Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2009 -00167
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/29/2009
Parcel: 1 S 135DC00200
Jurisdiction: Tigard
Site address: 11825 SW GREENBURG RD 1 -A
Subdivision: Lot: 0
Project: John L Scott
Project Description: Data Telecommunication Installation
FEES
Owner:
MGC PROPERTIES LLC & Description Date Amount
JEN PROPERTIES LLC, BY C &R REAL ESTATE Restricted Energy Permit 06/29/2009 $75.00
SERVICES CO, 1440 SW TAYLOR 12% State Surcharge - Electrical 06/29/2009 $9.00
PHONE:
Contractor:
PTSC
8025 SE TELFORD RD
GRESHAM, OR 97080
PHONE: 503 - 665 -4900
FAX: 503 - 665 -4830
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
Audio & Stereo. N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications Y Fire Alarm: N
HVAC N Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
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 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 95 01 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 332.2344.
Issued By: / - -� 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' 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.
O1/26/2 _ 009 FRI 13:48 FAX 5036654830 PTSC 1
REC
Electrical Permit Application Ei -
"r • • FOR OFFICE USE ONLY ' ' , o
ii , - City of Tigard
125 SW Hail vd., Tigar OR 972 JUN 26 2009 F. -- -
,, v .3
l'ennii N _)
6.: E L 17...,7_405,-
... ,,,,.._......
- ....-- .. 13 Bld, t
• '' - Phone: 50109.4171 Fax: 503.59131 ru it : OF Tin A fr.--
Dale/13y: Other Permit
TIGARD
Inspection Uric: 503.639.4175 8° L DING "RD Date Rcady/By: Jurix: I Eill See Page 2 for
Internet: www.tigard-orgov DilitSlo Notified/Method: Supplemental Informal
' ' . • " ':: ' .:' ' ....: . .7' '''' :' .' TYP:! - ' ::: Y ' ' - ' • • • ' - . ' '‘.::'':. .:'''
. . ...
.........
0 New construction
Please cheek alt that apply 6sulmil 2 arm, plans editinsin eheeked below):
/(
0 Service or feeder 400 11[61,5 or more 0 litIllding over (time ;tortes,
El Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
... • • ..• ,........ - ,,,.,.. ,,....... ,,,,. ..... , ... , .. ... .
exceeds 10000 amps at 150 volLs or 0 Floating buildings.
..... .... . .. ...
' ' - ' - ' ' - ' ' " ' ' ' ' - " ' ' • - ' - ' levi to ground, or excectiz, 14,0011 0 Commercial.uxe azricultural
0 1 - and 2-family dwelling N Comtnereial/industrial 0 Accessory building amps for all other inatallations. buildings.
0
Multi-family LI Master builder 0 Other: 0E112 pump 0 Installation of 75 KVA or
separately derived system.
. • , „Top SITE INFORMAJ ION :AND LOCATION 0 Add of new motor load ,,.., . : : , -,: .., ,'
. .. ., ition of 0 "A", "E",
. Job no. V.02 Job site address:1k 86 S touri.p-0 - R. d or MOM.
0 SiX or more redential units, 0 occupancy
Roe-National vehicle parka
---.,
City/State/ZIP: "1 ca_ a r.
b.,,re_ckon et-lga OH care facilities. 0 Supply v0 fbr mOr: than
0 Hazardous locations. 600 volts nominal.
1
Ilir 14/apt, no.: 1 lir\ Project riamejai 1. Se s9 OSerVice art 4tItler 600 amps. or more,
- ,: '...
Cross street/directions to job site: qa32._C\ bC..t.„`C% . 151 d cra--' ..:k.1._i_pi tion I On'. I Fee l Irtt.sil_l '
..,
New residential single- or multi-family dwelling unit.
Includes attached garage.
-
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
- En. add'l 500 sq. ft. or portion 33.40 1
Tax map/parlxi no.: Limited energy, residential
• , . .. 75.00 2
. . (with above sq. ft.)
. ...
0 - Limited energy, multi-family
75.00 2
EX,e 4 baLA:a. Ca-bi.2_ i.. resit:1,9110a' kzith above sa, ft.)
