Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00102
.TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 639 4171 Date Issued: 04/07/2009
Parcel: 2S 113 BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 200
Subdivision: Lot: 0
Project: Allstate Insurance
Project Description: Low voltage for data.
Owner: FEES
Description Date Amount
BEHRINGER HARVARD WESTERN
PORTFOLIO LP, BY EASLEY MCCALEB & Restricted Energy Permit 04/07/2009 $75.00
ASSOCIATES I, PO BOX 190700 12% State Surcharge - Restricted Energy 04/07/2009 $9 00
PHONE:
Contractor:
BRITTINGHAM ENTERPRISES INC
PO BOX 1978
SISTER, OR 97759
PHONE, 541 - 549 -1977
FAX 541 - 549 -6184
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
Audio & Stereo' Boiler Controls*
CCTV Clock Systems
Data & Telecommunications Y Fire Alarm
HVAC. Instrumentation Total $84 00
Intercom/Paging Landscape /Irrigation.
Landscape Lighting Medical. Required Items and Reports (Conditions)
Nurse Calls. Protective Signal
Security Alarm Other:
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 u z • • - 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 d- s ATTENTION Or -•on ac r�quir- you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-001-1110 thro gh OAR 952 -00 100 Y•u - obtain a copy of the rules or direct questions to OUNC by calling 503 246 6699 or 1 800 332.2344.
Issuedt: 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'N 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 Applicati i ,FOR OFFIC USE ONLY , E
CEI�IED �
III q City of Tigard Received Date /By. y 7 D 9 Permit No ,Q p_ 4
13125 SW Hall Blvd . Tigard, OR 9721JR 2 - 009 Plan Review
I
Phone 503 639 4171 Fax 503 598 196 Date /By Other Permit
T I GARD Inspection Line 503 639 4175 Date Ready /By 7ur � IN See Page 2 for
Internet. www tigard-or gov C ITY OF TIGARD Notified/Method / I 5.. Supplemental Information
T YPE o voD DIVISinN PLAN REVIEW
❑ 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
,. " " ` '"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
.. ❑ Emergency system larger separately derived system.
. - " ' JOB SITE • INFORMATION AND LOCATION? „' , ,' ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: '� y �� ±� �A' // /I� 100HP or more occupancy
�- 4� i= 1� - vTtit+ t� J ❑ S ix or more residential units ❑ Recreational vehicle parks
City/State /ZIP: \ . / L E 7 C 727:L; \ ❑ Health -care facilities ❑ Supply voltage for more than
-�r . i < —4 ID Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: L i s �- ❑ Service or feeder 600 amps or more
I �7 � �W . - . ; FEE SCHEDULE;
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft or less 145 15 4
Ea. add'I 500 sq ft. or portion 33 40 1
Tax map /parcel no.: Limited energy, residential 75 00 2
.'; ` . , . ' DESC RIPTION OF. WORK " , , , ' (with above sq ft )
.. Limited energy, multi -family
V C )�„ } ' o t, c . iib -"P" residential (with above sq ft) 75 00 2
ices or feeders installation, alteration, and/or relocation _
rze. Pelt() t - c -1- 4- 200 amps or less 80 30 2
❑
'• PROPERTY' OWNERS r ` "i�
- ❑' T ,:: ENANT -'-> 201 amps to 400 amps 106 85 2
`��`� 401 amps to 600 amps 160 60 2
Name: r P i .t, FOP kl=a�� )h �`�� 601 amps to 1,000 amps 240 60 2
Address: '1 {9 '� C,� ) t ) t � , A Over 1,000 amps or volts 454 65 2
�()� C' Temporary services or feeders installation, alteration, and/or
City /State /ZiP:
1 �� IL lx \ i � Z relocation
Phone: I Fax: ( ) 200 amps or less 66 85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133 75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
q APPLICANTu . ' _ `a CONTACT PERSON ' - ° above service or feeder fee, 6.65 2
each branch circuit _
Business name: B Fee for branch circuits
Contact name: without service or feeder fee, 46 85 2
first branch circuit
Address: Each add'I branch circuit 6 65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 90 90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66 85 2
E -mail: Pump or irrigation circle 53 40 2
".' 4 , -' . - . -` CONTRACTOR; I • . ' ,, .. - "" Sign or outline lighting 53.40 2
Business name: - Signal circuit(s) or limited -
�� i C��i._ � 1 \yC.LC cr='� i tic_ panel, alteration, or I
Address: \ (t1 $
extension Describe Page 2 �� 2
City/State/ZIP: _ Each additional inspection over allowable in any of the above
ty _ ��� �� (-0 ( Per inspection 62 50
Phone: ( ) [Q ,-- {... ' Fax: ( $ l) e -
��' �� � '� �{ ( 6 • s i Investigation per hour (1 hr min) 62 50
CCB Lie.: Electrical Lic.: Su rv. Lic.' `� Industrial plant per hour 73 75
� • pL ^ � 2:s--L z,•
ELECTRICAL - PERMIT .FEES= . _
Suprv. Electrician signature, required: i 4 i� gg- Subtotal 75 U0
Print name: Date: Plan review (25% of permit fee)
/It—
State surcharge (12% of permit fee) ?-°0
Authorized signature ! � � TOTAL PERMIT FEE 3e� 0 0
rr This permit application expires if a permit is not obtained within 180
Print name: 62fc oil Date: lip /re. days after it has been accepted as complete.
* Number of inspections allowed per permit
I \Budding\Permns \ELC- PermiApp doe 05/23/06 440- 4615T(I 1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:, t v
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ H eating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n 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
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n O utdoor Landscape Lighting*
n Protective Signaling
❑ O ther
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Buddmg\Permns \ELC- PermiApp doc 03/23/06