Permit ipli a • CITY OF TI�7AR® ELECTRICAL RESTRICTED ENERGY PERMIT
' Is COMMUNITY DEVELOPMENT Permit #: ELR2010 -00159
T I GARL) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2010
Parcel: 2S112AA00600
Jurisdiction: Tigard
Site address: 6713 SW BONITA RD 270
Subdivision: NELSON BUSINESS CENTER Lot: 0
Project: Sery Pro
Project Description: (1) data telecommunications
FEES
Owner:
WALTON CWOR NELSON 13 LLC Description Date Amount
BY TTA/EPROPERTYTAX DEPT 735, PO BOX Restricted Energy Permit 08/18/2010 $75.00
4900 12% State Surcharge - Electrical 08/18/2010 $9.00
PHONE:
Contractor:
ADVANTAGE AUDIOVISUAL
400 SW 141ST AVE
BEAVERTON, OR 97006
PHONE: 503 - 481 -3933
FAX:
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 $84.00
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:
I
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 0 952 -' 00. 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 ( 0-41/—
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.
Electrical Permit ADD licatio FOR OFFICE CSE ONLY
EC�IVE� Date d C 0 r ....0 5?
City of Tigard Date By Permit Nog-
IN
is 13125 SW Hall Blvd., Ti OR 9722 / ���•
Tigard, ] I (. Flan R eview
_ : Phone: 503.639.4171 Fax: 503.598.1 t: ,. :1. Date Bv. Other Femut
TIGARD Inspection Line: 503.639.4175 Date Ready By huis el See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: % lG Supplemental Information
TIPS OPNG DIVIruN PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply a submit 2 sets of plans w items 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 ) Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ F Pump- ❑ installation of 75 KVA or
❑ Enrragency system larger separately derived
J013 SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3"
Job no.: Job site address: 6' 1 3 5 w I001iP or more. occupancy.
D D1J i 7�4 t W ❑ Six or more residential units. ❑ Recreational vehicle parks.
0 Health-care
City / State/ZIP: C .� /D . 0 q 1 » - a 9._ ❑ facilities. ❑ Supply voltage for more than
600 volts nominal.
." Suite/bldg. /apt. no .. 'BLD 1'I =� C 90 Project name: ❑ Service or feeder 600 amps or more.
�u ,
FEE SCHEDULE
Cross street/directions to job site: Description 1 qty. 1 Fee. 1 Total 1 *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R 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 sq. ft) 75.00 2
Limited energy. multi- family 75.00 2
P hNC AND 17A-r A 1 Au r t 04 residential (with above sq. ft)
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
401 amps to 600 amps 200.34 2
Name: 3 t'fLJ 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
rnapo ar services or feeders installation, alteration, and/or
City / State/ZIP: e
Fax: ( ) 200 amp or less 59.36 1
Phone: ( ) -
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I oven which is not 401 amps to 599 amps 168.54 2
intended for sale. lease, rent. or exchange. according to (.)RS 447. - 449.670. and 701.
Branch circuits — new. alteration or extension. per panel
Owner signature: Date: A. Fee for branch circuits with
AZ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
-
Business name: tekov AJ� rk 61G Av Q t Q v 0. ) 4.L. Ldp B. Fee for branch circuits a nhoar
service or feeder fee, first 56.18 2
Contact name: Jl vvk y LA ,J DMZ. branch circuit
Each add'I branch circuit 7.42 2
Address: L( 00 5 W NI ll V e Miscellaneous (service or feeder not included)
/ StateZ: Each manufactured or modular
Ci
tY /IP ,/ j - ,. i r ()ft._ c loot:, dwelling, service and/or feeder 67.84 2
Reconnect only 67.84 2
Phone: (513) `t81 3 3 3 Fax: ( )
Pump or irrigation circle 67.84 2
E -mail: ad U an'i.a -11./ 'Prato 4 -e r .
V e v >M sign or outline lighting 67.84 2
- CONTRACTOR Signal eircuit(s) or 1uuited- energy
Business name: /��- 1 panel. alteration, or extension. Page 2 / 2
i"1 U V 61.117-.A. C fSIJ 01 t (,Su At Each additional inspection over allowable in any of the above
Address: iqt Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State/ZIP: '3egJ e-gru, ^I 0/1-- 5 D 6 Industrial plant (Ii hr min) 78.18/ hr
Phone: (6U3) +-(81 _. 3 C1 3 3 Fax: ( ) i if Inspections for which no fee is �/ hr
/ specifically listed CA hr min)
CCB Lic.: j c 1 3 D3 Et ---- rical Lic.: '53 IC
A/O Suprv. L ic.: ELECTRICAL PERMIT FEES
a/ / 7 ignattlte
Subtotal: 7 S O O
Suprv. Electrician s, ed
r
Plan review (25% of permit fee):
Print name: , j 1 g It et 00 E Date: g _ I .' / 0 State surcharge (12% of permit fee): q. 00
Authorized signature: TOTAL PERMIT FEE: & g. 00
l This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: J i t/Vt Date: �/ I t/ _ I O . Number of inspections allowed per permit.