Permit •
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CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
n
7 1
a'.. COMMUNITY DEVELOPMENT Permit #: ELR2013 00056
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/13/2013
Parcel: 2S101AA02900
Jurisdiction: Tigard
Site address: 12123 SW 69TH AVE
Project: Capitol One Bldg. A Subdivision: WEST PORTLAND HEIGHTS Lot: B
Project Description: (1) low voltage for Data/Telecommunications
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Contractor: COCHRAN INC Owner: TIGARD CORPORATE CENTER LP
• 7550 SW TECH CENTER DR #220 15325 SW BEAVERTON CREEK CT
. TIGARD, OR 97223 BEAVERTON, OR 97006
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PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/13/2013 $75.00
12% State Surcharge - Electrical 03/13/2013 $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.
Issued By: �L.F'.� ckea Permittee Signature: o . 4�1 t i60 *"fiQAL
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 14:07:41 03 -13 -2013 1 /3
Electrical Permit Application RECEIVE r FOR OFFICE USE ONLY
City of Tigard MAR 13 2013 Received 3 i 7� J �
IPR S Permit No.:eLA. /W - !)D
° 13125 S W Hall Blvd., Tigard, OR 97223 Plan Review
= Phone: 503.718.2439 iTY 439 Fax: 503.598.196e nF r� , Dat : : Other Permit:
TIGARD Inspection Line: 503.639.4175 X111 [[ l/I G " P Date Ready/By: /� H See Page 2 for
Interne: www.tigard- or.gov BUILDING DIVISI I ►I otified/Method: ( Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction l i. Addition/alteration/replacement Please check all that apply (submit 2 sets ofplans w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over threw stories.
El Demolition ❑Other.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - and 2 family dwelling ICommercial/industrial ❑ Accessory building amps s ground, t a exceeds ons, ❑ Commercial use agricultural
1 7' $ amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SIT INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
Pm [v 70 U ❑ Addition of new motor load of ❑
Job no. �QD 4/3 % Job site address: /21 / 2.3 C ,' p / 9A r e A / 1 OOHP or more. occupancy.
.7[�(J[Q ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: /�,� (:),e. 7 2Z ?� ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominaL
/�P
Suite/bldg./apt. no.: Project name: ❑ Service or feeder 600 amps or more.
()AA/ D� �
FEE SCHEDULE
Cross street/directions to job site: ,Sa(,' & 9-c-4-, /1 r -fie.- Description I Qty. I F� I Total I •
'Zit) L _ New residential single- or multi- family dwelling unit.
/ /'1 J itg . % ,5 / Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
'' // Limited energy, multi- family 75.00 2
'07i - Peru /n , It9 / /tiLQS_Sr ,4&!QSS PD /r r residential (with above sq. ft.)
�� Services or feeders installation, alteration, and/or relocation
L.J77' ‘ d/9_66_, 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
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: 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 125.08 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
above service or feeder fee,
❑ A LICANT I CONTACT PERSON each branch circuit 7.42 2
13. Fee for branch circuits without
Business name: ��1�n ../..4e.,,
service or feeder fee, first
Contact name: ....771...50/) ,i ion branch circuit 56.18 2
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
dwelling, service and/or feeder
Phone:4503 31)7 146 Fax:: OW) 205 V248 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
Business name: COCHRAN INC panel, alteration, or extension. l Page 2 15 2
Each additional Inspection over allowable in any of the above
Address: 7550 SW TECH CENTER DR. SUITE #220 Additional inspection (1 hr min) 66.25/hr
ity/State/Z1P: TIGARD OR 97223 Investigation (1 hr min) 66.25/br
Industrial plant (1 hr min) 78.18/ In
'hone: (971) 205 -4242 Fax: (971) 205 Inspections for which no fee is 90,00 / hr
specifically listed ('4 hr min)
:'.CB Lic.: 72942 Electrical Lic.: 37546C uprv. Lic.: 3447S - ELECTRICAL PERMIT FEES.
Subtotal: 15 0 C-- ) \
iuprv. Electrician signature, required: \ Plan review (25% of permit fee):
'tint name: KENNETH KATO Date: d ^/g c/3 State surcharge (12% of permit fee): 60
(/� TOTAL PERMIT FEE: cc) Authorized signature: GU nA�J
r � x [iL��✓ � This permit application expires if a permit is not obtained within 180
days after It has been accepted as com lete
'tint name: t i _ , r 4 . Date eg ' ...3-/ • Number of i nspections allowed per permit
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3uildingTennits 1ELC- PermitApp.doe 07/01/10 440.4615T(11/OS/COM/WEB
01 14:08:04 03 -13 -2013 213
Electrical Per Application - City of Tigard
Page 2 - Supplemental Information
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:
El 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
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
: 1BuildicgTamiroAELC- Pamiwpp.doe 07/01/10