Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
R 1 3 < COMMUNITY DEVELOPMENT Permit #: ELR2011 -00200
T1GAR 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/25/2011
Parcel: 25101 DCO3900
Jurisdiction: Tigard
Site address: 7150 SW SANDBURG ST
Project: Progressive Insurance Subdivision: Lot:
Project Description: Data telecommunications system.
Contractor: PROGRESSIVE TELEPHONE SYSTEMS & COMMUNI Owner: PROGRESSIVE CASUALTY
PO BOX 190 INSURANCE COMPANY
GRESHAM, OR 97030 REAL ESTATE NOTIFICATIONS
CLEVELAND, OH 44101
PHONE: 503 - 665 -4900 PHONE:
FAX: 503 - 665 -4830
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/25/2011 $75.00
12% State Surcharge - Electrical 08/25/2011 $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 OAR 952- 001 -0090. Y,nu- may- obta'. - o• of th> ules or • ect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i�� �� -� - �rL� Permittee Signature:
1
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.
From: �,. % � 08/25/2011 09:44 #118 P.002/003
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Electrical Permit Applicat>< 11.%\ Q
�, roll OFFIC C usr ONLY.
City of Tigard 4�� °�e� 't011r Permit No
I
:5 Date /B: e a G .-- ....2 /./ _
• 13125 SW Hall Blvd., Tigard, OR 97223 c'p Plan Review
2 Phone: 503.718.2439 Fax: 503.598.1960 r\ NN .k� Date /B : Other Permit:
TI GA R D Inspection Line: 503.639.4175 \� Date Ready /By: See Page 2 for
Internet: www.tigard or.gov 9) 9 � Notified/Method: Supplemental Information
n,-,, , `� ,*1. RA y y Ufa * .T 3''� - T - ` r i } 2i+ .,. , '',„s '" a-v ,,,, . ..,,- :' f :
n ; . "_. --x�;,e '' 'i 3 lK q,,, ,,s,t „a, - .� v'' ... l 4 14, s . ; s ti,1 e a
.. ... - .. - sue. ,ua•���. r + - : . .�- y „ya��. ,......^.W sue.' 4514 � ' a an.., : �A;j
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction /: . Addition /alteration /replacement
0 Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑Marinas and boatyards.
f � w+,� � ��� �� � �����
a ssv r�.' v�w.r +ara �s^Ya s n v s
�j� cr �Q V t . ¢,,, �r exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
"s;�sa F : *x ,s'","2. �„ ". 3' f u `.„_�.- ` �,,1w4 -' r��.Sle sK 6- - less to ground, or exceeds 14000 g .
gro . ❑ Commercial - use agricultural
E1 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 KVAor
jl , a, 1 t 1 _ - s x r x a r ,. -vim p 1,2 .,y o ❑ Emergency system. larger separately derived system.
.pus.- z1_,..b,+�u�a�r_nM.WP,. -rn ,..r4u? ��,1 ❑ Addition of new motor load of ❑• "fi•• ••1_2 .. 1.3 „
Job no.: L pt(, Job site address: r i 10 or more occupancy.
I T'C.: L: •J "t 1.3'c `_�(,,_ _)(. 1.t;.A,L t 1�. c�.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: LL- t/EEl I d ❑ Healt -care f ac ilities. 0 voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. n0.: I P roject name: , ❑ Service or feeder 600 amps or more azig
Cross street/directions to job site: ` Description �- < -:,r' ` #>Q.? w -y' °, � }r*„
Descri
J ption 1 Qty. 1 Fee. 1 Total
New residential single- or multi - fancily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R, or less 168.54 4
Tax map /parcel no Ea. add'l 500 sq. ft or portion 33.92 i
� i x3 Limited energy, residential
t ;s r r ., l ,., r:` . 4 4 ,4 S ._ a l:f- , , tZWiA�1 ti1XER 4 ; . y '" .. �:uA' t rte`P : a , : . .` (with abov sq. ft.) 75.00 2
{(c
, i m i ted energy, multi-family
y
( lit
: j Lx.0 c%j b -t' -) :i.. (( c? ^- C- n C1 ~'t r 75.00 2
�. - [ ° ( C P �/ " ` J C,• L CC. ru/ 'J residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
' .. { k • .ikOr .i.#f W ,,, .,, ls',sr+ #14 ',> 1 a'a',� rt sK 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
� ( C'C t t <' x.;11/ i. N q b t'� 601 amps to 1,000 amps 301.04 2
ti
Address: 7 / () c (,Q� `T %,, � - j I Over 1,000 amps or volts 552.26 2
City /State /ZIP:. y ` Temporary services or feeders installation, alteration, and /or
L_o&rr. , S t 4 ,, " 2 . relocation
` t 200 amps or less 59.36 1
Phone: (°x `7C , 4.'1` �3 Fax: ( ) L� {1 161-0)0 .')
