Permit • q
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR2013 -00055
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/13/2013
Parcel: 2S 101 AA03800
Jurisdiction: Tigard
Site address: 12259 SW 69TH AVE
Project: Capitol One Subdivision: WEST PORTLAND HEIGHTS Lot: B
Project Description: (1) low voltage for Data/Telecommunications
Contractor: COCHRAN INC Owner: TIGARD CORPORATE CENTER LP
7550 SW TECH CENTER DR #220 15325 SW BEAVERTON CREEK CT
TIGARD, OR 97223 BEAVERTON, OR 97006
PHONE: 503 - 234 -6564 PHONE:
FAX: 503 - 238 -2098
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/13/2013 $75.00
12% State Surcharge - Electrical 03/13/2013 $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 2- 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.
Issued By: I /L. Permittee Signature: Oro RUC4-T1O&.
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.
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Electrical Permit ApplicatioEIVED FOR OFFICE USE ONLY
City of Tigard MAR 1 3 2013 Re PermitNo.: d0/3 ° OboSs
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• C Phone: 503.7182439 Fax: 503.59 Date/:. Other Permit:
TIGARD Inspection Line: 503.639.4175 QFTIGARD Date /By: lore' El See Page 2 for
Internet: www.tigard -or.gov BUILDING DIVISION Notified/Method: �� p Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ViAddition/altetation/replacement Please check all that apply (submit 2 sets of plans wfitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition , ❑ 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
❑ 1 - and 2- family dwelling gl Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system
pm 6 JOB SITE INFORMATION AND LOCATION [(Addition of new motor load of ❑ "A ". "E", "1 -2 ", "1 -3",
Job no. 4 -/S1 Job site address: 4 �y Q L� 100HP or more. occupancy.
��� ' �Z7i� / $i ° (/t. v ? y ❑ $ix or mom residential units. ❑ Recreational vehicle parks.
City / State/ZIP: fy /e l> oz q 7 ez .3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg /apt. no.: Project name: 64 p ae D /2e ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SL L 9.6,A. )�e 91-- Description i I QiY• I Fee. 1 Total L •
New residential single- or multi- family dwelling unit.
t: 1,0 &Lin Akins 7 .S 7 Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 I
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
00 e2/3 / — / & W /t ss A- & "s s ?(.9 / A T residential (with above sq. ft.) 75.00 2
� A Services or feeders installation, alteration, and/or relocation
d A 69 g Lei 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ 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
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 2
Dwner 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 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Dwner signature: Date: A. Fee for branch circuits with
❑ A P LICANT I [ above service or feeder fee,
CONTACT PERSON each branch circuit 7.42 2
3usiness name: L�geekgan .- (7.. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
.7ontact name: J aS O .a con branch circuit
Each add'I branch circuit 7.42 _ 2
5ddress: Miscellaneous (service or feeder not included)
�ity/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
'hone: F ax: ; R Reconnect only 67.84 2
X03) ev7 , 9i 3 7 /) Zia �Z�
Pump or irrigation circle 67.84 2
? -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
3usiness name: COCHRAN INC panel, alteration, or extension. Page 2 00 2
Each additional inspection over allowable in any of the above
address: 7550 SW TECH CENTER DR SUITE #220 Additional inspection (1 hr min) 66.25/ hr
l'ity/State/Z1P: TIGARD OR 97223 Investigation (1 hr min) 66.25/ hr •
Industrial plant (1 lir min) 78.18/ hr
'hone: (971) 205 -4242 Fax: (971) 205 - 4268 Inspections for which no fee is 90.00/br
specifically listed ('A hr min)
:CB Lic.: 72942 Electrical Lic.: 37 6C uprv. Lic.: 34478 ' ELECTRICAL PERMIT FEES
;Ivry. Electrician signature, required: Subtotal: 77, Q D
Plan review (25% of permit fee):
Tint name: KENNETH TO Date: e _/ : ..../3 State surcharge (I2% of permit fee): 9 ()'Q
/ � TOTAL PERMIT FEE: 4G, /
authorized signature: ` U U This permit application expires if a permit Is not obtained within 180
da after It has been accepted as complete.
•
'rintname �dn ,�C� l Dater --45 • Number of inspections allowed per permit.
tuilding/Permits\ELC.PermitA . dos 07/01/10 441l- 4615T(t1/05 /COM/WEB
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential "system 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
F l Data Telecommunication Installation •
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ 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
:\Building\Pamits\El4PamuApp .doe 07/01/10