Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
r. - g , °< COMMUNITY DEVELOPMENT Permit #: ELR2010 -00264
16G'. RLA 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Date Issued: 12/02/2010
•1
Parcel: 2S101DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY, STE# 220
Project: ACS Subdivision: FARMERS INSURANCE Lot: 0
Project Description: Low voltage for data and security.
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 12/02/2010 $150.00
12% State Surcharge - Electrical 12/02/2010 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
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: Y Other: N Total $168.00
Other Desc: Required Items and Reports (Conditions)
This permit is issu-d 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 ' accordance wi approved plans. This permit will expire if work is not started within 180 days of issua or if work is suspended for more the 180
• day ATTENTION: Oregon es you to follow the rules adopted by the Oregpp_Utility-o a ion Center. Those rules are set forth in OAR
(uedBy:ks -001 -0010 through OAR • - 1 • -090. You may obtain a copy of the rules or direct questions to OUNC by calling .3.232.1 • i or 1.800.332. - 44. ,--.
I /� C�C'.(/.l D P e -n ittee Signature: i � . i�
OWNER INSTALLATION ON
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' ✓ U / /y, .� 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 FO OFFIC USE ONLY - ` ' '
City Of Tigard ECE
1104 P 503.718.2439 Fax: 503.598.1960 D EC Date/By: Received AZ a2
ermit No.: / D e kk�f0/
13125 SW W Hall Blv Tigard, OR 972 3 Y ~ ° '? �
Plan Review
„ -. 'Z010 Date /By: Other Permit: 1ut O_D.25 Z .
' Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
TIGARD
I Internet: www.ti and or ov Notified Method:
' ''
g g Supplemental Information
� " TYPE.f OF w ' � rrITY QFT • ,. ° I [lll DIVISt > 4 VW
; E . , „ ,... �= ;, � . PLAN RE
,
❑ 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.
` CAT G ORY -OF CONSTRUCTION , : ,r 0000 amps at 150 volts o
exceeds , or ❑ Floating buildings.
1
less to ground, or exceeds 14,000
gr ❑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 derived system.
. JOB SITE °INFORMATION' LOCATION
' ❑ Addition of new motor load of ❑ "A ", "E ", "I -2", "I -3 ",
100HP or more" occupancy.
Job a-1310 Job�t TTT��� ■ r } t ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ ZIP: I �/� n u "' 1ll llY 111 val. ❑ Health -care facilities. ❑ Supply voltage for more than
` I ' " 01 " `�� ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
. FEE SCHEDULE
Cross street /directions to job site: Description
p � Qty. 1 Fee. 1 Total 1"
New residential single- or multi- family dwelling unit.
I Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
111 Ea. add' 1 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
� =_ DESCRIPTIONt OFNWORK ". (with above sq. ft.)
/ � Limited energy, multi- family
( / t C L 1 +L4 residential (with above sq. ft) 75.00 2
t Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER 1 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 /State /ZIP: relocation
Phone: ( ) I 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 ❑'.CONTACT PERSON feeder 7.42 2
above service or fee,
each branch circuit
Business nom 0/ /n(� I _ �� ■ J B. Fee for branch circuits without
tl�l service or feeder fee, first 56.18 2
Contact name: I Vr Y/l V/ branch circuit
111/ ` J+ Each add'1 branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: 67.84 2
dwelling service and/or feeder
Phone: VU 4 ,C/ B�`) I Fax: I )) p.�-'„ /1,�,.(„ Reconnect only 67.84 2
tt ��`` �� ��JJ� --vv vv uu// Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
.. , - 5C ONTR A CT,OR : _ Signal circuit(s) or limited - energy •
Business name: os /r �-( �/� panel, alteration, or extension. Page 2 2
�J , I `X tM PVC Each additional inspection over allowable in any of the above
Address: — 1i3 0 SU) j G C A (\ -
ty (V0, o p t1 ci r x ll//�� Additional inspection (1 hr min) 66.25/ hi
(1 hr min) 66.25/ hr
City/State/ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (' /z hr min) 90.00 / hr
CCB Lic.T1 2 Electrical Lie ., (�-
�' L Suprv. Lic.:3�� � �ELECTRICAL.:PGRNIIT`;FCES_,: ' . °'
Subtotal /, h,,
Suprv. Electrician signature, required: l �k t 50, v✓
. Plan review (25% of permit tee):
Print name: y_,,L,A.n e Date: \"41 t--., State surcharge (12% of permit fee):
TOTAL PERMIT FEE: lt 0 0
Authorized Signature. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print Hanle: Date: * Number of inspections allowed per permit.
1; \ Building wermits\ELC- PermitApp.doc 07/01/10 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: , =U ' .
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
r i Garage Door Opener*
❑ Heating, Ventilation and Aix 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
❑ hire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
TO Other IIALL)
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: U3uildingPermits \ELC- PermitApp.doc 07/01/10