Permit •
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C rrY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00257
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11!14/2012
Parcel: 2S113AC00103
Jurisdiction: TIGARD
Site address: 7244 SW DURHAM RD 900
Project: Foremost Forwarders Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 25 -27,2:
Project Description: (1) low voltage for Data Telecommunications 12/3/12 REPRINT to correct ASI information
Contractor: EMMONS ENTERPRISES Owner: PACIFIC REALTY ASSOCIATES
20525 S UNGER RD ATTN: N PIVEN
BEAVERCREEK, OR 97004 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 632 -3535 PHONE:
FAX: 503 - 632 -6329
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/14/2012 $75.00 •
12% State Surcharge - Electrical 11/14/2012 $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) .
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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 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.
Issued By: Permittee Signature: Oki 4 P _Ii 1Tl U�
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:
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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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CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t3 COMMUNITY DEVELOPMENT Permit#: ELR2012 -00257
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/14/2012
Parcel: 2S113AC00103
Jurisdiction: TIGARD
Site address: 7244 SW DURHAM RD 900
Project: Foremost Forwarders Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 25 -27,2:
Project Description: (1) low voltage for Data Telecommunications
Contractor: EMMONS ENTERPRISES Owner: PACIFIC REALTY ASSOCIATES
20525 S UNGER RD ATTN: N PIVEN
BEAVERCREEK, OR 97004 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 632 -3535 PHONE:
FAX: 503 - 632 -6329
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• FEES. •
Description , Date Amount
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Specifics: Restricted Energy Permit 11/14/2012 $75.00
12 % State Surcharge - Electrical 11/14/2012 $9.00
Type of Use:
Class of Work:
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. r/
Issued By: .J t Permittee Signature: &J 4 PPC �4 7 DR
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.
Nov 13 12 03:29p Emmons Enterprises c 503 - 632 -6329 p.2
I ECEIVE . 1 :
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard NOV 1 3 2012 Rcccived
Ill Dale 3v: L i 1 I 41-1/2'111 Perm"' NO : j IY OD ) 1
13125 SW Hall Blvd, Tigard, OR 97223 . P ricw 'w �
Phone: 503.718.2439 Fax: 503.598.1960CITY OF TIG ' • D R : Other Permit C�..JOI ray- OD(
I' I G A k U Inspection Line: 501639.4175 p� DIVIS ,� a 8 See Pn e : for
Inta�t'tet: www.tigard- oi.gov BUILDING lJ1VI SappErntentat Information
. TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /altoratiott/replac'ment Please check all that apply (submit 2 sets of plugs writers checked below):
❑ Service or fader 400 amps or mute ❑ Bcildir.; over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards,
CATEGORY OF CONSTRUCTION exaseds 10.700 amps at 150 volts or 0 Floating bcildinci.
less to around, or exceeds 14.000 ❑ Commercial -use agdrJltural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other insttallalions. bui:dirtm.
❑ Multi- fancily ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA u'
JOB SITE INFORViATIOY AND LOCATION ❑ agency system. larger separately derived system.
❑ Addition anew motor load of ❑ ".V - E . " -i
Job no.: I Job site address: 7244 Sw Durham Rd 103149 or more. occupancy
❑ Sin: or more residential units. ❑ Recreational ♦vehicle parks.
City /State/ZIP: Tigard, OR 97224 ['Health-cam facilities. ❑ Su.ply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 900 Project name: Foremost Forwarders ❑ Sct•ice or feeder 6(a) amps or more.
