Permit CITY OF TIGARD • ELECTRICAL RESTRICTED ENERGY PERMIT
.
11 • COMMUNITY DEVELOPMENT Permit#: ELR2010 -00200
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/28/2010
Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Subdivision: FARMERS INSURANCE Lot: 0
Project: Triangle Pointe
Project Description: Data telecommunications system.
Owner: FEES
TRIANGLE POINTE LLC Description Date Amount
901 NE GLISAN ST #100 Restricted Energy Permit 09/28/2010 $75.00
PORTLAND, OR 97232 12% State Surcharge - Electrical 09/28/2010 $9.00
PHONE:
Contractor:
COCHRAN INC
7550 SW TECH CENTER DR. #220
TIGARD, OR 97223
PHONE: 503 - 234 -6564
FAX: 503 - 238 -2098
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 Total $84.00
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 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 ted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OA - 001 -0100. - . .y o• -in : +• erect questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
•
Issued By- Permittee Signature: _
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 RECEIVED _
City of Tigard Received
Tigard DateIRy: q to 1 .377" Permit No.: - ' 1. , Q ? io- 0 : 0 . 4 1 - 0
n 13125 SW Hall Blvd., Tigard, OR 97223 C O 4 n flan Review
EP Phone: 503.639.4171 Fax: 503.598.1960) t 1 2 [ t t 0 Date /1ty: Other Permit: 2 I ,pA fn _ cr ki c '
T I G A R D Inspection Line: 503.639.4175 Date Ready /By: luris: (,J 65 See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified /Method: Ly (9 Supplemental Information
TYPE OF WIPING DIVISION PLAN REVIEW
❑ New construction 'ddition /alteration /replacement Please check all that apply (submit 2 sets of plans wtitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition El 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 14.00(1 ❑ Commercial -use agricultural
❑ 1- and 2- funily dwelling .(omntercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - fancily ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system
['Addition anew motor load of ❑ "A" "L "' "I -2" 1 _ ;^
Job no.: ( 1 Job site address:13333 ,5't „ 10(I or or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /Stale /ZIP: T - � 02 9 7 ] 2 _3 O fieahh -care facilities. ❑Supply voltage for more than
J ` \ 000 Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: A ' c ( TJ%ansittZ I h � ❑ Service or feeder 60(1 amps or more.
-
tt1 FEE SCHEDULE
Cross street /directions to job site: Description 1 Q. 1 Fe r. 1 °,ai I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ti. or less 168.54 4
Ea. add•; 500 sq. 0. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy,
U rfv� 1 `� ( (with above sq . 75.00 2
V \ C.P� CLv,U \v�ll�y� residential (with abve sq 0.)
4 Services or feeders installation, alteration, and /or relocation
200 amps or Tess 100.70 1 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
City /State /ZIP:
Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ItKONTACT PERSON above service or feeder tee, 7 4� 2
each branch circuit
Business name: 70-Me. Ck.,S C 1.1(\ a v ` 13. Fee for branch circuits without
service or feeder fee, first
Contact name: ) c\e -4-: branch circuit 56.18 2
Each add'l branch circuit I I 7.42 I 12
Address: g.LM Q., as eon Ck Miscellaneous (service or feeder not included)
Each manufactured or ;nodular
City /Stale /ZIP: dwelling, service and /or feeder 67.84 2
- V O ^ Reconnect only 67.84 2
Phone: (5'03)401 - 9 � Fax: : (r 2.3v f e.(J
E -mail: saato.i� t te (IC �.� (', (\ \ f L r (1 � Pump or irrigation circle 67.84 2
Q �`�r,,,N Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy _
Business name: ` panel, alteration, or extension. 1 Page 2 '75 2
n Each additional inspection over allowable in any of the above
_ /
Address: ' 5 50 5W 1 1- `� C e_(� r # D Additional inspection (1 hr min) 66.25/ hr
(� Z Investigation (1 hr min) 66.25/ hr
City /State /ZIP: ( t6 C (•• rd " 72 J Industrial plant (1 hr min) 78.18 / hr
.34
Phone: 603) 1- 6,5 69 / Fax: (),..3 ) 23 2_0 °/ O d Inspections for which no fee is
90.00 / hr
specifically listed (%: hr min)
CCB Lic.: '1 2el( fZ Electrical Lic.: C Suprv. Lic.: $ ELECTRICAL PERMIT FEES
r `� t
Suprv. Electrician signature, required: y 1,
Plan review (25% of permit Suhlo feeal): :. 95-
Print name: KP r n,,.._; 1 v ` K Date: State surcharge (I 2% of penult fee): q
TOTAL PERMIT FEE: O y
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
I:•nuildin5 its ETC- Pei nitApp.doc 07'01'10 440- 4615T(11'05 CONI•WEn
/// /o Reprf pe iFi Ce--11( (�-) /W C/ `S
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 00200
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/28/2010
Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Project: Triangle Pointe Subdivision: FARMERS INSURANCE Lot: 0
Project Description: Data telecommunications system. 11/09/10 added (2) inspections. BT.
