Permit ,� CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' :''' COMMUNITY DEVELOPMENT Permit #: ELR2011 -00239
TIGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2011
Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 330
Project: Parsons Subdivision: ASHBROOK FARM - Lot: PTS 5 &
Project Description: Data telecommunications
Contractor: OREGON ELECTRIC CONSTRUCTION INC. Owner: SUN LIFE ASSURANCE CO OF CANADA
1709 SE 3RD AVE BY NORRIS BEGGS & SIMPSON
PORTLAND, OR 97124 121 SW MORRISON ST #200
PORTLAND, OR 97204
PHONE: 503 - 234 -9900 PHONE:
FAX: 503 - 234 -1001
FEES
Description Date Amount
Specifics:
Restricted Energy Permit 11/18/2011 $75.00
12% State Surcharge - Electrical 11/18/2011 $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 $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through 0= : 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
fia
Issued By: , Permittee Signature: ,04U /970/°4 C" T70.-
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
• OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Electrical Permit Application FOR OFFICE CSE ONLY
City Of Tigard (� ) Received Permit 1es . //
1 2 a 13125 SW Hal Blvd.. Tigard, OR �J� t10�\ TTatc'Ry: / /� / " ���� /� = D� � 3
Plan Review J
• Phone: 503.718.2439 Fax: 503.5 U \ Q � t�atc ;R•r. Other Pernliteafp'6// Q do2, 7
7rtcAr U ittsptxtion Line: D03 c � � 0 kite Ready:ily Jur /mil 8J See Page 2 for
S l tS
\ N ot ified Met o d:
Internet: www.tigard- or.gov Supplemental information
Q$K +� - ` ; Fes" < ;.,
(21 New construction ®Additionialteratit?n• 1 f?iellt `
Please check all that apply (submit 2 sets of plans w,ircros checked below):
- ❑ Service or seeder 4(X) amps or More ❑ i utidrng over three stories.
0 Demolition El Other: where the avaiiahk fault currcut ❑ Marina; and hoar yards_
r, :I -II ;I I--,iza :.
,,,'_;,,_, ; .I.:. -e r...... ,
.::......._:.. .t _ . 11.x.; ;,',-..,,,;:.'s);::_:;-':,,),-,,,,)-:;::.;
�b :' :,F`,r "j..•r ; : ; ;_ ; {'�'� , .� : � i i . - - - - �,.� s amps ksatinE building:.
, (,''';tf1,�L." Rl� p ' LJ fiF '' ,
' volts �) r ❑P
Lsi to ground, or exceeds 14.00 ❑ Commercial-use agtr;ulturai
❑ _ and 2-family dwellin ® Commercial /industrial ❑ Accessory building amps for all other iostalialions. buildings
❑ Multi- family 0 Master builder ❑ Other: pump
- '. - .. :. :.•:.. : :.. .. :. :.....:_ ❑ t
larger separately derived Installation of 7 5 KVA o s• > 3AB.' ' "LE:r� A :0, ['ti
.. t .: , . ..., .. ,!y'i ",�XR"..'` :'�'.,.. _'. , :: s ; . - ['Addition of new motor load r' -t"
Job no.: 55223 Job site address: 9600 SW OAK ST IoOHP m mom. occupancy
❑ Six of more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD, OR 97223 [] (lealth' care facilities ❑ Supply voltage for more than
' ❑ tlarardouv locations 600 - coils nominal.
