Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00342
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/05/2009
Parcel: 1S135BC00700
Jurisdiction: Tigard
Site address: 10831 SW CASCADE.AVE
Subdivision: Lot: 0
Project: Comcast
Project Description: Install restricted energy for voice /data.
FEES
Owner:
CH REALTY III /PORTLAND INDUSTRIA Description Date Amount
BY THOMSON PROFESSIONAL & Restricted Energy Permit 11/05/2009 $67.84
REGULATOR, CONTROLLING OWNER OF 12% State Surcharge - Electrical . 11/05/2009 $8.14
PHONE:
Contractor:
AIRWAVE LLC •
9865 NW 307TH AVE.
NORTH PLAINS, OR 97133
PHONE: 503 - 647 -5999
FAX: 503 - 647 -7443
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
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
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. At 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 -0100. You may obtain,acopy of the rules'or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
�-.T
Issued By: L. A.N Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property l own which is,notintended 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 are required on the job site at the time of each inspection.
i .,, 02:45 503 —E47 -7443 AIRWAVE LLC PAGE 01
REC ` P� ..f.,.';;;.14, r',
Electrical Permit Application � , v.1 z i r:.,.,_FOR OF(;)I SE1Q404 i trle i ri
; ` ' City of Tigard _
2 ��9 Received �J Permit No.: a ...
•
a ' 13125 SW`Hall Blvd., Tigard, OR 97223 NOV O `5' ' C ' e/B view .ra
$ p i' Phone:- 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
-•' " Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: luris: b5 See Page 2 for
TI,GAR)D' (± �+ ^A � oufied/Method iii Supplemental lnformatron
Internet wow hgard or gov BUILDING DIVISION
TYPE; OF WORK PLAN RE%1EW -J
❑ 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 ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY O.F CONSI`RLICTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial -use aricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: El Fire pump. ❑ Installation of 75 KVA or
❑Emergency system. larger separately derived system.
30B SITE INFORMATION' AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -7 ", "1 -3",
• 100HP or more occupancy.
Job no.: Job site address: 10831 SW Cascade Ave ❑ $ix or more residential units. ❑ Recreational vehicle parks.
City /State /Z_,1 P: Tigard, OR 97223 ❑Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suitc/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. '
FEE. SCHEA,IILE
Cross street/directions to job site: Between Greenburg & Scholls Ferry Rd Description I Qtr. I Fee. 1 Total 1
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'I 500 sq. ft. or portion 33.92 . r 1
Tax map /parcel' no.: Limited energy, residential
67.84 2
::DESCRIPTION (JF. WORRK:' (with above sq. ft.)
Limited energy, multi-family 67 84 2
Install CATS Network Cabling residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation .
200 amps or less 100.70 2
• ❑ PROPERTY OWNER 1 •[} TE14ANT ' 201 amps to 400 amps 133.56 2
Name: Comcast 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps • 301.04 2
Address: 10831 SW Cascade Ave Over 1,000 amps or volts 552.26 2
• City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)617 - 1133 ] Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made :en property that 1 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 J •
' Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with .
• . ❑ APPLICANT: ;' ❑` CON'T'ACT PERSON above ser vice or feeder fcc, 7.42 2
each branch circuit
Business name: Airwave LLC B. Fee for branch circuits
• without service or feeder fee, 56.18 2
Contact name: Sue Marshall first branch circuit
Address: 9865 NW 307 Ave Eachadd'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: North Plains, OR 97133 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 647 -5999 Fax: : (503) 647 -7443 Reconnect only 67.84 2
E -mail: joe @airwavellc.com Pump or irrigation circle 67.84 2
• CONTRACTOR Sign or outline lighting _ 67.R4 2
Business naive: Airwave LLC
Signal circuit(s) or limited-
'energypanel, alteration, or
Address: 9865 NW 307th Ave _ extension. Describe: 1 Page 2 $67.84 2
City /State /ZIP: North Plains, OR 97133 Each additional inspection over allowable in any of the above
• Per inspection 66.25
Phone: (503) 647 -5999 I Fax: (503)647 -7443 Investigation per hour (1 hr min) 66.25
CCB Lic.: 160},Z8 I Electrical Lic.: 34- 688CLE I Suprv. Lic.: 542 LEA Industrial plant per hour 78.18
' tO • 1.0 1 • 1 e 1 l .... E l Eti.3 R>(GAL PER11 T'FEES
Suprv. Electrician signature, required: Subtotal: $67.84
Print name: Bob Sherwood Date: 11 -5-09 Plan n view (25% of permit fee):
State surcharge (12% of permit fee): $8.14
Authorized signature' /�L TOTAL PERMIT FEE: $75.98
This permit application expires if a permit is not obtained within 180
Print name: Joe son Date: 11 - 5 - 09 days after it has been accepted as complete
• * Number of inspections allowed per permit
• 1:lnuilding1Permits'ELC PormitApp. 10101/09 440- 4615T(11/05/COht/WES
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