Permit v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
F1 ': COMMUNITY DEVELOPMENT Permit #: ELR2012 -00248
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/31/2012
Parcel: 25101 DCO3900
Jurisdiction: Tigard
Site address: 7150 SW SANDBURG ST
Project: Progressive Insurance Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: (1) low voltage for cable as neeed to customers equipment moves
Contractor: PROGRESSIVE TELEPHONE SYSTEMS & COMMUNI Owner: PROGRESSIVE CASUALTY
PO BOX 190 INSURANCE COMPANY
GRESHAM, OR 97030 REAL ESTATE NOTIFICATIONS
PO BOX 89429
CLEVELAND, OH 44101
PHONE: 503 - 665 -4900 PHONE:
FAX: 503 - 665 -4830
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/31/2012 $75.00
12% State Surcharge - Electrical 10/31/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: N 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 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 rules or direct questions to OUNC by calling 503.232.1987 or 1.800,332.2344.. . I
Issued By: 2/44( 1f�1.L6/ �' Permittee Signature: y / P>PL I `K L r d ^-+
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.
From: 10/31/2012 10:39 #415 P.002 /002
Electrical Permit AppiicaREC r
IV( lion OF1 1( 1. 1st: :NIA
City of Tigard n r T ° �a► Received )
II I 9 331 3 1 202 `/B : M/ 3 / � PermitNo.:ete � Dva
Phone: 503.639.4171 Fax: 503.598.1960 Plm Review o
6 1 i I inspection Line: 503.639.4175 �j�/ /'r Date/B : Other Permit; co .2.0 le), _ D 011
Internet www.tigard-or.gov
�^ e 1 L/f r � Date Ready/By:
RI Page i for
( •
j f�a, Notlfied/Methad:
t` _ C j � , IV I S I - Supplemental Information
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I: Y :;Ly-: {r` •'..g is::P '1•'.' ' w `:'-',1 ?.i ,''( t i _ •'r ^,
ID New construction aO Addition/alteration/replacement Y apply (submit " "item e e d ` b l w
Please cheek all that apply (submit I sets of place w /items ebeck below)::
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
'' • , where the available fault current ❑Marinas and boatyards.
. : , : CATE(OR OF •CONSTRi1CTjOJY : ; • , exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Uindustrial less to ground, or exceeds 14,000
❑ Accessory building Cor lwse agricultural
❑ 1 and 2 - family dwelling ommercie
El Multi ❑ Master builder m u m other installations. buildings.
❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
• - _S1lT . K .. 90 . . :;II,NI) LOCI�TION - ❑ Emergency system larger separately derived system. • ❑ Addition of new motor load of ❑ °A ^, °E' °1-2 "I -3 ",
Job no.: . I J I 5 I Job site address: i l Srj Ste) < bL(.ro oc 100HPormore. y
City/State/ZIP: 119 ❑ Sia err more residential unity.
❑ Health-care facilities. ❑ Recreational vehicle pang.
� - ❑ Supply voltage for more than
Suite/bldg./apt. n0.: I Project name: ///yyy��� 0Hazardous locations. 600 volts nominal.
�oi assi J a_ L VIS --- ❑ Service or feeder 600 amps or moro.
Cross street/directions to job site: v :i:'': `
nraertpt - • ;-$CIJEII �';
ion ?, Qty. . Fee. .
.
Total •
New residential single- or multi- family dwelling unit.
includes attached garage.
Subdivision:
I Lot no.: 1,000
sq. ft. m leas 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92
Limited e - i
DESCRD!TION:o WORK - tom. residential
(with above sq. ft) 67.84 2
d ens
Limited , _ / _ IX e (, , C te
c � I t lic-� ,� residential above ft.) 67.84 2
WI S 61) IA
ervices or feeders installation and/or relocation
200 amps or less
D.�.PROPERTY OWNER.. _ / 100.70 2
I !�' TENANT ` ' �. 201 amps to 400 arnps Name: �SS (UQJ I AS �,(, -& y. v�., 401 amps to 60 amps 20 03 4 2
V 2
Address: / d 5 () � 601 amps to 1,000 amps 301.04 2
` Y� Over 1.000 amps or volts 55216 2
iry /State /LIY: �r� Temporary services or feeders installation, alteration, and/or •
�, //� relocation
Phone: {503}
`J f , 39 Fax: 6� ytqS e , `7 1 103 3 / _ 200 amps or less Owner installation: This installation is bein made o op which not
`P 201 amps to 400 amps 125.08 1
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
2
401 amps to 599 amps 168.54
signature: 2
! B ran ch ci rcu i ts— new alteration or extensio per anal
Owner si
Date: A Fee for branch c with
•
•. i0OANT: , I i L'J (O rt4'gI','PERSOIV.:':. ' above service w fader fee,
•
Business name: , each branch circuit 7.42 2
CO Ir-e. ( �4) Le- &- phOf. gu c4- ��. B. Fee for branch circuits Fust wi hour
Contact n 1 ervice or feeder fee,
� c>z X s C. branch circuit 56.18 2
Address: 7 �/ i c12-.) / t7a Each add'I branch circuit 7.42 2
I !/ Q .Yt f Miscellaneous service or feeder not included
City /State /ZiP: ( (.L5 it ri pZ Q Q . 6 ach E in service a d/ mar
Phone: 603) `V " �, 6 dwelling service and/or fee 67.84 2
S• • i 62) Fax:: E6� _ :.6 Reconnect only 67.84 2
Pump or irrigation circle es 1/ 7 $ a v t e 67.84 2
'
t.Nf1(tAGl?O$. ` k: Sign or outline lighting 67.84 2
Business name: , a...1J Uv � Signal circuit(s) ara ion or o limited-energy xextension. l i
a/) panel alteration, I 7 Pepe 2 / 5 2
Address: Each additional ins , etion over allowable in an of the abov
_ Additional inspection (I he min) G6.25/ In
City/State/ZIP: Investigation (1 hr train)
66.25/ hr
listed % hr min
Phone: ( ) Fax; u f t 1 4' Industrial plant (t i r mm} 78.18/ hr
CCB Lic.: E V ��: i c. ( ) I
Inspections for which no fee is
R 5 a� • / S / F Wad }dry 90.00/ hr
s.
Suprv. Electrician signature, required: l � 11 ; ''` -:-
'' II ,, L Subtotal:
int name: ( W �� Dgles Plan review (25% of permit fee): q -�
/J si�`� State surcharge (12% of permit fee):
•
" 00 / _ / TOTAL PERMIT
� � � 4 )u
FEE: F n IS
Authorized signatur
Print name: �.) ,�
r �` This permit application expires If a permit is not obtained within 18
C t ' , Date: / o 2e)1 , - 1 Number of inspe days a il er ons it allowed has been accepted as rnmplete
1 : 1 Bu , IdinglPermiu�ELC- PermnA •,doe 10/01 /09 per perm
440-46155(1 I /OS /COM/WEB