Permit � ! CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' : COMMUNIT DEVELOPMENT Permit #: ELR201 1 -001 1 9
T.IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/25/2011
Parcel: 25101 DB01000
Jurisdiction: Tigard
Site address: 7080 SW FIR LP 200
Project: Tetra Tech Cable Subdivision: 72ND BUSINESS CENTER Lot: 12
Project Description: data /telecommunication
Contractor: TELESPHERE Owner: SHROYER FARMS INC
449 SW ALDERWOOD PO BOX 789
WEST LINN, OR 97068 PHILOMATH, OR 97370
PHONE: 503 - 880 -9412 PHONE:
FAX: 503 - 638 -9286
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/25/2011 $75.00
12% State Surcharge - Electrical 05/25/2011 $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 0 1 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 .2 TJ 322.198 - 7 � or1.800.332.2344.
Issued By: Permittee Signature: �N 7 iG / 9-77 0/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 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.
Telesphere 503- 638 -9286 p.1
Electrical Permit Application ,.
of a nd �
City R eceived .,
`7 f Ti g ���� Permit No.:
q � y DaterB : 5 .`. /� �'� _ />Il L�e 2 ® /I OQ — l/
13125 SW Hall Blvd., Tigard, OR 97223
1 ra Phone: 503.718.2439 Fate 503.5 8.1 Igic t∎� Other Permit:
TI GA RI? Inspection Line: 503.639.4175 �4 Dale Ready /By: 0 See rage 2 for
Internet wsvw.iitrd or.gov V� • Notified/Method: r Supplemental. Information
� . - TY PE o W , . ' . '�. ` `: , ` s i , N, . . . -• • .. .. PLAN REVIEW .. --
❑ New construction ® Addition /altera Please check all that apply (submit 2 sets ofplans w/items checked below):
�' ❑ Service or feeder 400 amps or more Q Building over three stories
❑ Demolition El Other: l ,• �� where the available fault current ID Mannas and boatyards. l
exceeds 10,000 amps at 150 volts or ❑ Floating buildings. I
,• ' , . ; _ . , • .. • '.CATEGQRY: • OF. CQNS!•RUCT .. • P s g
less to ground, or cameds 14,000 Q Commereal -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations buildins-
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire Pump- ❑ Installation of 75 KVA m
JOB INFORMATION LOCATION. .. ❑ Emergency system. larger separately denvedSteem.
❑ Addition of new motor load of ❑"A' "E" "I -�" - 1 3
Job no.: Job site address: 7080 SW Fir Loop IOOHPormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than.
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: rd FlooM/Project name: Tetra Tech Cable ❑ Service or feeder 600 amps or more.
. F S C]'IEDLLF -
Cross street/directions to job site: 72 and For Loop near 217 Description I Qty. 1 res. I Tatal I • 1
New residential single or multi - family dwelling unit.
Includes attached garage.
I
Subdivision: Lot no.: 1,000 sq. it or less 168.54 1 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2 • `DESCIZIPTION. OF WORK' • .. (with above sq. fl.)
Limited energy, molli family
Low Voltage Electrical 75.00 2
residential (with above sq. X)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2 ,
. ❑ PROPERTY Ow:YER . .... l . ❑'TENANT , , . , 20I amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 snips 301.04 2
Address: Over 1,000 amps or volts 552.26 • 2
I
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) F ax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is bung 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 amp to 599 amp 168.54 2
Branch circuits - new, alteration, or extension, . • r panel
Owner signature: Date: .4 Fee for branch circuits with
... Q. APPLICANT . - - - . r : . . . . • . ; : . 0 CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Foe for branch circuits without
service or feeder fee, first
Contact name: branch circuit SG. 1 11 2
Address:
Each add'l branch circuit 7.42 I
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular I
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E: Pump or irrigation circle ' 67 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal eircuit(s) or limited energy
Business name: Telesphere panel, alteration, or extension.
Paget /5-,et/ 2
Each additional inspection over allowable in any of the abov
Address: 449 SW Alderwood 1)r , Additiowat 5tivtpectkan(1 hr min) , 66.25/ to '
City: /State/ZIP: West Linn, OR 97068 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 880 - 9412 Fax: (503) 638 - 9286 Inspections for which no fee is
9o In
I specificall v listed (Yr hr mitt) L_.__
CC3 Lie.: 149154 Ito E l ectrical Lie.: CLE 118 Su rv. Lie.: 455l LEB p , EL ECTRICAL PER&IIT FEES Suprv. Electrician si ature, required: 7I I I 1 ,10 Subtotal: 75.00
Plan review (25% of permit fee):
Print name. Michael Ciccotelli Dale: 5-24-11 State surcharge (12% of permit fee): 9.00
Authorized signature; .' _ ! TOTAL PERMIT FEE: 84.00
��-�C This perm ap plication expires if a permit is not obtained within 180
Print name: Frederic I. Ciccotelli Date: 5 -24-11 days after it has been accepted as complete.
*
Number of inspections allowed per permit,
l:l Buildatg \PcrmiLdELC- PennitApp.dcc 07/01/19 l.00 . i15T(11/05/C01111U/IlB
Telesphere 503- 638 -9286 p.2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESII3ETJIAL.WOtK.4}I"±1I Y: .
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
. COMMERCIAL WORKK.ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
I Clock Systems
® Data Telecommunication Installation
❑ Fire Alarm Installation
(�riAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
Outdoor Landscape Lighting*
❑ Protective Signaling
Other
Total number of commercial systems: , /
*No licenses are required. Licenses are required
for all other installations
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