Permit (4) t '�., - CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
ip
n COMMUNITY DEVELOPMENT Permit #: ELR2010 -00062
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/19/2010
Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY E
Subdivision: Lot: 0
Project: Rite Aid
Project Description: Voice and data cabling
FEES
Owner:
SN PROPERTIES PARTNERSHIP Description Date Amount
1121 SW SALMON ST Restricted Energy Permit 04/19/2010 $67.84
PORTLAND, OR 97205 12% State Surcharge - Electrical 04/19/2010 $8.14
PHONE:
Contractor:
ALLPHIN COMMUNICATIONS INC
23220 SW BOSKY DELL LANE
WEST LINN, OR 97068
PHONE: 503- 638 -9000
FAX: 503- 638 -9100
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: y Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: � .' l� :'. J i Permittee Signature: 1X/ Off 'I
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 an Inspection that business day.
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.
04/16/2010 FRI 10:58 FAX 503 638 9100 Allphin Communications ?001/001
ECEIVED
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Electrical Permit ApplieatiorR
City of 'figard Ro.,iv.1
pcm,i( No.: gi_/2-0 10 - ooe
II APR .1 6 201 0 D.,..11,
13125 SW Flan Blvd„ Tigatt1. OR 97223 ' ' '" :
p lan iz
1 phone: 503.639.4171 Fax: 503.59S.1960 Dte.By Other Vaunt:
_
' tti"". Inspection hill:: 503.639.4175 CITY OF TIGARD Dm, Ready'lly Kim: 0 SCI• Page 2 for
1 12tF i ta 11)1(1111er www.t4 i..i rd.orgov
BUILDING DIVISION Nmi ''' N1..`": 1 Supplemental Information
1
..-
. TYPC, ()T W()ItIC • • . : . PLAN REVIEW • .
, • • .. ..• • • • • • .
,_____
cheek t! bd—
D New construction P:Ise a that thyty (salami 2 so.s orplalIN w.iloms clrucked :
D. Aiiilitiott/a Iteratiiintreplacentent k
0 service or feeder 400 amps or nave 0 Building over three stories.
Li Denmition i iOther: whe :. the available litult current 0 Manilas anti boatylids,
.• • • • ... • •.... ... . • CA TE.O()RY OF t:orisTRucrioN „,,,,,,,,is 10,000 „,,,,,,, :II i SO VAN or 0 Homan: littitdin
. i to gloiloti. or exceeds I 4,000 fil commereialmse ark:Miami'
0 1- itnd 2-family dwelling X(:oinntereial/inclustrial E Accessory building amp: tin. im othur installatiotts. lutildioes.
CI multi-6.1,4 (1 Master builder 0 Other: 0 Fire pomp 0 himanition 0 1 . 75 KVA or
0 Emergency system. larger svparaMy ilia ;vial syaleal.
:...•:'I • • ' : . ' • • JOR SITE INFORMATION AN!) LOCATION .. 0 Atittititto a III:W 1001 1d of 11111;i
. .. - 1 _. 100I1P or more. iie.mpati,y.
Job no.; ( ( Job site address: j ( on .f..c:, :R..., (2; ..c 1
.,. .. 0 '4,_
- / - Six or mor.; ivsicloillal iiiiii,, 0 Recreational vehicle parks,
.,...--- ,/-''';', 0 11calth-etue facilines. 0 Supply voll,Tc till. mote illair
City/State/ZIP: ) i (. ( 1 (,,..,, 1-`'\ 7 - 7 e;i cR L i 0 Ilaziatious !ovations. blin vults nominal
,
Suitefbldg./apt. no.: • 1 Pmject name!' Ar \. f\ % L 75,:.,..2.- os or rued.' MO:11HO 01 Mole.
FEE S(IEDULE
Cross street/directions 10 job site: Dorrt!tivit ' ' ' 1 (Z. L
. , . ,,„„„,„ „
New residential single- or multi-family dwelling unit.
Includes attached garage. ,
1,000 sq. 11. or less 145.15 4
Subdivision:
Lot no.;
r.a. adit'l 500 sq. 11. or portion 33.40 1
Ttlx inap/poreel no.:
Limi A
ted eneigy, redential
' - • ' 75.00 2
• DESCRIPTION ()IV W()RK • • (with above sq. 11.)
•
I mulled enemy, multi -Iiiiiiily
75.00 't
... 6 , ,1, ,(€ "i Nal . A k / 1(5' residential (with ohow sq. 11 )
. — -- --.
Services or feederAtsta__it
s I II I I
too, a.I tcratoo • rctocatim
200 2) I s les 83
_ :nap or s 0.0 2
....__— „ .. ....._.„„......................____.
0 PR()PERTV ()WNFR I . 0 TENAN'T ,1___ ____ ..... ................. ..... .... .... .... .. .... ,. .. , ........_... ..... ... ...... ...
( amps (00(1 atolls 106.8 „ ,. • 5 2
, ........,...... .........
• • ... ,
401 tinvis to 600 amps 160.60 2
Name: . ... ... .
