Loading...
Permit , .ELECTRICAL RESTRICTED ENERGY PERMIT CITY OF TIGARD COMMUNITY DEVELOPMENT Permit #: ELR2009 -00334 AiGA D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/23/2009 Parcel: 2S101AD01300 Jurisdiction: Tigard Site address: 12750 SW 68TH AVE Subdivision: WEST PORTLAND HEIGHTS Lot: 33 Project: Clearchoice Project Description: Install restricted energy for voice /data. FEES Owner: HAMPTON BUILDING, THE LLC Description Date Amount 75 - 796 HIONA ST Restricted Energy Permit' 10/23/2009 $67.84 HOLUAIOA, HI 96725 12% State Surcharge - Electrical 10/23/2009 $8.14 PHONE: Contractor: LAN TEL SERVICES INC 1900 IRVING RD BLDG C EUGENE, OR 97402 PHONE: 541 - 688 -1427 FAX: 541- 688 -4642 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 Total $75.98 Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions) Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Other Desc: 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 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 thro gh 0 • ' 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC bycalling 503.246.6699 or 1.800.332.2344. I Issued By: ' 4 L.. A - .._ Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is notintended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' . 2 `r Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. OCT -23 -2009 02:50 �AN GEN 154 P 82 , . , Y " , lectrical Permit es r �� � �� ll ii ii� . �M a i Jam, a , a , � t 1k C 4 Dili t r ,r t r d 2 t i ti f� h / E . Applica .d , � l.4 o , rt 9 ,, � 1 c >R Or F 1<�> i i Sr��N I yitA , i� �� ` Hob 11 111th .d �, . ai U. iii . w ...a1 it"0'�(i` 11 ti elr , i �s h I !ai G, a V r'R1r kr Received City of Tigard (� v c ( 1 P i:mutNo.; ??U " � a 13125 SW Hall Blvd.. Tigard, O R 9 YLZ3 T � i " D ate/D ` , g Plan Review Phone: 503,639,4171 fax: 503.598,1 6 Date/By: OthcrPermit: egi�i A aD ins ection Line: 503.639,4175 �1' T 11 TIG�IRD ;G p DateReadyiBy: lu�re See .Page Zfoi' it i '* Internet: w "-tigard•ors °v BUILDING DIVISION Notified/Medtod: 1 Kli Supplemental Information, - • TYPE OF WORK PLAN REVIEW El Demolition Please checkall that apply (submii'?� m sets of plans,w /ites checked below): - ❑ New construction ®Addition /alteration /fepl8Cel17ent (� ID Service or feeder 400 amps or more ❑ Building over three stories. ❑ Other: where the available fault current ❑ Marinas-and boatyards. CATEGORY OF CONSTRUCTION exceeds 10.000 arms at 150 volts or ❑ Floating buildings. . less to ground_ or exceeds 14.000 ❑ Commercial-use agricultural [] [- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for ail other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pimp. 0 Installation 01'75 KVA or - JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system ❑ Addition of new motor Toad of ❑ "A" "E" ^ I -Z" "1 -J" Job no.: Job site address: 12750 SW 68 AVE. 100 or more. oecupancy, 0 six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: PORTLAND, OR 97223 ❑ Healfli•ca a facilities. 11] Sup1y voltage for more than ❑ Hazardous locations. 600 volts nominal, Suite/bldg. /apt. no.: Project name: CLEARCHOICE DENTAL 0 Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: ptioh ... J Qty. l ter. 1 - rata New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. R. or less 16854 4 Ea. add'l 500 sq. ft. or portion 33.92 I Tax map /parcel no.: Limited energy residential DESCRIPTION OF WORK (with above sq. R) 67.84 2 Limited energy, multi - family LOW VOLTAGE VOICE & DATA CABLING residential (with above sq. ft.) 67.84 2 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 • Name: CLEARCHOICE DENTAL IMPLANT CENTER 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: 