Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00104
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2012
Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 570
Project: Epic Land Solutions Subdivision: ASHBROOK FARM Lot: PTS 5 &
Project Description: Data Telecommunications
Contractor: COCHRAN INC Owner: SUN LIFE ASSURANCE CO OF CANADA
7550 SW TECH CENTER DR #220 BY NORRIS BEGGS & SIMPSON
TIGARD, OR 97223 121 SW MORRISON ST #200
PORTLAND, OR 97204
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/22/2012 $75.00
12% State Surcharge - Electrical 05/22/2012 $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 $84.00
Other Desc: • Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 9, 52- 001 -0090. You may obtain a - yy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ., --
Issued By: tJ 1 L Lt Permittee Signature: t)N. 4� t 4' ,,. (QAJ.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each Inspection.
01 , T 15:35:10 05 -21 - 2012 113
Electrical Permit Applicatil, i EC NE 1.0R ()HALE rsi.: 05-21-2012
4 � Received 5
City of Tigard AY 21 2012 Date/By: f L Sr PermitNo.: Ea- c 20 131- 00(0
° 13125 SW yell B1 , Tigard, OR 9
Plan Review
Phone: 503 Fax: 503
Date/By: Other Permit::
/
i' I t.. A RI) Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: ),cis
® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: lip Supplemental Information
• .i ,:,'. r:T ,OhIE::,':•: ; • „ � c' v .
. a'i:i;i ... .. .'1• ..,. r. .. r:, �l$ i' �: 54': f4.,:.•:^! �SrRY'! 17rC ::Ti1 ,•,;
❑ New construction ddition/aiteration /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 stories.
❑ Demolition Other where the availa le
b fault current ❑ Marinas and boatyards.
;'r "• 'li' ?'�,:,V, ? ; :, :?..rl:'CAT CORY' "OF t ^:r
,r I .f-': c`i ',• ; . ! . : , , ,
t,;... exceeds10400mans at (SO volts or ❑ Floating buildings.
. ,:. . . .. ., ... � ..E h,, : ' ;COINS I'RU.C'f101V;.';k, ; �`;,:; •,•: ,. t ' i � -, ::'.•; .
°. •..• , , a'. •.t,r:: •: ;._ t.;. :. , less to ground, or exceeds 14.000 ❑ Commercial-use agricultural
❑ I- and 2- family dwelling ommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ] Master builder ❑ Other ❑Fire pump. ❑ Installation of KVA or
, JO$ . SITE I NFORMATION. ' AND',LOC2tTION •• Emergency system.
o��/i .• •.:. system.
larger separately derived t
....r....,: .,,, ,••,.,.:,...�.:.� ..........:... � ❑ itionof cum torloedof 1
Q 2 0`, q/ i 9 LO 044 C I00HP or more.
r
Job no.: ✓ � a.Y Job site address: iWU/ S F i � cey.
❑Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: 77 6 , Aiep O/Z t77 7 �7 3 ❑ Health -care facilities. 0 Supply voltage for more than
!i ! ❑Hazardous locations 600 volts nominal.
Suite/bldg. /apt no.: 5- () Project name: Ep /G n pA r11y ❑ Serviceor feeder 600amps A .�7 I••� eon or more.
•: r!-':`r: ": „ : .` ' 49 , ,FEE '' SCHED,UI,E: '.' ?.; ".'.: ,
Coteen bun? QmA Desa(ptlon I Qty. I Pee I Total ' 1 `
:
Cross street/directions to job site: ' New residential single- or multi- family dwelling unit.
S 1.0 04K. S'!-,tre_ •�-- f Includes attached garage.
Subdivision: Lot no.: 1,000 sq. it or less 168.54
4
Tax map /parcel n0.: Ea. add'1500 sq. ft. or portion 33.92 1
Limited energy, residential
' .: DESCRIPTION ' OF WOK. " ' (with above sq. ft.) 75.00 2
•
/ ^�g/046 � Z /. Limited energy, multi - family 75.00
-9 - _/fsrjt,l.(L Zii r eA F S i Air residential (with above sq. ft.) _ 2
6
Services or feeders Installation and/or relocation
e IIG471erS 2.q779 LFCO/Y/'7!d/ I / /0/V 20 amps or less
.PROPERTY :OWNE�i: F. '{.'' '" t� 100.70 2
0
{ ., , : �� TENANT' .. 201 amps to 400 amps , 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: Temporary services or feeders Installation, alteration, 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 400 amps 125.0 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 -
0, APPLICANT : " . I D i CONTAcT PERSON above service or feeder fee,
G, � ' each branch circuit 7.42 2
Business name: Jam• . cS C.�t1 d--0-1--- B. Fee for branch circuits without
service or feeder fee, first
Contact name: I!! e/ 1°n I me branch circuit I 56.18 2
` Each add'1 branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/ State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: 63 505 Z 7 z Fax: • 7 e T'GLOU /7 / _ Q Reconnect only 67.84 2
E - mail: C� ` / /! 7/ )L(/ t5 Pump or irrigation circle 67.84 2
Signor outline lighting 67.84 2
COJVTRACTOR Signal circuit(s) or limited-energy
Business name: C ca panel, alteration, or extension. t Page 2 �� 2
Each additional inspection over allowable in any of the above
Address: 15 50 5i � ec (
k � tr . #22 ) Additional inspection (I hr min) 66.25/hr
City/ State/ZIP: '`6(, ("A OK R 72. Z•� investigation (1 hr min) 66 -25 /h ,
'J Industrial plant (1 hr min) 78.18/ hr
Phone: 5°3) 2_3 e{-_ i p 5 6 c / Fax: ( .3) Z-3 - 2.0q."8/ Inspections for which no fee is
specifically listed 01 hr min) 90.00 / hr
CCB Lic.: `72 $42_ Electrical Lic.: 75 %C Suprv. Lic.: 34473 ;; d;; i(: ^;:`; t EGECPRI •CAG:PERMIT'�FEFS.. •: '
Suprv. Electrician CCllac ` 1 IJl'll Subtotal: .
p signature, required: 3 Plan review (25% of penult fee): �5 .60
Print name: . ,_j_ .� o Date: .- S a 12 %of p M
• a, \ ` i / Dt g ( permit fee): (
/ Authorized si nature: This application expires if a permit is not obtain TOTAL PERMIT FEE: e 3 7 00 ✓
g / / / within 180
Print name: i Date: e / ^ days after It has been accepted as complete.
V� ,` u .0 t '. • Number of inspections allowed per permit.
I' Buitdin ;Ponnil.ELC-PennnApp.doc 07101.10 440.4615T(I l`OS.COM,WEa
01 15:35:41 05 -21 -2012 213
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORE ONLY:
Fee for 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*
El 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
TZ(Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
•
❑ Protective Signaling
❑ Other
Total number of commercial systems 1
*No licenses are required. Licenses are required
for all other installations
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