Contractor: COCHRAN INC Owner: TRIANGLE POINTE LLC
7550 SW TECH CENTER DR. #220 901 NE GLISAN ST #100
TIGARD, OR 97223 PORTLAND, OR 97232
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/28/2010 $75.00
12% State Surcharge - Electrical 09/28/2010 $9.00
Type of Use: COM Additional Inspection 11/09/2010 $132.50
Class of Work: ALT 12% State Surcharge - Electrical 11/09/2010 $15.90
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 $232.40
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 thro R 952- 001 -0090. You m- • • - • • - i questions to OUNC by calling 503.232.1987 or 1.8.0.332.2344.
Issued _ _ Permittee Signature: — Al• '=
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.
Electrical Permit Application ��w rou owlet: usi.: o:»,i.Y
14 q City of Tigard f 1 q G �p� Permit No.:
13125 SW Hall B Tigard, OR Ivd. Ti 9 � , 0 Date By. I' 1 / O 0 1 1 EL��(0 — UV X/0
Plan Review
C Phone: 503.639.4171 Fax: 503.590 V 0 Date /B : Other Permit:
I' I ii A It D Inspection Line: 503.6394175 \' \GPS \% ° 'sate Ready /By: luris: ® See Page 2 for
Internet: www.tigard- or.gov r` O r O \V�
, YPE
Notified/Method: 776 Supplemental Information
OF WORK V ,PLAN REVIEW
❑ New construction dition /alteration4
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.
Jot �/ � \ 77�� El Addition of new motor Toad of ❑ "A" "E" "I - 2" "1 - 3"
�4l�r1V Job site address: 133'2) 1 31.- , 100H more ore. occupancy.
y l ( c D _ G� � ""�„ ❑ Six or mo residential units. ❑ S u ppl ytio lta vef parks.
than
/State/ZI P: ❑ Health -care faa s. ❑uply voltage for more an
�,/' }' ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: I tl.�i 1 "�� V �/(`) Service or feeder 600 amps or more.
va` FEE SCHEDULE
Cross street/directions to job site: n" � go 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 Tess 168.54 4
Ea. add'I 500 sq. 11. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRI ION F WORK (with above sq. ft.)
(V)
rnI G
� — Limited energy, multi-family a
75.00 2
residential (with above ve ft.)
Services or feeders installation, alteration, and/or relocation
7
e,i1, 200 amps or less 100.70 2
❑ PROPERTY OWNER v I ❑ 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 /StatelZl P: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. -
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: J0, c`,S C 'Cr — - '(' &. B. Fee for branch circuits without
c service or feeder fee, first
Contact name: 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: ( ) Fax: : ( ) 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: h can � panel, alteration, or extension. Page 2 2
_ Each additional inspection over allowable in any of the abov'
Address: — 5 50 Skit (e�h C e_n r X36 # 22 0 Additional inspection (1 hr min) 66.25/ hr ('�
— Q n C 7 � Z Investigation (I hr min) 66.25/ hr
�
City /State/ZIP: l 6�l �Gl " Industrial plant (1 hr min) 78.18/ hr
Phone: 5 03 ) Z3q-- /p5-6 q Fax: ( ) 23g - 2_09.8" Inspections for which no fee is 90.00 / hr
specifically listed (%r hr min)
CCB Lic.: ', 2. $42 Electrical Lic.: 3? 5L6 C Suprv. Lic.: 344751 ELECTRICAL PERMIT FEES
r1/5-1- I CI) Suprv. Electrician signature, required: \ 1 �
Plan review (25% of permit fee): l: •
Print name: \<H - N \ ` k Date: State surcharge (12% of permit fee): t !-'-- 1 0
TOTAL PERMIT FEE: 111 V V. It 0
Authorized signature: This permit application expires if a permit is not obtained within 180
Print Warne: Date: days after it has been accepted as complete.
Number of inspections allowed per pennit.
Ii Building •Permits'ELC- PermitApp.doc 07 440 -46 I$T(11'05,COM.,WEB