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Permit (69) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT _ COMMUNITY DEVELOPMENT Permit #: ELR2013 -00142 Date Issued: 06/25/2013 T'GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S135BD00100 Jurisdiction: Tigard Site address: 9600 SW OAK ST 570 Project: Houser & Allison Subdivision: ASHBROOK FARM Lot: PTS 5 & Project Description: Data telecommunications for new tenant. Contractor: DYNALECTRIC Owner: SUN LIFE ASSURANCE CO OF CANADA 5711 SW HOOD AVE BY NORRIS BEGGS & SIMPSON PORTLAND, OR 97239 121 SW MORRISON ST #200 PORTLAND, OR 97204 PHONE: 503 - 226 -6771 PHONE: FAX: 503 - 226 -7720 FEES Description Date Amount Specifics: Restricted Energy Permit 06/25/2013 $75.00 12% State Surcharge - Electrical 06/25/2013 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 0 Audio & Stereo: 0 Boiler Controls: 0 CCTV: 0 Clock Systems: 0 Data & Telecommunications: 0 Fire Alarm: 0 HVAC: 0 Instrumentation: 0 Intercom /Paging: 0 Landscape /Irrigation: 0 Landscape Lighting: 0 Medical: 0 Nurse Calls: 0 Protective Signal: 0 Security Alarm: 0 Other: 0 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 -009 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: Q J - Permittee Signature: 6'A i/ L /C- 7O 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 603.639.4176 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. Jun. 24. 2013 1:39PM Dynalectric Oregon No. 1263 P. 1 _ -__ Electrical Permit Application FOR OF i s : ONLY City of Tigard RECEIVE P. Du 7,5 .. 3 ,./- iA Permit No :E1Z / /3 D /9 IN • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 11 Phone: 503.7182439 Fax: 503.598.1960 ! '.N 2 4 2013 Date/B : Other Pe „- G •, , i 3 _pp/ Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for I It; Internet: www_ligard or.gov I+Tl G , r 1, Notified/Method, /Melhod. IIM Supplemental Information TYPE OF PLAN REVIEW /�1 Addition/alteration/replacement Please check all that apply (submit >a sets of plans w/items checked below): 0 New construction ['service or feeder 400 amps or more ['Building over three stories - DefrtOlition Ir r. where the available fault current ❑ Marinas and boatyards. ' CATEGORY OF CQNSTRUCnON , 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. 12 Multi-family CI Master builder 11 Other: ❑ Fire pump ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system JOB SITE INFORMATION AND LOCATION : ❑ Addition of new motor load of O "A ", "E" "I -2 ", "1 -3", 10010' or more occupancy. Job no.: 11;019 -104 rob site address: CI, 0 0 5 /� V 0 Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: r �i �/L ❑ Health -care facilities. ❑ Supply voltage for more than /. L ❑ Hazardous locations. 600 volts nominal. .Idg. /apt. no.: 5' Projec name: 4 n I * i 0 Service or feeder 600 ampa or more, FEE SCHEDULE Cross street/directions to job site: Bex .ion 0 Fee. Total • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 s4. It or less 168.54 4 P P 11 �1 Tax ma / arcel no.: , bESC1R1l1pTIONI OF WORK with Limited energy, multi - family III 75 � © v� p / D at 0011'1/ residential with above s.. It. Services or feeders installation alteration, and/or relocation 200 amps Of kaSS 100.70 2 ❑ PROPERTY owNIEIt I ❑ TENANT _ ' arnps t 400 Name: 601 amps 301.04 Address: I s om 1,00o amps or volts 55216 2 Temporary services or feeders installation, alteration, and/or City/State/ZIP: relocation Phone: ( ) { Pax, ( ) 200 amps or less 59.36 1 I 201 amps to 400 amps I:53.04 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 163. 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits new alteration or extension , er anal Owner signature: Date: r III APPLICANT I ❑ CONTACT PERSON each branch circuit Business name: a l 1 e 1 ,ogn (/� Vh B, Pee for branch circuits without service or Iberia* fee, first 561S 2 Contact name: NWotjL branch cirmil Address: 6 SVII I Q r ' i Miscellaneous service or feeder not Included As Each manufactured or modular iii—' City /State /ZIP: 6 111 V i i W i ' 11 dwelli _ service and/or feeder Phone: (5g) 224 - to 9 g 1 Fax: : (93 ) Lig ''QZ33 Reconnect only 67.84 il , Pump or irrigation circle Email: 1 ( 1�t ' 61/604. OOVl v Sign or outline lighting CONTRACTOR Signal circuit(s) oLMited.angr ' n �� /q� n panel, alteration, or extension. J � Page 2 Willi Business name: rp �Q1.7 I C [' �� : Each additional inspection over allowable in an of the above Address: 5' 17() Stil Hood Additional inspection (1 hr min) 6625/ hr III Investigation (I hr min) 66.25/ hr City/State/ZIP: .p o n a ( 7'Z.-3 Industrial plant (I hr min) 78.18/ hr "Phone: (51)1) Z l. (tr 609 9 I Fax: (93 ) Y 0 L/ - f Z. 3 Inspections for which no fee is 90 hr specifically listed (X hr m ) CCB Lic_: , , " 3 Electrical Lic.: �6 - 91 , Suprv. Lic.: , ELECTRICAL PERMIT FEES ` Subtotal: Suprv. Electrician signature, required: - - Wit. r � IJlf / ' , Print name: -64)1,01# A _ Date: • J 1, i/� _ Authorized signature: y � . , "A / �� J This permit application expires it a permit is not allied within 180 days niter It has been accepted as complete. ` 'ntname-. f— ' - /` te a Date:ar • • Numberofinspeellonsallowedperpermit. 7i/ oi) 'ermhauLC- eennitAppdoe 07/01(10 440- 161srttr/0 1COMIWEB - , Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 9600 SW OAK ST 570, TIGARD, OR, 97223 Commercial - Electricial Limited Energy 135 Low voltage 06/28/2013 00:00 ELR2013-00142 PASS Violation Summary: Inspector Contractor