Permit v1 � ' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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, ° 1 COMMUNITY DEVELOPMENT Permit #: ELR2010 -00080
4;r Date Issued: 05/11/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
c ;,, r ,.; Parcel: 2S101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 500
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: University of Phoenix
Project Description: Low voltage for fire alarm.
FEES
Owner:
GK TRIANGLE CORPORATE PARK III L Description Date Amount
BB# 73- 1771- GK1130, CBRE, PO BOX 2096 Restricted Energy Permit 05/11/2010 $67.84
WARREN, MI 48090 12% State Surcharge - Electrical 05/11/2010 $8.14
PHONE:
Contractor:
SAFE TECHNOLOGY GROUP INC
6400 NE HWY 99 SUITE 375
VANCOUVER, WA 98665
PHONE: 360- 699 -2130
FAX: 360- 719 -1527
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: N Fire Alarm: Y
HVAC: N Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
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 ordance 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. A ENTION: Oregon -w r- • uires 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 -0 -0110. Yo ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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P ermittee Signa ture: k�r� --
Issue By:
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.
Electrical Permit Application r � FoR o 1 1c1 U . S o r
`F4 ,, i ? c J 1 • C it y of Tigard Received C �/ �
f _ . t , Date's • J � Permit No.: f(�aOIO two ��
>= a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
;' ' ® Phone: 503.639.4171 Fax: 503.598.1960 Date/B .
Other Permit: /G/23A0/29 -D��.�
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(T IGA i Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
...,si - . Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 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 ❑ 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 2 ", "I - ",
Job no.: 1097 Job site address: 13221 SW 68 Parkway 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks
City/State /ZIP: Tigard OR ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.:6'570 Project name: University of Phoenix ❑ Service or feeder 600 amps or more.
FEE SCHEDULE -
Cross street/directions to job site: Description 1 Qty. 1 Fee. .1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft or portion 33.92 1
Tax map /parcel no.: Limited energy, -
gy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
Fire alarm residential (with above sq. ft.) 67.84 2
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 I25.08 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 ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: Safe Technology Group Inc. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Jason Sweet branch circuit
Each add'l branch circuit 7.42 2
Address: 6400 NE Hwy 99 Suite G375 Miscellaneous (service or feeder not included)
City/State/ZIP: Vancouver WA 98665 Each manufactured or modular
Ci
ty dwelling, service and/or feeder 67.84 2
Phone: (360) 699 - 2130 Fax: : (360) 719 - 1527 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: sales @safetechnology.net Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Safe Technology Group Inc. panel, alteration, or extension. 1 Page 2 67.84 2
Each additional inspection over allowable in any of the above
Address: 6400 NE Hwy 99 Suite G375 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Vancouver WA 98665 Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (360) 699 - 2130 Fax: (360) 719 - 1527 Inspections for which no fee is 90.00 / hr
specifically listed (/2 hr min)
CCB Lic.: 173731 Electrical Lic.: CLE79 Suprv. Lic.: 4272LEA ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ✓� A o Subtotal:
P lan review (25 /o of permit fee):
Print name: Jason Sweet Date: 5 -6 -10 State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
Authorized signature: I7� ,, T his permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Jason Sweet Date: 5 - - * Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(tl /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
Audio and Stereo Systems*
❑ Burglar Alarm
Garage Door Opener*
Heating, Ventilation and Air Conditioning System*
• Vacuum Systems*
❑ Other:
I .COMMERCIAL- WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
• Clock Systems
O Data Telecommunication Installation
O Fire Alarm Installation
▪ HVAC
0 Instrumentation
• Intercom and Paging Systems
O Landscape Irrigation Control*
❑ Medical
n Nurse Calls
• Outdoor Landscape Lighting*
0 Protective Signaling
▪ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits'ELC- PermitApp.doc 10 /01 /09