Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° - COMMUNITY DEVELOPMENT Permit #: ELR2011 -00053
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/08/2011
Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15887 SW 72ND AVE
Project: Knouf Investments Subdivision: OREGON BUSINESS PARK III Lot: 40
Project Description: Data telecommunications system.
Contractor: FRAHLER ELECTRIC CO Owner: PACIFIC REALTY ASSOCIATES
11860 SW GREENBURG RD 15350 SW SEQUOIA PKWY #300
TIGARD, OR 97223 PORTLAND, OR 97224
PHONE: 503 - 639 -4627 PHONE: 503 - 624 -6300
FAX: 503 - 639 -4673
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/08/2011 $75.00
12% State Surcharge - Electrical 03/08/2011 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N 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 OA - 001 -0090. You may obtain a copy of the yestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: '1�t ermittee Signature: -i ��r�L.�
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 FOR OFFICE ISE OyLI
City of Tigard Received
_ �� Date /B : �A Permit No.. A* l�00c5
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review l
Phone: 503.718.2439 Fax: 503.5%1 9 Q��� 6 Date /B : Other ,` v -
Inspection Line: 503.639.4175 V
TIGARD
Date Ready /By: . ® See Page 2 for
Internet: www.tigard - or.gov g Notified/Method: Supplemental Informahon
.. TYPE OF WORK;t. � Ge , `3' PLAN REVIEW
Itae tO. Please check all that apply (submit 2 sets of plans w /items checked below):
El New construction Et Addition /alteration /re
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑Other: O
■\ where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONST)1ON exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
I - and 2- family dwelling [3 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder
❑ Other: 0 Fire pump. 0 Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ ` A ", "E ", "1 -Y', "1 -3 ",
Job no.: 68294 Job site address: 15887 SW 72nd AVENUE 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: PORTLAND, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
i ❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: I Project name: KNOUF INVESTMENTS ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Fee. 1 Total I *
New residential single- or multi - family dwelling unit.
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 1
. Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family
DATA CABLING residential (with above sq. ft.) 75.00 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
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
—
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 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: B. Fee for branch circuits without
- service or feeder fee, first 56.18 2
Contact name: branch Circuit
- Each add') branch circuit 7.42 I
Address: Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: [ ELECTRIC COMPANY panel, alteration, or extension. 1 Page 2 75 2
Each additional inspection over allowable in any of the above
Address: 11860 SW GREENBURG ROAD Additional inspection (1 hr min) ' 66.25/ hr '
City /State /ZIP: TIGARD, OR 97223 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503 ) 639 -4627 Fax: ( 503) 639 -4673 Inspections for which no fee is
specifically listed (/2 hr min) 90.00 / hr
CCB Lic.: 37410 Electrical Lic.: 34 -13C I Suprv. Lic.: 1816S
/ � / ELECTRICAL PERMIT FEES
Suprv. Electrician signature, r ed: / , / Subtotal 75.00 •
7 / — ' Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): 9.00
Authorized signature: TOTAL PERMIT FEE: 84.00
This permit application expires if a permit is not obtained within 180
Print name: days after it has been accepted as complete.
Date: * Number of inspections allowed per permit.
1:\ Building \ Permits \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:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air 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
g Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
1: \ Building \Permits\ELC- PermitApp.doc 07/07/10