Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• ' COMMUNITY DEVELOPMENT Permit #: ELR2012 -00015
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/26/2012
Parcel: 2S102AD02400
Jurisdiction: Tigard
Site address: 8950 SW BURNHAM ST 100
Project: NW Preferred Credit Union Subdivision: TIGARD HIGHWAY TRACTS Lot: 21
Project Description: Trench for data telecommunications system: No circuits or wiring.
Contractor: E C COMPANY Owner: NW PREFERRED FEDERAL CREDIT UNION
PO BOX 10286 8450 SW BURNHAM
PORTLAND, OR 97296 PO BOX 231269
TIGARD, OR 97281
PHONE: 503 - 224 -3511 PHONE:
FAX: 503 - 295 -3012
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/26/2012 $75.00
12% State Surcharge - Electrical 01/26/2012 $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: 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 OAR 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.
1
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Issued B _ `�� ..►� 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.
Jan. 24. 2012 1:29PM No. 0564 P. 1
Electrical Permit Application FO1t OC FI(.;r USE ONLY
.,:r» Received
Cit of Tigard Date/B . / Gil[ L�� l'°""11).1°'' - eXX)!
14 13 125 SW Hall Blvd., Tigard, OR 97223 Flail Review
1 II Phone: 503.718.2439 Fax; 503.598.1960 a t. �ate/B : Other Permit:
1LCiAItLn lns 503.639 e`, r ' ., • DateReady/Dy: See Page 2for
Internet: www,ti and -or. ov ' , , Notified/Method: ! Supplemental Information
TYPE OF .WI2it . 61 PLAN REVIEW •
❑ New construction ® Addition /alleralion/re13J Arent e . P?) Please check all that apply (submit 2 sets of plans wliteras checked below):
❑ Demolition ❑ Other: O r c \s 0 � `' ❑ Service or feeder amps or mare ID Building over three stories.
where the available le ( null current ❑ Marinas and boatyards,
CATEGORY OF CON$T1UJ t+"1 6 \ \). exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
0 1- and 2- family dwelling ® Commercial/industrittlb\ 'Accessory building amps for all otherioslallalinns. buildings.
ID Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
J013 SITE •INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑Addition of new motor load of ❑ "A ", "F. "1 - 2 ". "1.3 ".
Job no.: 74098 - 10 f Job site address: 8950 SW BURNHAM ST 10011P or more. R c re attay -
a Siu or MOM residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD OR 97223 ❑ Health-care Facilities- El Supply voltage for more than
❑ I)'aaardous locations. 600 volts nominal.
Suite/bldg. /apt. n0.: • �) Project name: NW PREFERRED CREDIT UNION ['Service or feeder 600 amps or more.
1 — FEE SCHEDULE
Cross streel/directions to job site: Nurtured I oty. I ee I Total 1 , -
Ncty residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less 166,54 4
Fa. add'l 500 sq. ft. or portion 33,92 I
Tax map /parcel no.: 4
Limited energy, residential 75.00 2
DESCRIPTION OP WORK _ (with above sq. li )
Limited energy, multi -family 7500 2
Trench for coin munitcation conduit- no circuits or wiring residential (with above sq. R.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
. 601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
City/State/ZIP: / State/ZIP: Temporary services or feeders installation, alteration, and/or
y relocation
Phone: ( ) i Fox: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to S99 amps 168s4 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or cxtcntion, per panel
Owner signature: , Date: A. Pee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: EC Company B. Fee for branch circuits without
service or feeder tee, first 56,18 2
Contact name: Kathy Kelly branch circuit
Pesch add'l branch circuit 7.42 2
Address: PO Box 10286 Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State/ZIP: Portland OR 97296 dwelling, service feeder 67.84 2
Phone: (503) 224 -3511 Fax: : (503) 248 -6353 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: kathylo @e- c- co.com Sign or outline lighting 67.84 2
CONTRACTOR - Signal circuit(s) or limited-energy
Business name: EC Company panel, alteration, or extension. 1 Page 75 '� 2
-. Each additional inspection over allowable in any oldie above
Address; PO Box 10286 Additional inspection (I hr min) , hr
investigation (1 hr min) 64,25/lir
City/State/ZIP! Portland OR 97296 -
Industrial plant (I hr min) 7818/ hr
Phone: (503) 724 -3551 Fax: (503) 248 -6353 Inspections for which no fee is 9D.00/hr
r r " - 5pecifieall listed (% hr min)
CCD Lie.: 49737 li S/1 Elect Li .. �4 Suprv. Lie.: 23455 • ELECTRICAL PERMIT FEES .
Subtotal: 75.00
Suprv. Electrician signature, required: Plan review (25 % ofpemrit fcc):
Print name: Ron Coffman Date: 1 -24 -2012 State surcharge (12% of permit fcc): 9.00
TOTAL PERMIT FEE: 84.00
Authorized signature: Thla permit application expires if a permit is not obtained within ao
days after It has been accepted as complete.
Print name: Anna Hen I Date: 1 - - 2012 > Number ofinsp ections allowed per permit.
t:\ 0 aitdine\PermisrELC- PermhAtp.doc 0 440.46151(1l/osrcoM/WEn
Jan. 24. 2012 1:29PM No. 0564 P. 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
• RESIDENTIAL WORK ONLY: • '
Pee for all residential systems combined „ $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ 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
❑ Boiler Controls
❑ Clock Systems
® Data Telecommunication Installation
❑ Fire Alatm Installation
n H VAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ O utdoor Landscape Lighting*
❑ P rotective Signaling
❑ Other
Total number of commercial systems:
''No licenses are required. Licenses are required
for all other installations
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