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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2011 -00253 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2011 . Parcel: 2S 112 D B00200 Jurisdiction: Tigard Site address: 15255 SW 72ND AVE Project: Pittman & Brooks Subdivision: FANNO CREEK ACRE TRACTS Lot: 45 Project Description: Low voltage for data Contractor: PROCOM TECHNOLOGIES LLC Owner: BROOKS & PITTMAN RENTALS PO BOX 22288 15255 SW 72ND AVE PORTLAND, OR 97269 PORTLAND, OR 97224 • PHONE: 503 - 797 -0000 PHONE: FAX: 503 - 233 -8052 FEES Description Date Amount Specifics: Restricted Energy Permit 12/21/2011 $75.00 12% State Surcharge - Electrical 12/21/2011 $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. ATTE • : Or-•• law requ' -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -00 r through OAR 9 ' 001-••90. o . m- obtain a copy of the rules or direct questions to OUNC by calling 503.232. or 1.800.332.2344. 4. 4/ ,/ V Issued y: , 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 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 USE ONLY City of Tigard Da Received te/By �Z� _"/ t�� ao// i/ vpc Permit No.: II I 'q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review - P hone: 503.718.2439 Fax: 503.598.1960 Date/By. Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready/By: luris: 0 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information - _''> . -', ' - TYPE .OF' WORK _ ; PLAN REVIEW. ' -. . ID New construction El 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 stones. ❑ Demolition ❑ Other: wt....., 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 - ", "l - ", Job no.: Job site address: r -� ( 100HP or more. occupancy. / Q Z 5.F s,, , C-U�� E ❑ Six or more residential units. ❑ Health - care facilities. ❑ Recreational vehicle parks. City /State/ZIP: PD (�Tt.A'tv'S7 / GAR / 1 ? 22 ID Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: Pi r> 1 ,/ g 8 mil ,. ❑ Service or feeder 600 amps or more. 4 FEE „SCHEDULE_:. Cross street/directions to job site: Description I Qty. I Fee. I Taal I New residential single- or multi -family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential .� _� 75.00 2 •`,, .,. , . � � _...~DESCfiIP,- TION = ,OZa,,WORK, __. - (with above energy, multi- family 7500 2 lib t eE g � residential (with above sq. fl.) , Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑` PROPERTY .OWNER , . . ❑- TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City /State/ZiP Phone: ( ) Fax ( ) 200 amps or less 59.36 1 201 amps to 400 amps 8 125.0 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 �, y [� APP ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit // B. Fee for branch circuits without Business name: Q�0 service or feeder fee, first 56.18 2 Contact name: �R.t 1 (--V-0.2 branch circuit E ach add'l branch circuit 7.42 2 Address: Pis ze5 2-2z, % Miscellaneous (service or feeder not included) City/State/71P: Each manufactured or modular y 0 c / � / q t 7 ZG dwelling, service and/or feeder 67.84 2 Phone: ( p3) .7 R1-- oacx> Fax: : ( 3) 23 -- '5652_ Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 - - ' .. i;;. `. -;:: :': CONTRAA 1'OR -' Signal circuit(s) or limited-energy Business name: pi,„ ice+. i Kt9 ��t- �e) t. it-e- panel, alteration, or extension ( ' Page 2 1 -- 2 .Each additional inspection over allowable in any of the above Address: PO B 6,( -z2,-z. gg Additional inspection (1 hr min) 66.25/ hr � Investigation (1 hr min) 66.25/ hr City /State/ZIP: P —/ (5K/ q 7 o / j Industrial plant (1 hr min) 78.18/1n. Phone: ( ) 7 47 - oaec Fax: ( , 7) Z' 5 .-- j S 2 Inspections for which no fee is 90.00/ br specifically listed (rh hr min) CCB Lic.: ( C L 2 7._ Electrical Lic.: c.4 28 Z Suprv. Lic.: t 1772 -�1 - . --ELECTRICAL , PERMIT FEES . - - • Suprv. Elect required: �, 7/11/4f � /o % /if Subtotal: 1 S w ors -z- C firm Plan review (25% of permit fee): Print name: SNALu , R , �X f Date: /2- Z / / State surcharge (12% of permit fee): t "- n / TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: S t,( Q g c, Date. / Z -- Z/ - 1 / • Number of inspections allowed per permit. \ 1:Building \Pemuts\ELC- PemtilApp.doc 07/01/10 440- 4615T(11 /05/COM/WEB