12750 SW 68 AVE. Over 1,000 amps or volts 552:26 2 City / State/ZIP: PORTLAND, OR 97223 Temporary services or feeders installation, alteration, and/or relocation Phone: (503)639 -5136 Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made property that [ own which is not 201 amps to 400 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 Owner sigriaturc: Date: Branch circuits -- new, alteration, or extension, . er panel A. Fee for branch circuits with ❑ APPLICANT 1 kti CONTACT PERSON above service or feeder fee. 7.42 2 each branch circuit Business name: LAN TEL SERVICES, INC. 13. Fee for branch circuits Contact name: DAWN DOVER without service or feeder fa. 56.18 2 first branch circuit Address: 1900 IRVING RD., BLDG. C Eachadd'1 branch circuit 7.42 2 Miscellaneous_pervice or feeder not included) City/ State/ZIP: EUGENE-, OR 97402 Each manufactured or modular 67.84 2 • dwelling, service and/or feeder Phone: (541) 688 -1427 I Fax: : (541) 688 -4642 Reconnect only 67.84 2 E -mail: Purnp or i r ri gat i on c 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: LAN TEL SERVICES, INC. Signal circuits) or limited- energy panel, alteration. or Address: 1900'IRVING RD., BLDG. C extension. Describe: 1 Page 2 2 City /State /ZIP: EUGENE, OR 97402 Each additional ins ins ection over allowable in on of the above Per inspection 66.25 Phone: (541) 688 -1427 Fax: (541) 688 -4642 Investigation per hour (l hr min) 66.25 CCB Lic.: 90461 Electrical Lie.; 20 -353C1 - S drv. Lic.: 4332LEB Industrial plant per hour 78.18 • Suprv. Electrician signature, required: ^ /' - ELECTRICAL, PERMIT FEES Subtotal: Print name: JEROME BOETTNER Date: 10/23/09 • Plan review (25% of permit fee): /� - State surcharge (12% of permit fee): Authorised signature: /! ln t- TOTAL PERMIT FEE: -6+t Print name: DAWN DOVER 4 Date: 10 /23/09 This permit Application ecpirp it a permit is nor obtained within 180 days after it has been accepted as complete. • Number of inspections allowed per permit. 75.'3.8 :\a tuilynglPcm 10/01 /09 440- 4015T(I I /05 /COM/WE 34-c. ve■A L. Q o ch. Ir (a r\ OCT-2Z-2009 02:50 LAN TEL- 5UC`a,F;UGENE 15416884642 P.02 Electrical Permit Application, City of Tigard Received T X009 DatrJCG1 : Perim d`o L f 0 13125 SW Mall Blvd.. Tigard, OR 97223 Plan Review a Phone: 503.639.4171 Fax: 503.598.196Q DateB : Other Permit: a Inspection Line: 503.639.4175 , 1* Y OF UGARD Date Readyi8y; Jung 61 See Page Z for Internet: www.tigard•or.gov i, 4,,j1NG D IVISIO 1 Notifled/Mediod: SupDlementAi Information TYPE Of WORK PLAN REVIEW ❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 3 sets of plans w/items checked below): ❑ Service or feeder 400 amps or more ❑ Suitding over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinm and boatyard9. CATEGORY OF CONSTRUCTION exceeds 10,000 ands at 150 volts or ❑ Floating buildings, less to ground. or exceeds 14,000 ❑ Cornrivrcial-use agricultural ❑ 1- and 2-family dwelling ® Commercial/industrial ❑ Accessory building arms for all other installations, buildings. ❑ Multi-family ❑ Master builder ❑ Other: 0 Fire pump- ❑ msmilation 01'75 KVA or ❑ r nergency system larger separately derived system JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E", "1 a", 'W", Job no.: 1 Job site address: 12750 SW 68Th AVE tool->P or more, occupancy. Q Six or more residential ttnits. ❑ Reatealional vehicle parks. City/State/ZIP: PORTLAND, OR 97223 ❑Health-care facilities. ❑ Supply voltage for more dun ❑ Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: CLEARCHOICE DENTAL El Service or feeder 600 amps or more. FEE SCHEDULE Cross strect/directions to job site: Desert rion Re