Permit •
•
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELR2012 -00262
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/21/2012
Parcel: 25101 BB01400
Jurisdiction: Tigard
Site address: 12100 SW GARDEN PL, BLDG# 4
Project: Ricoh Subdivision: CROW PARK 217 Lot: 2
Project, Description: (1) low voltage for Data Telecommunications
Contractor: COCHRAN INC Owner: WALTON CWOR PARK BC 8 LLC
7550 SW TECH CENTER DR #220 BY CTMT - WALTON RE TAX
TIGARD, OR 97223 4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
PHONE: 503- 234 -6564 PHONE: •
FAX: 503 - 238 -2098
FEES
Description Date Amount •
Specifics: Restricted'Energy Permit 11/21/2012 $75.00 '
12% State Surcharge - Electrical 11/21/2012 $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 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.
int
Issued By: ` l Permittee Signature: 0 PPG / CA17O1J1 .
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.
•
01 09:20:59 11-21-2012 1 /3
Electrical Permit ApplicatiRECEIVF,
i 1014 OFFICE 1:S11 ONLY
City of Tigard . Received
Date/By: lit i,D• I //el- at Permit No.: „ a . - 0 0 ..1( .2-
. 13125 SW Hall Blvd., Tigard, OR 97223 NOV 2 1 2012
Plan Review
er Peit
111 1 . Phone: 503.639.4171 Fax: 503.598.196.1 . Date/By: Oth rm
D
Inspection Line: 503.639.4175 (1 OF TIGARD Date Ready/By: El See Page 2 for
TIGAR
Internet: www.tigard-or.gov
13(111 notIO DIYIslor Notified/Method: 'ITC' Supplemental Information
. •: - . 1;. .1: ::ri; ' . */*4 ' .. :0 : : .**C. : . ' ,..: . :: : ., : :.:;:',.... ,1 •::; ... ::;- ....'...,::;'.i .:.:..:::::.•:-. i;;':.....3:•:' •
0 New construction Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
- ..: l'.11:'.:'; •.: .., :,' ':' :
CATEGORY OF CONSTRUCTION exceeds 10,000 snips at ISO volts or 0 Floating buildings.
less to ground, or exceeds 14.000 0 Commereial-use agricultural
El 1- and 2-family dwelling ' Commercial/industrial 1:1 Accessory building amps tbr all other inshillations. buildings.
DI Multi-family Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
• . . 0 Emergency system. larger separately derived system.
• . .
JOB SITE INFORMATION AND . O
CATION . . '.....L: . • 0 Addition of new motor load of
Job no.: 169 / Job site address: /2/00 ,c11) 64e1.)ea4 0/lee I 00HP or more.
-d 0 Six or more residential units. occuPencV.
0 Recreational vehicle parks.
City/State/ZIP: c r j 6, A le.A oe_.. 9 7Z Z .2, 0 Health-care facilities. 0 Supply voltage for snore than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: R.... 0 (4 D Service or feeder 600 amps or more.
' ....' E.. :' ...:■::: ..:, . ...:
Cross street/directions to job site: 50 1..\_,. t R
. _ N 14.
k. ..i , N. Description . I Qty. I Fee. j Total . 1 •
New residential single- or multi-family dwelling unit.
LI1/4) (=A-0)er\ I etG Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'I 500 sq. R. or portion 33.92 . 1
Tax map/parcel no.:
Limited energy, residential
75.00
. . DESCRIPTION OF WWORK . (with above sq. ft) 2
Limited energy, multi-family
IA90 (nb3 - Neu) V oice./bik *To fzErtcncrure, residential (with above sq. R.) 75.00 2
Services or feeders installation, alteration, and/or relocation
PA\ 69 C' 200 amps or less 100.70 2
0 PROPERTY OWNER .- ' .-.::' : •••' r l' :•. ., : TENANT r • ', ... 201 amps to 400 amps 13156 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/Z1P:
. relocation
Phone: ( ) Fax: ( ) 200 amps or less . , 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 12.5.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 168.54 _ 2
. Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
.. . El. APPLICANT . . .-: ' '.• • I .'.'".. II ii.:0i,itAci PERSON -.:. ., above service or feeder fee,
742 2
each branch circuit
Business name: 50_0,r cS C.i)C\ Li---0.-..(-- B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch circuit
Each addl branch circuit 7.42 2
_ I
Address:
Miscellaneous (service or feeder not Included)
Each manufactured or modular
City/State/ZIP:
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2 ..
E
Sign or outline lighting 67.84 2
. .
. ' CONTRACTOR •
•••• ..' • • • • • • Signal circuit(s) or limited-energy
Business name: act) r' .1 i
panel, alteration, or extension. / • Page 2 76, 2
, an
. Each additional Inspection over allowable in any of the above
—
Address: 7 550 5‘ ( C f...n k e _ K . ,4, c 422 D Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: - 766. reA OK 72 a _
Industrial plant (1 hr min) 78.18/ hr
• . .
Phone: 5(73 ) 2314.-. 1:05-641 , Fax: ()3 ) 2.3?c - 2-0 q g/ Inspections for which no fee is
90.00/ hr
. specifically listed Oh hr min) _
CCB Lic.: 7 z 5,4 a Electrical Lic.: 7541 e, Suprv. Lie .: 314+73 EILEOFt.I.CAl.,PERMIVFEE.S.':,
Suprv. Electrician signature, required: – Subtotal: .
Plan review (25% of permit fee): 75, no
Print name: K 0 -ti K ,, • p Date: ' )– V –/Z,, State surcharge (12% of pennit fee): 9, VD
Authorized signature: e i , . . . 7 g s idi-/--_
TOTAL PERMIT FEE: 846
This application expires Ira permit is not obtained within 180
–2/–/ a • days after it has been accepted as complete.
Plint nam Date: e: i ,,,„ s • Number of inspections allowed per permit.
1 07131.I0 440-4615T(11,05•COINWEB
01 09:21:28 11 -21 -2012 2 /3
Electrical Permit Application - City of Tigard
Page 2; Supplementallnformation
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL 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 . . , •
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 •'S
BlinlAinnWrrm;MF.7!'- PirmitAm Mt n7min0
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12100 SW GARDEN PL BLDG 4, TIGARD, OR,
97223
Commercial - Electricial Limited Energy
199 Electrical final
05/08/2013 00:00
ELR2012-00262
PASS - No C of O
Violation Summary:
Inspector Contractor