Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
� I�� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00321
AA
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 10/15/03
SITE ADDRESS: 11308 SW 68TH PKWY PARCEL: 1S136DA -00100
SUBDIVISION: ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
Project Description: JOB NO. 52020 Voice & data - Work located in the mail room
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
BENSON CAPITAL OREGON ELECTRIC CONST /GROUP
1708 3RD AVENUE 1010 SE 11 TH AVE
NEW YORK, NY 10017 PORTLAND, OR 97214
Phone: Phone: 503 234 - 1001
Reg #: L$03- 234 00
SUP 4460S
ELE 26 -95C
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 10/15/03 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Tax 10/15/03 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
Issued by Permittee Signature arrize--a/Cf--0"--
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'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
OCT--03 ; 02:16PM FROM-Oregon Electric Estimating 5032313587 T -047 P.001 /002 F -859
✓ ' lectrical Permit Application
OFFICE USE ONLY
A* City of Tigard Date received: Permit no.: 200 -7 ,- 003Rt
13125 SW Hall Blvd RECEIVED Project/appl. no.: Expire date_
,al4.. !r4!' Phone: (503) 639 -4171, FAX: (503) 588.1960 Date issued: By: (Receipt no.:
Internet address: www.d ; ..ogr� uuw Infil Case file no.: Payment type:
24 -Hour Ins section R:-5u3-694175
• 182 family dwelling .or accessory d Commercial/industrial • Mult - famly ❑ Tenant improvement
❑ New construction u_ a' :::.uaa rent ❑ Other • ❑ Partial
JOB SITE INFORMATION
Job Address: 11308 S:W. Beth Pa ' ' ' ' = • ,. 0-' Suite no.:Mit (mail room) Tax map/tax lot/account no.:
Lot: Block: Subdivision
PJect Name: Tieard•Data Center Description and location of work on premises: Low voltage for volco and data
Estimated Date of completion/inspection:
Will • u call for ins • ection within 24 hours? Yes . ❑ No ❑ Proiect Contact K lo Coo • r (so) 549.2469 Phone
CONTRACTOR APPLICATION FEE SCHEDULE
me mmo.
Job No.: 52020 Description Qty Fee (ea.) Tetol imp
NW roswenuar- atngte or
multIdamly per dwelling unit.
Business name: Oregon Electric Group ..., Includes attached garage.
• Sorvlee Included:
Address: 1010 SE 11th Ave. 1000 aa. R or less 1 145.15 S - 4
City: Portland J,tate: OR tip: 97214 - Ea Aden 500 SF or Portion $ 33.40 $ - 1
Phone: (503) 234 - 9900 Fax: 503) 234 -1001 I Email: Limited Energy.1 a 2 Panty $ 75.00 $ 2
CCB no.: 203 Elec. bus. ilc. no.: 26-95C Limned Energy, MuIU-Fanuy $ 75.00 $ - 2
Citylmetr • - . & . 1 • • Each manutacnnod home or
��_ � modular dwelling. Service
u,,,�,,,,,,- . er , !!..,,..Jr' L• ti/14I2003 anworfeeder. S 50.90 $ - 2
■
• SMVIC8 or Feeders -
Su • . Eleat. Name • n ITRIMS License no: 4460S Installation, Alteration Or
Relocation:
P. SP RT'i OWNER 200 amps or teas 5 00.30 S 2
Name (print): 201ampa- 4a08mos $ 109,85 $ • 2
Man • Address: 401amps ! 600amps 1 184.60 $ - 2
C' State: ZI • : 601arnps - 1000am. $ 240.80 S - 2
Phone: Fax: E-mail Over 1000A or volts $ 454.65 $ - 2
Owner/rural/at/on: The installation Is being made on property 1 own which is Reconnect Only 5 6685 $ - 1
7 cos °f
not intended for sale, lease, rent, or exchange according to ORS 447, 455,
Feeders • tmmst111aaen,
479. 670, 701. Alteration or Relocation:
Owner's s nature: Date: 200 am or lees 5 66.95 — $ - 2
201am9e- 400ampa $ 100.30 $ 2
Name: Over 401amoa- 600amps 5 133.75 $ - 2
=ra mu - ' err,
Address: Alteration or Extension Par
Panel: A. Patio' branch
City: State: Zip: circuits WW1 WORM dservlw
or feeder feo, oath branch
Phone: Fax: E-mail: circuit s 6.66 _$ - 2
B. Fee for branch circuits WIOU1
Purcha:4 of SeMce Of Feeder.
Id Branch OK 5 48.85 $ 2
0 Service over 225 amps-comrr ❑ Health-Care fadllty Each additional branch droult s a.65 $ -
O Service over 320 amps -rating of 0 Hazardous Location Mist Meows - (service or
feeder net Included)
1&2 family dwellings 0 Building over 10.000 square feet four or Each pump or Irthgatlac circle $ 53.40 $ - 2
0 System over 600 volts nominal more residential units in one structure Each Siam or (Marto LiOhting $ 53.40 $ - - - 2
o Building over three stories ❑ Feeders, 400 amps or more Signal Oireuiue) or tinged Energy
Panel Ate n or Extension
0 Occupant load over 99 persons 0 Manufactured structures or RV park 1 , s 75.00. $ 75.00 x
0 Egress/lighting plan ❑ Other_ meaatpuon:
Submit 2 sets of plans with any of the above. - -
The above are not applicable to temporary construction service. Each AddMonalInspeeGen over
rho alowarde in any el she
Hondo Ms pantile application Above. Per Inspection
expires /fa permha not S 62.50 $ -
optarr•d.ddrb4 Irlvaetlgatlanfee;
has boar ecwpred as cemp/eta. (Otlror -
Permit Fee $75.00
Plan review 25% $OHO
State Surcharge B °,6 $6.00 i
Total Sato()