Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
`''F'! COMMUNITY DEVELOPMENT Permit #: ELR2012 -00004
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/06!2012
Parcel: 2S 102AA04201
Jurisdiction: Tigard
Site address: 8955 SW COMMERCIAL ST
Project: Essential Planning Group Subdivision: TIGARD HIGHWAY TRACTS Lot: 2
Project Description: TI
Contractor: T & L COMMUNICATIONS INC Owner: BUTTERFIELD, CHARLES W JR &
PO BOX 87387 MICHELLE S
VANCOUVER, WA 98687 -7387 825 SW VIEWCREST DR
DUNDEE, OR 97115
PHONE: 360- 737 -9725 PHONE:
FAX: 360 - 737 -9648
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/06/2012 $75.00
12% State Surcharge - Electrical 01/06/2012 $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: N Fire Alarm: y
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. You may obtain a copy of the rule • •irect questions to OUNC by calling 503.232 1987 or 1.800.332.2344.
41.
Issued By • Permittee Signature: : ,„„ . / .a■ AND
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.
01/05/2012 13:23 FAX 360 737 9648 ;Communications 20001 /0001
Electrical Permit Application e holz o1 lac (NEN
Receive
III 41 City of Tigard C4 '� Date/a , d 1 , PermitNo.: --- • • 1 _
13125 SW Hall Blvd., Tigard, OR 9 a i . /�.,�
m ` Phone: 503.718.2439 Fax: 503.598.1'; P \ \ Q '"5 • .` : Other Permit: /3 N a 1I /-- . ,
i 6.� I ,1 Inspection Line: 503.639.4175 ' �' � " Ready/By: kris: 81 See Page 2 for
Internet: www.tigard- or.gov O Q Notified/Method .-T-.6, Supplemental Information
in v a °. - -,- e,"r 3 ,,, ' , Z ` ." 1v 1vr ,i, ,, , , ' t , z ` ` , ,.. " ri7 , Pi sa ,. ' ,'e R; ti
2 ,,a. 1z ! - i ,�
❑ New construction ® Addition /alteration/rep].'': ent 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 0 Other:
where the available fault current ❑ Marinas and boatyards.
s > '' c `�`. € 'i ': 1. i -? : ' r ;. -' ���ira , . ., exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
zx, s t t1 z , � 1 t# s
❑ 1- and 2-family dwelling less to ground, ar exceeds 14,000 ❑Commercial -use agricultural
y g ® Commercial/industrial ❑ A ccessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
r r „ gyp �� tt b �� ❑Emergency system. larger separately derived system.
�:r a J a � �aax � , s; ...x - _ , t . ... % :. ❑ Addition of new motor load of ❑ .. " 2 ., ..
Job no.: Job site address: 8955 SW Commercial St toor>P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
['Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: Essential Planning ❑ Service or feeder 600 amps or more
i1 m`, �"„r@3 Bi _Mr-x: a`a
c#chc& J,rsvr.3 - ,. i�3?la zc
Cross street/directions to job site: Description Otv. Fee. Total •
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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
J. 1 a , - E ' > `� t �' a i i a t`'it �°a` z,, t" _ �i Yj:s ��%. . i (with above sq. ft.) 7$.00 2
a *,�.a, Limited energy, multi family
Fire alarm tenant improvement residential (with above sq. ft.) 75.00 2
Services or feeders installation and/or relocation
200 amps or less 100.70 2
u: a �`�� �� i 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:
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 I 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amp , 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
3 r ix �, e — 1 r s � m s E above Service or feeder fee,
.aa: ,isas��� 3_ r �+ ., :��,3 each branch circuit 7.42 2
Business name: T &L Communications, Inc B. Fee for branch circuits without
service or feeder fee, fast 56.18 2
Contact name: Larry Bushaw branch circuit
Each add'l branch circuit 7.42 2
Address: PO Box 87387 Miscellaneous (service or feeder not included)
City /State/ZIP: Vancouver, WA 98687 Each m d /mfdular
dwelling, service 2
and/or feeder
Phone: (360) 737 -9725 Fax: : (360) 737 -9648 Reconnect only 67.84 2
E -mail: office @ tl- communications. Pump or irrigation circle 67.84 2
com
s g r as „ Signor outline lighting 67 =84 2
sm.n '7,' . a -.,..;
la"nr :::: � �,' V...: E xs Paz 6rai:ivs,f ai.,rtzu.•".".'41.1'?:,:,:-. 3�. ,,, :•:,::.- °
-.7 c :. �# `r Signal circuit(s) or limited-energy - 4.
Business name: T &L Communications, Inc panel, alteration, or extension. Page 2 �S 2
Each additional inspection over allowable in any of the above
Address: PO Box 87387 Additional inspection (1 hr min) 66.25/ hr
City / State/ZIP: Vancouver, WA 98687 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (360) 737 -9725 Fax: (360) 737 -9648 Inspections for which no fee is 90.00/ hr
,' cificall listed 6 hr min
CCB Lic.: 67787 Electrical Li .i 37 -428CL Suprv. Lic.: 684LEA to h } O : ha : T , , € ; ` q
Suprv. Electrician signature, required: z . o Subtotal: 757 AV. Al Plan review (25% of permit fee): ---
Print name: Larry Bushaw . Date: 1/5/12 State surcharge (12% of permit fee): , G/ . G tI—
Authorized signature: TOTAL PERMIT FEE: (.12g-1.4 •A( /�I a °'/i �'Y We ✓ This permit application expires if s permit is not obtained within 180
Print name: L Bushaw Date: 1/5/12 days after it has been accepted as complete
arty • Number of inspections allowed per permit,
l:1Building1Permus 'E.C- PermitApp.doc 07/01/10 4404615T(1 /o5 /CQM/WID
01/05/2012 13:20 FAX 360 737 9648 T &L Communications Z0003/0003
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
R'3ta2vWnI:G^n m.:cv ..SSrs�ii3s.,:a�� s.ry:i Ls;.'v.�a' s: 4�il '.Flsir�aaua:ezF&�bkalu:uk.cr
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*
❑ Other:
;.��. ,�.....
S k. °
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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
p Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
1 : lBuildinetPcmiu\ELC- PamitApp.doc 07/01 /IO