..„...„. 601 amps to 1,000 amps 240.60 2
Addrexs: Over !Mu() amps or volts 454.65 7
/State/7,1 Tm
eporary ser o
vices r fecciers insialliation, :Men thin. midi (,,
City l':
__
relocation
, . .. , ................... ...... ....... ..... ...........__ ..... .________ _____............................................................. ..., .....,„.. ,
) 200 amps or fess 66.85 1
s as
Owner installation: This insuilltition is being inade 1)11 in•t>perty that I own which is not 201 amp to 400 mp 100.30 2 --
intended lin• sale, lease, t•ent, or exchange, according to ORS 447, 440, 670, ;Ind 701, 401 amps to 599 atolls 133.75 2.
Bondi circnits - new, alteration, or extension. J2er Line'
Owner signature:
----.. -..=-•::.:,=:-.....,:;::::::,,,...:::;::::,-;:::::,',.„,,.:::,..,;.:.,...,==,.. Pee Rir branch eimuits with
. . . " ,0 APPLICANT , 1 0 C<)NTACT PEItSON above service or re,•der tee,
( ,65
each branch cileitit
Business nante Ail pi) ,‘ ( La17 i_ (..:( at: C...tt- 2 CP.d-S 13. Fee for branch circuits
without service or 1 fee.
1 ta
(no id name: ,3 z Z C 3 7.5,,,s,.1 ' Di 1/ 1 rit,_ (IN, bE„ct, cii.,,, it 40.1i5 ,)
Addi \ j e., ,,.,...\. i , . .. 1
C.11 ci:7_0 1.oP) 1.,:achad(1.1b..,,i, circuit 6.65
Miscellaneou r s (service o feeder not inclu(ed)
..---- / I
4 ,
, St. L.. R , 6_,. / / /.) i) ticl._ 9/0 Each inattiOettired or modular
90.90 2
dwelliq, service tintlior feeder
Phone: (9),; ) 63 -'._.,. c j a.)c) I Fax: ; Q ) ((, (.7
J , .." ' - Reconnect only 06.115
1::.-Inail: „ . 6tk:,' /1 a -d, c „„., ,<-.._ p,.,,,,, or irrigation circle 51,40
- _.._. .
____._-_.
CONTRACTOR : •:. .: . . . 51140 01 outline lighting 53.40 2
. „ . „ ........................ ..... ...................................
C-_-' ,. Simla! eireuit(s) or limited-
i3oSineti:: niliel ' DA' i )'' ) II A.136 V i-:- energy panel, alleraliOn. Of
0
xension, 04:scage 2 73 2 . „.._.
Address: et ribe P
i
__ ..... .......... ...... ............. ..... .........._............................................ .. , , ,.,. .„,„ .., ..... ............ . ..... _ ________
C:ity/State/ZIP; Each tithlitional inspection over idiom' ble hi any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour ( I la min) 62,50
........................ ..... _________ . ________ ........ ,..., .
0-16/ efli Lie.: lo '1 5 c. I LIcctrical Lie.: 3 _4, ( q...;,,prv.I.,i,....: ; /, 7611 ,:4 lnausnial Plant Por In)" 73.75 L _
... ... , . .. ELECTRICAL, PERNIIT FEES ,.
Suprv. idectrician signature, required: s 7 „__,, total! ...
. ....______ ....... .____________...........
: . .n7 '
/{ ' .
,...- ..!. I .. /--- 7/ ') /
, ,,,t ..., ji ,. /. 1 1172 / / (2) Plan review (25% of permit Ice):
Print 11■IMC
,..„„.. - -
sl: ',till:hu ( I 2`11, or permit Fee): ,, ,.. ci ... ............... •
Authorifed signature; / /
/1i . '..
TOTAL PERmiT r0.0.: LI
... „ . ,
, , ,,,,, permit application expires If H pC1111it k mg oblainoll within 1141)
Print name: 72:: , . R - jv , ni .-,/ j . 6 ,,,/ I 1)itie: .2kizb‘) II WI aftcr It has ticcii ticceptcli as completc.
'' Nanilicr a iopediuns :Illowc(1 pei permit.
1 roillils'aetemiltArgitur 0.5 2 1 (I. .14o..a.ts l'( 11 1)5'01!11.1V1:1S
04/16/2010 FRI 11:01 FAX 503 638 9100 Allphin Communications ?001/001
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
:R
RESIDENTIAL WORD ONLY: .. . ?i
Fee for all residential systems combined $75.00
1.
Check Type of Work Involved:
Audio and Stereo Systems'' t l
30 \( :.
n Burglar Alarm
/ - 7 - \ '
_ - Garage Door Opener* � - \ J V
❑ Heating, Ventilation and Air Conditioning System=" '\', � �_ l;. V
V
- Vacuum Systems"' \ '\J
_ J
Other: : :,)
COMMERCIAL WORK ONLY:
Fee
or cich commercial $75.00
system
. (SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
D B oiler Controls
Li clock Systems
Data Telecommunication Installation
n Fire Alarm Installation
. . i HVAC
❑ instru 1 t ntatioa
U Intercom and Paging Systems
[1 L andscape Irrigation Control:
❑ Medical
Nurse Calls
n Outdoor Landscape Lighting ""
P rotective Signaling
- Other
Total number of commercial systems:
"No licenses are required. Licenses are required
for all other installations
I •I4uildin YrimiuhL(•d4,imilApp.duc 0:k 46