Services or feeders installation. alteration, aindfur relocation
200 amps or less 80.30 2
• LJ PROPERTY OWNER • ., ;, , ,. " • TENAN . :, . '. _ ' 201 amps to 400 amps 106.85 2
Name: ).
,
401 amps to 600 amps 160.60 2
9 i
to y. ik. 1-... SC C.-
N.
601 amps to 1,000 amps . 1 240.60
i
Address: IS, 8,a5 S L -P.s...1 TO-- t' h Over 1,000 amps or volts 454.65
City/State/ZIP: H i :) Temporary services or feeders installation, alteration, and/or
t, ( FP- I.rft- relocation
Phone: 56B t , uil Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps 10 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 111.75
. .. .-.,...--.- 2
-----......, .
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch etxuits with
APPLIC,N I CONTACT PERSON above service or feeder fcc,
' - 6.65 2
i , each branch circuit
Business naineret-e_IVO.,-. . .
..___ 1-L, c_pi e Lex.e gc-{,5121.11-41 ( =I - 0.6)14 rrt , B. Fee for branch circuits
without sex:vibe or feeder fcc
Contact naine-Y,414-1 -ch.( s ort) first branch circuit , 46.85 2
Address:'FA f -52,.. ' „1 .41- ri .„Ci. Each add'I branch circuit 6.65 2
.-.
Miscellaneous service or_fectler not„includeR
City/State/ZIP: 111Pl c E 5 Ka__ k,-,-, ro_o q--7 00 Each inantdctured or modular
90.90 2
_ I
Phone: 603 ,t , t.. gm Fax: ; 603 , l Lt dwelling, service and/or feeder ?3e) Reconnect only 66.85 2
E-mail: . ,(11 (,/ P e D., pt Pump or irrigation cinde 53.40 2
..-- -
.. .......
'
• Sign or outline lighting 53.40 2
-. .
Business name: €CC-YYL.-e___ -- Signal circuit(s) or limited-
energy panel. alteration, or .1.,
Address: extension. Describe: Page 2 2
City/Stat./7,IP; Each additional inspection over allowable in any of the above
- - ' Per inspection 1 62,50
Phone: ( ) Fax: ( ) Investigation per hour (1 to mia) 62.50
CCI3 Lie,; , c). Electrical ic_:(V_F On Suprv. Lie„ 1,1,0 5 q LEA Industrial plant per hour 73,75
.
C ' i iv i ity _t ,f
,. . . .: .'.„ " ELECTRICAL; PERMIT. FEES..
„ • „ .....
pi L e t tel.= signature, required: `7h III .5
Subtotal: 1 ..
"-,
t t it Plan review (25% f permit fee):
Print name:Ja rm ( p cs cryL .,‘,.. G 2 t o / c3oz ) 9, o
C fr -
state surcharge ( i 2% of pcnnit fee):
Authorised si ma ..d ic .,, '_ C,L Li/ . . ,Z14,!) al--- ToTALPF.RMIT WE:
' $'..--
s permit application expires if A permil. is eol Ili/tallied N 1111111 Igo
print nunc: 'A 44,-) i , M t a , Date: This
. i fft w . 620
days after ft has been accepted as complete.
• Number of inspections allowed per permit
1 : \ EitriMin0 ■Po■m■to-:1,C-P,Ilit Ay .d. 0523106 440
\ . i
0/26/2009 FRI 13 :48 FAX 5036654830 PTSC ?003/003
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WOIZKONLY:..
Fee for all residential systems combined $75.00
Check Type of Work Involved:
Audio and Stcrco Systems"
I I Burglar Alarm
n Garage Door Opener'
Heating, Ventilation and Air Conditioning System"
I I 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
7 Boiler Controls
in Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
( HVAC
U lristrurncUtatron •
❑ Intercom and Paging Systems
E Landscape Irrigation Control"
Medical
Li Nurse Galls .
Outdoor Landscape Lighting"
❑ Protective Signaling
n Othcr
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
I:1 00.n '•Pa In ils'.CLC- PcrmitApp.doc 03,23/06