Tat.t New residential single. or multi-family dwelling unit. Includes attached garage, Subdivision: Lot no.: 1,000 sq. ft- or less 168,54 4 Ea. add'1500 sq, ft. or portion 33,92 1 Tax map/parcel no_: Limited energy, residential DESCRIPTION OF WORK with above s q. fL 67.84 2 LOW VOLTAGE VOICE & DATA CABLING Limited energy, multi-family residential with above s j. fL 67,84 2 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 Name: CLEARCHOICE DENTAL IMPLANT CENTER 401 amps to 600 amps 200.34 2 401 amps to 1,000 amps 301.04 2 Address: 12750 SW 68~' AVE. Ovcr 1,000 amps or volts 552.26 2 City/Statc/ZlP: PORTLAND, OR 97223 Temporary services or feeders installation, alteration, and/or relocation Phone: (503)639-5136 Fax: ( ) 200 amps or less 59,36 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 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, er panel Owner Signature: Date; A. Fee for branch circuits with ❑ APPLICANT ® CONTACT PERSON above service or feeder fee, each branch circuit 7'42 2 Business name: LAN TEL SERVICES, INC. B. Fee for branch circuits Contact name: DAWN DOVER without service or feeder fee, 56,18 2 first branch circuit Address: 1900 IRVING RD., BLDG. C Each add'] branch circuit 7.42 2 Miscellaneous service or feeder not included City/State/ZIP: EUGENE, OR 97402 Each manufactured or modular 67,84 Z Phone: (541) 688-1427 Fax:: (541) 688-4642 dwelling, service and/or feeder Reconnect only 67,84 2 E-mail: Pump or irrigation circle 67-84 2 CONTRACTOR Sign or outline lighting 67-84 2 Business name: LAN TEL SERVICES, INC. Signal circuit(s) or limited- energy panel, alteration, or Address: 1909 IRVING RD., BLDG, C extension. Describe: 1 Page 2 2 City/State/ZIP: EUGENE, OR 97402 Each additional Inspection over allowable in an of the above Per inspection 66.25 Phone: (541) 68$-1427 FaJt: (541) 688-4642 Investigation per hoar _0h, trdn) 66.25 CCB Lie.: 90461 Electrical Gic., 20-353Ci c rv. Lic.: 4332LEB industrial plant per hour 78.18 Suprv, Electrician signature, required: ELECTRICAL PERMIT FEES Subtotal: Print name: JEROME BOETTNER Date: IO/Z3/09 Plan review (25v% o of permit fee): State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: Print name: DAWN DOVER Dale: 10/23/09 This permit application expires If a permit is not otltained within 180 days after it has been accepted as complete. • 1:t8uildingTermitsti El,C-PemuNpp.dVt lo/0I109 440-4615T(111051COM/WE6 Numbcrofinspectionsallowedperpemrit. 75. c` Q CJ '-dC vevt L. C o c r Q r CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT r, COMMUNITY DEVELOPMENT Permit#: ELR2009-00334 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/23/2009 Parcel: 2S101 AD01300 Jurisdiction: Tigard Site address: 12750 SW 68TH AVE Subdivision: WEST PORTLAND HEIGHTS Lot: 33 Project: Clearchoice Project Description: Install restricted energy for voice/data. FEES Owner: HAMPTON BUILDING, THE LLC Description Date Amount 75-796 HIONA ST Restricted Energy Permit 10/23/2009 $67.84 HOLUAIOA, HI 96725 12% State Surcharge - Electrical 10/23/2009 $8.14 PHONE: Contractor: LAN TEL SERVICES INC 1900 IRVING RD BLDG C EUGENE, OR 97402 PHONE: 541-688-1427 FAX: 541-688-4642 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 Total $75.98 Intercom/Paging: N Landscape/Irrigation: N Required Items and Reports (Conditions) Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Other Desc: 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 thro gh 0 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: 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 an inspection that business day. 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.