Permit rl CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELR2013-00248
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2013
Parcel: 2S 101 AA09100
Jurisdiction: Tigard
•
Site address: 12447 SW 69TH AVE
Project: Capitol One Cafe Subdivision: WEST PORTLAND HEIGHTS Lot: A
Project Description: Data telecommunication for cash register
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 10/10/2013 $75.00
12%State Surcharge-Electrical 10/10/2013 $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- 01-0 0. 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: e` Permittee Signature: 0Ar
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 " 07:16:42 10-08-2013 1 /3
Electrical Permit Application �'cp:Aitli F oR OFFICE USE ONLY .— Received
City of Tigard 1; p �3 Dates : /D 1/ .3 .0p., -PermitNo.E� ing D0�
- ° 13125 SW Hall Blvd.,Tigard,OR 9 -2 u D 1'O Plan Review
Phone: 503.7182439 Fax: 503.598.1960 c.,-C‘ at Dates ; Other Permit:
TIGARD
Inspection Line: 503.639.4175 �\G�e` !` J 0 See Page 2 for
Internet: www.tigard-or.gov CO 1* �,��e�\11 I Supplemental Information -
❑
TYPE OF WORK`\`t,(\,� . PLAN REVIEW
v� Please check all that apply(submit 2 sets of plans w/items checked below):
New construction ,Addition/alteratiorl/ lacement
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION 150 volts or ❑Floating buildings.
exceeds 10 000 amps at
less to ground,or exceeds 14.000 ❑Commercial-use agricultural
❑ I-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
JOB SITE INFORMATION AND LOCATION
ID Emergency system. larger separately derived system.
_ .. .. ... . . _ ❑Addition of new motor load of ❑"A""E""I-t2""I.3"
Q 100HP or more. occupancy.
Job no. D170 5 Job site address:la 41417 $/(J /,,c/-63- ,,,W°. ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: !`/a ir� (1)2 q 7li2 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Sui - bid_ apt.no.:Bo t Project name: i /74 .0,7-,,le,DAed eAre, ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: ,St Ievc/An1�— e- Description I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Su, (a 9174. A-ye. Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 I
Limited energy,residential
DESCRIPTION OF WORK (with above sq.It) 75.00 2
_ Limited energy,multi-family
�D/7�Q PmLo 7h _1�s AL(-&)(�i-. /(O residential(with above sq.ft.) 75.00 2
V CJ Services or feeders installation,alteration,and/or relocation
!QQeh 6u- Ibis TE 4- /r1 CA-F ' 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 l
201 amps to 400 amps 125.08 2
Owner installation:This installation is being 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 168.54 2
Branch circuits-new,alteration,or extension,.er panel
Owner signature: Date: A.Fee for branch circuits with
above service or feeder fee,
❑ APPLICANT- gCONTAC T PERSON . . each branch circuit 7.42 2
Business name:(Q rAy1 �ri B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Contact name: ,el-ex // ''jii branch circuit
q� n,, I_ Each add'I branch circuit 7.42 2
Address: 7�SD S`U /Lam( / ( '4h',- Miscellaneous(service or feeder not included)
City/State/ZIP: 77 , ej> pie -L 722 33 Each manufactured service and/or or r modular
tY dwelling,service and/or feeder 67.84 2
Phone:97/ ) Z05 4'Zgz Fax::q7))Z./5S 4/268 Reconnect only 67.84 2
Nrna.c.h go ecthrzni4t"_IdDm
Pump or irrigation tineigting 67.84 2
E-mail: U
Sign or outline fighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:COCHRAN INC panel,alteration,or extension. 1 Paget 75°3 2
Each additional Inspection over allowable in any of the above
Address:7550 SW TECH CENTER DR.SUITE#220 Additional inspection(I hr min) 66.25/hr
City/State/ZIP:TIGARD OR 97223 Investigation(I hr min) 6625/hr
Industrial plant(I hr min) 78.18/hr
-
P ne:(971)205-4242 Fax:(971)205-4268 Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
CCB Lic.: 72942 Electrical Lic.: 3� 7546C ( uprv.Lic.: 34475 L ELECTRICA PERMIT'FS EE
Suprv.Electrician signature,required: � \ '
Subtotal: 76,Vd
Plan review(25%of permit fee):
Print name: KENNETH K TO Date: / ....U / State surcharge(12%of permit fee): 9. Qio
TOTAL PERMIT FEE: ti Vr 6D
Authorized signature:l D4L This permit application expires If a permit is not obtained within 180
Print name: ),`& to W ..1 C Date:/9_ 8/3 days after It has been accepted as complete.
Lt U ' Number of inspections allowed per permit.
Sui lding1Pamits\ELC-PemulApp.doc 07/01/10 440-46I5T(11/OS/COMIWEB
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
FEE'
Fee for all residential systems combined ... $75.00
Description 1 QtY. I Fee I Total I
Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70 2
5.01 to 15 kva 133.56 2
n A• udio and Stereo Systems*
15.01 to 25 kva 200.34 2
ElB• urglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
❑ Heating,Ventilation and Air Conditioning OAR 918-309-1X140)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
n V• acuum Systems* >100 kva—noadditional charge 0.0 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(% r ml )
•
_.CO B B RCIiAL.WQ K ONLY ELECTRICAL PERMIT FEES • =
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
nA• udio and Stereo Systems days after it has been accepted as complete.
Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
LVI Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ M• edical
❑ Nurse Calls
n O• utdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Buitding\PermitawEt-C PermitApp ELR ERE.doe Rev 05/21/2013