Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00068
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/19/2012
Parcel: 25101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY
Project: Clear Channel Radio Subdivision: VARNS ACRES Lot: 9
Project Description: Electrical for TI.
Contractor: BERGELECTRIC CORP Owner: TRIANGLE POINTE LLC
13650 NE WHITAKER WAY 901 NE GLISAN ST, #100
PORTLAND, OR 97230 PORTLAND, OR 97232
PHONE: 503 - 255 -1818 PHONE:
FAX: 503 - 255 -1919
FEES
Quantity Description Date Amount
5 ea Services or Feeders - 200 04/18/2012 $503.50
Specifics: amps or less
231 crt Branch Circuits w /Purchase 04 /18/2012 $1,714.02
Type of Use: COM Service or Feeder
Class of Work: ALT 4 ea Signal circuit or Limited 04/18 /2012 $300.00
Energy Panel
Type of Const: 1 ea 12% State Surcharge - 04/18/2012 $302.10
Occupancy Grp: Electrical
1 ea Plan Review Electricial 04 /18/2012 $629.38
Total $3,449.00
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 a rrlance wi proved 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. ATT TION: Oregon la r uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 10 through OAR 952 -0 -00 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: ' 2
�, Permittee Signature: ``'-
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, I ase or rent.
OWNER'S SIGNATURE � / Date: OYA
TRACTOR 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 Applicatio FOR OFFICE USE ONLY
City of Tigard I R L E U N Dateiv Permit No.: i /. _it- I
111111 ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review '
Phone: 503.718.2439 Fax: 503.598.1969A 2012 DateB : �� 2 Other Permit: - Lt , a i.
T t G A R D Inspection Line: 503.639.4175 Date Ready /By: Juris: - ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: ah /1j2 4 017 -- (7)>Cp Supplemental Information
4 •, l 'aD
TYPE OF I NG DIVISION w' ' I` ' rni ' PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more El Building over three stories.
❑ D emolition
❑ Other: where 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
❑ I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. El Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION O Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: I Job site address: 13333 SW 68 Pkwy 1001Pormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Portland, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 300/420 I Project name: Clear Channel Radio ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: From 217, exit onto SW 72nd Ave - north Description I Qty. I Fee. I Total I •
th New residential single or multi - family dwelling unit.
turn right onto SW Hampton St then right on SW 68 Pkwy & right into site Includes attached garage.
Subdivision: Lot no.: 00104 1,000 sq. ft. or less 168.54 4
Li Limited 500 y, es ft. or tia lion 33.92 1
Tax map /parcel no.: Map2S101DA /Lot 00104
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
Interior tenant improvements on 3' & 4 111 floors for offices & radio broadcast residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
facilities; back -up generator on grade; roof - mounted mech & comm equip. 200 amps or less 100.70 `03 1 , 2
❑ PROPERTY OWNER ` ® TENANT 201 amps to 400 amps 133.56 2
Name: Clear Channel Radio 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 2625 South Memorial Drive Over 1,000 amps or volts 552.26 2
City/State /ZIP: Tulsa, OK 74129 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 70 401 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 I rgl CONTACT PERSON above service or feeder fee, 231 7.42 / u �2
each branch circuit 7 j 7� 7 •
Business name: Luckett & Farley B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Michael W. Mazeika branch circuit
Each add'I branch circuit 7.42 2
Address: 737 South Third Street Miscellaneous (service or feeder not included)
City/State/ZIP: Louisville, KY 40202 Each manufactured or modular 67.84 2
y dwelling, service and/or feeder
Phone: (502) 585 - 4181 Fax: : (502) 587 - 0488 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: MMazeika @luckett farley.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
�anel, alteration,orextension. Pale - CO, b 2
Business name: to be determined � � L.
Each additional ins l ection over allowable in an of the above
Address: 6 ,s-7) Afe W ,-tyf,64.ei— v J 'r / Additional inspection (1 hr min) 66.25/ hr El
City /State /ZIP: Qt< - tom / O(.. q 71 J 6 Investigation (I hr min) 66.25/ hr
(
Industrial plant (l hr min) 78.18/ hr IIII
Phone: (5 ,3 ) LSS- (f ` 0 Fax: ( S1 ) r9 Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
5;21 CCB Lic.: il0 I Electrical Lic.: ,37 6 Suprv. Lic.: S-tl/ ff5 5 ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee): � a a
Print name: g e A i -1, ‘ S D e: / 2 State surcharge (12% of permit fee): OCZ 0 Authorized signature: 1r 1 I
TOTAL PERMIT FEE: • 3 ,, ca
This permit application expires if a permit is not obtai ed within 180
Print name: 1 1. pt4�2 Date: vI days after it has been accepted as complete.
I J I 1 • Number of inspections allowed per permit.
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r 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 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 Alarm Installation •
® HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
O Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
® Other Broadcast Equipment
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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