{
Suite/bldg./apt. 0.: 330 Project name: PARSONS & GEMER CP A'S ❑ Service or feeder 500 amps or more
I ' >_ f, `3 ';;, i : ° ; . ; ..(. ;; :5 11 _ ''.,: `` ); ; -'. '
I Cross street/directions to Job site: I _ 6excriptien 1 Qty. i Fee. I total I
1 New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: i Lot no.: 1,000 sq. Si. or less 168,54 4
La. add'l 500 sq. ft. or portion 1 3.92 1
Tax map /parcel no.:
Limited CIICfj residential 1
i1 pN r}$ ;` (with above s fi. ) 75.00
�. .......• •• •, r. .. -
Limited energy, mull i- family
LOW VOLTAGE VOICE AND DATA CABLING residential (with above sq. ft.) 75'00 '
'
Services or feeders installation, alteration, and/or relocation
2 0(1 amps or less 1 00.70 I -
i': 201 amps to 400 amps 133.56 1 2
4O1 mps f 0(' liij 5
200, 54 2
N i
x601 amps to I,1)00 amps 301.04
Address: Over 1.000 amps or volts 55 2
Temporary services or feeders installation, alteration, and /or
City:'State ZIP: relocation
' 1 I
Phone: ( I Fax: ( ) 200 amps or less I 5034 I 1 1
is being on property that 201 amps to 400 amps 135.08
1 prop_ _ at I own which is not
Owner installation: This installation ,
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amp to 59e amp: l b8.S4
Branch circuits - new, alteration, or extension, per k
2 Owner signature: Date: _ • . e loi branch circuits with
�
A. Fee 1
•1 .,,• „�: - _. - _ above service or feeder tee.
,::
, ;:::';,d;. - :
� : �;'.., :.. . : ; ;., : ;' �
. ...- , <,.... ,., .. ,, :.:. .. .
.., each blanch cucuit
Business name: B. Fee fur branch circuits without
service or feeder fee, first 1
Contact name: branch circuit I 56.18
- - Each add') branch circus? 1 i 7.42 2 2
Address: Miscellaneous (service or feeder not included)
C'ityr S Late -Z1P: Each manufactured or modular i f, i Si
7
-_ __ dwelling, scrvrce and/or feeder
Phone: ( Fax:: ( } Reconnect only 67.84 2
._....._.
-- ------ -- -. -- --- -' -' -- Pomp Jt irrigation circle 07.84
E - mail: Sign or outline lighting 67.84 1 ,
nit :.R
. .. :: ,, . - , s .
-_, . , ",.Y... . ?, �,: . � .. - . � ... .• . _ Signal circmf(s} or limited-energy ' f f I
Business name: OREGON ELECTRIC COISTRUC•TION, INC.' f panel, alteration, or exrensior.. _ 1 Page 2 75 00 2 • Each additional inspection over allowable in any or the above
Rls r ..--- I 1 Additional'ias anon (1 to min ' ' 1 I 60.25; h;
Address: 1709 SE 3 AV � P 1
1 t Invcstigaiion (1 hr min) 66.25; hr
City / State''ZIP: PORTLAND, OR 97214 i ' - —
1 1 industrial plant (l hr mini 78,18i In
Phone: (503) 234 - 9900 I Fax: (503) 234 - 1001 1 : Inspections for which no fee: is
90,00; hr
specifically listed (i %. hr mini .
/C "C'B Lic.: 203 / Electrical Lie.: 26 -95C' - Suprv. Lie,.: 4$18:5 �. ,., • r.`, .. iCtStCT,RfI :'#*4IT41£S x � ; . -
Subtotal: 75.00
Sur t itii:ia ii sign atu e, r <. "•' 1 f f/ .
1 signature. 1 f • I Plan review (25% of permit fee):
Print name: MARK WERN : T ) if
ry: 0 ,,, --, ; + Z i State surharge(12 %ofpermitf'ee1: * 00(1 i
r. TOTAL PERMIT FEE: 84.00
Authorized signature: y i
< i 1• :l "_ ' `aK: - -�— This permit application expires if a permit is not obtained within 180
4 4. — sir ¥ 7 11. a days after it has been accepted as corn ) te.
Print name: MARK W F.. B 1 II Date: 11/17/11 --. ”
' \uniM1ci o f in,pecuons allovs•e(1 per permit AC � i'.htuaain ,aermIiv.hLC-P,n-nn Arc Sea 0':5 "ml) 440=4'at (1 VU`. Covl.whIS C
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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*
E Other
Fee for each commercial $75.00
system
(SEE OAR 918 - -309- 0000)
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
n Clock Systems
® Data telecommunication Installation
In Tire Alarm Installation
E HVAC
▪ Instrumentation
Intercom and Paging Systems
7 Landscape Irnsgation Control*
✓ Medical
C Nurse. Calls
E Outdoor Landscape Lighting*
C Protective Signaling
!. Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1.' DwIth. �g,Per:u,u'' K ;,7 is