspection over allowable in any of the above
Address: / g Z R ,gU /NV f,,6E .� 2g - i" — 5l7 /7--&-- fg, Additional inspection (1 hr min) 66 25/ hr
/ Investigation (1 hr min) 66.25/ hr
City/State /ZIP: /004r�
z/,O Q/` n g 7 2-/ 6 Industnal plant (I hr min) 78 18/ hr
Inspections for which no fee is
Phone: (SO 3) 38 I — 7 Fax 3) q' " 856 ) 90 00/ hr
4{ specifically listed ('/ hr min)
CCB Lic.: / L f Z'g 3 11 \ 7 A , Electrical Lic . 35 - 0/ a - Suprv. Lic.:3 %7 LEA ELECTRICAL PERMIT FEES
Suprv. Electrician sig required: ` ` ° ��t�ty f f1 fig a Subtotal. 7
4
.C11 Plan review (25% of permit fee): .—
Print name: D sr /� ���_, D ate: /0 - _ / _ State surcharge (12% fee): 9' -O O
� �/ ® e
TOTAL PERMIT FEE: 7
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
I \Buiiding\Permns\ELC- PermiiApp doc 07/01/10 4404615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: f f
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*
TI Vacuum Systems*
❑ Other:
"COMMERCIAL WORK ONLY: -�
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El 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
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❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Buddmg\Permus\ELC- PermitApp doc 07/01/10
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