FEE SCHEDULE
Cross street/directions to job site: ocurtpaoa 1 Q 1 Fee 1 Tolai I •
New residential single- or multi- family dwellin8 unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 R. ft. or less 168.54 4
Ea. add•I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
with above 75.00 2
DESCRIPTION OF WORK ( sq. ft i
Limited energy, multi - family
Data wiring residential (with above sq. 0.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 133.56 2
Nance: 401 amps to 600 amps 20034 . 2
601 amps to 1.000 amps 301.04 2
Address: Cher 1.000 amps or volts 552.26 ; 2
Temporary services or feeders itntallation, alteration, and /or
City /State/ZlP:
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is bcine made on property that I own which is not
intended for sale, lease. rent, or exchange, according to ORS 447, 449. 670, and 701. 401 amps to 599 amps 16854 2
Branch circuits - new. alteration, or extension, per panel
Owner signature: Dale: A. Fee for branch cuurits tvi :h
0 APPLICANT 0 CONTACT PERSON at,ov c Venice or leader fee, 7.42 2
each branch cuwit
Business name: Emmons Enterprises Inc A. Fee for branch cir.:uits urthour
semi= or feeder fee, first 56.I8 2
Contact name: Gary Emmons branch circuit
Each add'I branch circuit 7.42 2
Address: 20525 5. Unger Rd Miscellaneous (service or feeder not included)
Each manufactured or modular
dular
City /State /ZIP: Beaverereek OR 97004 dwelling, semi= and /or feeder 67.84 2
Phone: (503) 201 -7115 Fax:: (503) 632 -6329 Recormorl. only I 67.84 2
Harp or irrigation circle 67.84 2
E - mail: emmons.enterprises@.hotmail.com Si gn or cmtlme li trl,ling i 67.84 2
CONTRACTOR Signal cuwit(s) er limited•enemy
Bossiness name: Emmons Enterprises Inc panel. alteration. or extension, l Pace 2 75.00 2
Each additional Inspection over allowable in any of the above
Address: 20525 S. Unger Rd Additional inspection (1 hr min) 66.25/hr
City/ State /ZIP: Bcavcrcreek OR 97004
Investigation t.1 hr min) 56.25: hr
Industrial plant (1 hr mint 78.18/ hr
Phone: (503) 632 -3535 It ) ` \ Fax: (503) 632 10� Inspections for which no fee is
90.00' hr
V 1 specifically listed CA hr min)
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CCB Lic.: 106940 l Electrical Lic.: CLE3 -330 Suprv. Lic.: S7OLEA ELECTRICLI, PERMIT FEES
Suprv. Electrician signature. required: ( // Subtotal: 75.00
L7 - -- C �""^'� - " - '''� Platt review (25% of permit fee):
Print name: Gary Emmons _ y ,1. Dale: 11/13/12 State surcharge (12% of patnit fear): 9.00
' ' TOTAL PERMIT FEE: 34.00
Authorized signature: ---- a4,4-1 C �
This permit application expires if a permit Is not obtained Within 180
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Print Hume: Gary Emmons 'bays aver it has been accepted as complete.
Date: 11/13/12 • Mather of inspections allowed 7ie- permit
1.\ 1uldiag,PemitstELC•PemarApp,crc Cr01 10 4.t0 .bl5 /COM/WED
Nov 13 1,2 03:29p - Emmons Enterprises Inc. 503- 632=6329 'p.3
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Electrical Permit Application - City Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: .
RESIDENTIAL WORK ONLY:
Fee for all • residential systems combined........ $75.00
Check Type of Work Invoked:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
❑ 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
❑ Clock Systems
®' Data Telecommunication Installation
.0 Fire Alarm Installation
• ❑•HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
O Landscape Irrigation Control* .
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of systems: 1
*No licenses are required. Licenses are required
for all other installations
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riBuikthevan,iri‘ELC- vemiupp.d« CVO 10
Nov 13 12 03:28p .. Emmons Enterprises Inc. • - 503 -632 -6329 p.1
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Emmons Emmons Enterprises, Inc. Phcne: 503- 6323535
Enterprises, Inc. 20525 S. Unger Rd. FAX: 503 - 632 .6329
, Beavercreek, OR 97004 email: EmmEntIncjuno.com
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Facsimile
To: Electrical Permit Dept
Company: City of Tigard
@Fax: 503 - 598 -1960
From: Gary & Gail Emmons
Date:, Tuesday, November 13, 2012 @2:33 PM
Re: Electrical Permit App, plus authorization form
Pages: 4, including this
Enclosed please find a 2 -page electrical permit application and a payment
authorization form.
Thank you,
Gail Emmons