Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/25/2012
Parcel: 1 S 136AD06000
Jurisdiction: Tigard
Site address: 11437 SW PACIFIC HWY
Project: Carl's Jr. Restaurant Subdivision: VILLA RIDGE Lot: PTS 1 -2
Project Description: Audio and Intercom systems.
Contractor: TRITON COMMUNICATIONS, LLC Owner: EJM PROPERTIES INC &
PO BOX 1091 MAVERICK DECATUR GEORGIA LLC
HILLSBORO, OR 97123 3633 E BROADWAY
LONG BEACH, CA 90803
PHONE: 503 - 615 -5800 PHONE:
FAX: 503 - 628 -5689
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/25/2012 $150.00
12% State Surcharge - Electrical 01/25/2012 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: y Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: Y Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $168.00
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 co• of the rul- . . direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344_,
/�� / n
Issued By: /': �' i i`�" 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.
01/22/2012 21:28 5036285689 TRITON COMMUNICATION PAGE 02/04
Electrical Permit Application p � `— FOR OFFICE USE ON L 1
City of Tigard i /L 7 Received I .
D e e 6 .7 Permit No.: • uz 00_
1 13125 SW Hall Blvd., Tigard, OR 97223 JAN ` 2 2012 Plan Rev
1 Phone; 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit: i /
Inspection Line: 5 03.639.4175 r ^ D ate Ready /By: See Page 2 for , (.06
T AN.0 CITY OF TIGARD Page www.tigard- or.gov At 111 DING, � 1 ii'lhl Notified/Method: Supplemental Information
TYPE:'OF WORD Pt AN. 12EY EW
❑ Demolition ❑ Other: ❑ where the available fault current ore sets o ❑ El Building checked below): over three stories.
® New construction ❑ Addition /alteratton/r lacement
l
and boatyards.
• CATEGORY :OF C STR SUCT „, •
1 - and 2-family dwelling El .. IO N:.. ` ... les to exceeds 10,000 imps at ] 50 volts or El Floating buildings.
less to ground, or exceeds 14,000 Commercial - use agricultural
. El y g dustrial ❑ Accessory building amps for all other Mstallations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE. INFO1 'I M'ID LOCATION r...: •El Addition of new motor load of ❑ "A" "E" "1 - 2" "l - 3"
Job no.: 3967 Job site
address Pacific Hwy
or more. occupancy.
El six or more residential units. ❑ ftecreaizonal vehicle parks.
City /State/ZIP: Tigard, OR 97223 ❑ Health facilities. ❑ Supply voltage for more than
.. ❑ Hazardous locations. 600 volts nominal.
• Suite/bldg. /apt. no.: Project name: Carl's Jr ❑ Service or feeder 600 amps or more.
.. .; EE• -SC11 E»tfL :
Cross street/directions to job site: Dmeriotlon I Qtr. I Fee. I Total I
New residential single- Or multi - fancily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or loss 168.54 4
Ea. add'1 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
' - 75.00 2
(with above sq. It )
Install sound system and drive- tltru T.
Limited energy, multi - family 75.00 2
system. residential (with above sq. R.)
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
City /State /ZIP: Temporary services or feeders installation, alte and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to doe amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701- 401 amps to 599 amps 168.54 2
Branch circuits new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ' ,b. CONTACT PERSON above service or feeder fee, 7,42 2
each branch, circuit
Business name: B. Pee for branch circuits without
service or Paeder fee, first 56.18 2
Contact name: branch circuit
- - Each add'l branch circuit 7,42 2
Address: Miscellaneous (service or feeder not included)
— Each manufactured or modular 67.84 2
City /State /ZIP: _ dwelling, service and/or feeder
•
Reconnect onl 67.84 2
Phone: ( ) Fax::( ) .
- Pump or irrigation circle 67.84 2
E -mail:
- Sign or outline lighting 67,64 2
. ' . CONTRACTOR .. • . . , . _ . Signal circuit(s) or limited -energy
Business name: Triton Communications, LLC panel, alteration, or extension. 2 Page 150 2
_ . Each additional inspection over allowable in any of the above
Address: PO Box 1091 Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: Hillsboro, OR 97123 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) . 78,18/ hr
Phone: (503) 615 - 5800 Fax: (503) 628 - 5689 Inspections for which no fee is 90.00 / hr
specifically listed (1 hr min) _
CCB Lic.: 154665 Electrical Lie.: 34648CLE Suprv, Lic.: 28261E ' E LIEC' ELECTRICAL PERMIT FEES
Suprv, Electrician signature, required: e-----) i01 In Su fi l: 150
(4 -2--- Plan review (25 % o�ermit fee): 0 Irv~
Print name: Aaron Van Fleet Date: 1/22/12 State surcharge (12% of permit fee): 18
Authorized signature: -a- ! " - TOTAL PERMIT FEE: 168
� ~ This permit application expires if a permit is Uot obtained within 180
Print name: Aaron van Flees Date: 1/22/12 • 4' Number after it has been accepted as complete.
Number of inspections allowed per permit,
I:1 Building lPcrmits\E1.C- Permit.App.41o5 07051 /to 440 -40157(11 /05 /COM/tVEa
01/22/2012 21:28 5036285689 TRITON COMMUNICATION PAGE 03/04
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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 Syste s*
❑ 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 Alarm Installation
❑ HVAC
❑ Instrumentation
Z Intercom and Paging Systems
❑ Landscape Irrigation Control*
(1 Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 2
*No licenses are required. Licenses are required
for all other installations
I:1 Building \Permits\ELC- POrmitApp.doc 07/01/10
01/22/2012 21:28 5036285689 TRITON COMMUNICATION PAGE 01/04
:• EcEivr:n
COMMUNICATIONS, 4/NIGA1'%ONS ,LLG JAN 2 2 2012
CITY OF TIGAF 3D
BUILDING DI'VISIOP
TO: Electrical Permit Section
COMPANY: City of Tigard
FAX: 503 -598 -1960
FROM: Julie Van Fleet
DATE: January 22, 2012
PAGES (Including cover sheet): 4
COMMENTS:
To follow is a permit application and payment authorization form.
PO Box 1091 Hillsboro, OR 97123
Phone: (503) 615 -5800 Toll Free: (877) 615 -5800 Fax: (503) 628 -5689
Website_ www.tritonnw.com Email: info. ()tritonnw.com
CCB Numbcr: 154665