Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN ` _ COMMUNITY DEVELOPMENT Permit #: ELR2013 -00138
Date Issued: 06/24/2013
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S 24/201 9100
Jurisdiction: Tigard
Site address: 12447 SW 69TH AVE
Project: Capitol One Subdivision: WEST PORTLAND HEIGHTS Lot: A
Project Description: Data telecommunications.
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
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 -238 -2098
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/24/2013 $75.00
12% State Surcharge - Electrical 06/24/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data & Telecommunications: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging' 0 Landscape /Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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- 090. 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: ��t� Perm/ / 97° / 64 ittee Signature: /97 / e'¢ `
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 603.639.4176 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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cEi FOR OFFICE
€y c
Electrical Permit A licatio '11.E ONLY
.� �i Received it
City of Tigard Date/B . t3 ' .', EllgEntritM
13125 SW Hall Blvd., Tigard, OR 97223 I UN 0 2013 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960' Date/B : Other Permit:
TI GARD Inspection Line: 503.639 Date Ready /By: NM 0 See Page 2 for
Internet: www.tigard- or.gov CITY}{O� OF TIGARD Notified/Method: Supplemental Information
TYPE OF L lkDING DIVISION PLAN REVIEW _
❑ New construction pi Addition/al teration/rtplacement Please check all that apply (submit 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 0 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
❑ Emergency system. larger separately -3 system.
I�/Il,(�70 J OB SITE INFORMATION AND LOCATION ID o Addition of new motor load of ❑ "A ", "E E"", , ""1I- 2 "",, " "1 1 -3 ",
DS ,' g / ,. p Six or or e r more. occupancy.
Job no. : I Job s ite address: / ���? �c!/ W �U if ❑ Six or snore residential units. ❑ Recreational vehicle parks.
City ❑ Health-care facilities. ❑ Supply voltage for more than
ty ! l �P�le� �� Z ❑ Hazardous locations. 600 volts nominal.
Suitteb no.: " i✓ - Project name: CAP i ?-4-L one. ❑ Service or feeder 600 sups or more.
FEE SCHEDULE
Cross street/directions to job site: ket, {A11. J St- 0 n 3 Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
,SL o q A 0-e---- Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fl. or less 168.54 4
Ea. add'l 500 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
4DD VO/Ce— 4— A»T74 C/.& j A & 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 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
❑ APPLICANT r5CCONTACT PERSON` above service or feeder fee 7.42 2
each branch circuit
Business name: (f9 C/In �� B Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Ai& boo circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Ci / State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: (7! )�J9 R Fax: : (97/) 7..05 z/Z108 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. I Page 2 75°i0 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
City/State/ZIP: TIGARD OR 97223 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (971) 205 -4242 Fax: (971) 205 -4268 Inspections for which no fee is 90.00 / hr
specifically listed W. hr min) —
CCB Lic.: 72942 Electrical Lie.: 37546C uprv. Lic.: 3447S ELECTRICAL PERMIT FEES
C _ t �' subtotal: 7 ex
Suprv. Electrician signature, required: \ \ Plan review (25% of permit fee):
Print name: KENNETH K 0 Dater .2‘) State surcharge (12% of permit fee):
/ TOTAL PERMIT FEE: T 00
Authorized signature: G 1. This permit application expires if a permit is not obtained within ISO
( days after it has been accepted as complete.
Print name: t D Y \ , ca C „ { - Date:: , _ ) /3 • Number of inspections allowed per permit.
I.1Bwldma\ Permits \ELC -Perm A .doc 07/01 /10 440 -4615T( 1 1/05 /COM/WEB
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for a 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
I I 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
I .\Building\Pamits\ELC- PermilApp doe 07/01/10