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
�� s � � , , pw t o,,r ,, l , F -r f : above service or feeder fee,
--i�, >4;i ;;;O'�`? a.r a ..} .<.4�, x.1:AV O -x.. .:, -- , a?.r;r; VI 7.42 2
each branch circuit
Business name: f-c)�1l 1i_.- (-.t „ .-r 1 ),C.0 .`i;(. <tc.- 7at.,,c- -- B. Fee for branch circuits without
1 service or feeder fee, first
Contact name: rtl,`t { 4
/� ( ft 'i. 1 - r ; i = branch circuit 56.18 2
( �Ci G ' > Each add'► branch circuit 7.42 2
Address: ,_ - A L,. 1 V i (j 6 ..i (X .4(. E , yr' Miscellaneous (service or feeder not included)
t Each manufactured or modular
City/State /ZIP: (... � c ) L 3 ( • 4 — 67.84 2
4 -E- �L - -� f 't ( ��' { "� dwelling, service and/or feeder
Phone: (!'30 i )[ (t, L. (,i 62,,,; Fax:: (`3L! 3) L� 6', , z/ g 3 6 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
t
E-mail: 1k L L ' (~u. , Tl (. k) 7
i �).. -,: -3 `��t � >t r� /r s' ,✓. ,.�¢ �w�. -ten". f >r .r ry, ,� Sign or outline lighting 67.84 2
{3,..?„ ..�.-,.?G s ” f. V t-r to !Tim' `o - 4`� " ;"' -� ri. , F t x Signal circuit(s) or limited -energy
;
Business name. -IT l' (.- ,lr, 5� a 1L1�C. c. , c r. % L t �, . /.yL ,; panel, alteration, or extension. 1 Page 2 (• e 2
F / Each additional inspection over allowable in any of the above
Address: - 1 V -�rC 2`� ';C� eL } C i.= . ) 1• , - s- ' - Additional inspection (1 hr min) 1 I 66:25/ hr
City/State/ZIP: 1 Investigation (1 hr min) 66.25/ hr
�_.. i - t L....� yet_ E - k_.
: CO t C.
Industrial plait (1 hr min) 78.18/ hr
Phone: E - ac'. S L_C." C, L. Fax: (`..'-.X(`..'-.X.:' Lt L
-' 3) {. J C r r 4E- 1 . Inspections for which no fee is 90.00 / hr
{ specifically listed (h hr min)
CCB Lic.: t1,5 C ( �' Electrical Lic.:. • 11 ( :j C
Suprv. Lic.: C-1 6.:t6`745 645 - a k x
db r} /� 7 / / / /il fah ifs Subtotal ��- c-t?
Suprv. Electri an t gnature, required(..] , / , f 7
j 1) tiL. I r, .L Plan review (25% of permit fee):
n J
Print name :' f I i! /.� `a �') 2 D to i +' State surcharge 12 °/a of permit fee ? 'p
f TOTAL PERMIT FEE: � .-{ / )
Authorized signature: /7 `° ` / / , � i �7... —
/. v ( f L.- r J /� C t / �, yL / This permit application expires if a permit is not obtained within 180
/ / days after it has been accepted as complete.
Print name: • i; -i /(;i) :2t_ ate: / D . ") �-& ( , 1 p f. L. ,/' f Z * Number of inspections allowed per permit
I:\ Building \PerraiWELC- PcrmilApp.doe 07/01/10 440- 4615T(11 JOS /COM/WEB
From: 08/25/2011 09:46 #118 P.003/003
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
NKVIIUNMKWMDCWVSISMSIICNIRIISIA
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
oimogr t, w ml Wi t. s ,.. r:
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
NI Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
U Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:- Building \Permits \ELC- PcrmitApp.doc 07'01'10