Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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q ,:. COMMUNITY DEVELOPMENT Permit #: ELR2010 00273
171 1- I TIGAR.D! 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/07/2010
Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 460
Project: Bjorklund & Montplasir Subdivision: Lot: 0
Project Description: Data telecommunications system.
Contractor: FIRE PROTECTION SERVICES Owner: WISCO REAL ESTATE EQUITY
5573 SW ARCTIC DR FUND I LTD PARTNERSHIP
BEAVERTON, OR 97005 BY WYSE INVESTMENT SRVS CO
1501 SW TAYLOR ST STE #100
PORTLAND, OR 97205
PHONE: 503 - 590 -3732 PHONE:
FAX: 503 - 628 -6214
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/07/2010 $75.00
12% State Surcharge - Electrical 12/07/2010 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N 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 -0090. You may obtain a copy of th url direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ='�L — / Permittee Signature: 2 �'►
Ala 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 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.
Dec 06 2010 5:31PM Fire Protection Services 503 628 - 6214 p.l
•
Electrical Permit Applicatia _ �' ® ro'lz,oi I lcr ilsc oNL ,
City of Tigard N b Mro •.rm Received f,
7 ]3125 SW Hall Blvd., Tigard, OR 97223 Date B `,urr ost
r 7 q Plan Review
Phone: 503.639.4171 Fax: 503.598.11960L 6 L IU DateiB : Other Permit ( ,0- DO
Inspection Line: 503.639.4175 Date Ready/8y: See Page 2 for
it,�•�ltii g g CITY OF pp
Internet: WWW.ti and -or. ov No tified /Method: Supplemental
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1:1 New construction El Add ition/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 stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
' 1.ro e g : L
1 exceeds 10,000 amps at O volts or ❑ Floating buildings.
a' 1 lI t to a tJ "R 41- less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2-family dwelling M Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
s „ dSi z r�rx i ❑Emergency system. larger separately derived system.
I- � "i''" * hri, Oit , - � 1 , . N t. i €a ."=` " ,, �` ❑ Addition of new motor load of ❑ `:A `: t _2 "1.3
I?0HP or more. occupancy
Job no.: Job site address: 9020 SW Washington Square Rd. ❑ Recreational vehicle parks.
El Six or more residential units, p ks.
City /State /ZIP: Tigard OR 97223 ❑ Health -care facilities. 0 Supply voltage for more tbaii
❑Hazardous locations, 600 volts nominal.
Suite/bldg. /apt. no.: ¢55 ' h(( yb Project name: Bjorklund & Montplaiser , , ❑ Service o a r fender 600 amps more
q
Cross street/directions to job site: Descnptioa Qty. Fee. 'Total •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision. I Lot no.: 1,000 sq. fl. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
4 r �s� rl � ; 0 4 a3 .e r f � with ab
^a ove 5q. ft,) 75.00 2
., l artrr-2'?" . - m iii 4 - .. .u. .' 1a;;' 1 r Rt' 1 -.i : l.•
Limited energy, multi - family
Phone/Data residential (with above sq. ft,) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
t E 1 kii y ,r SEI tr w T , 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 _ 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 I 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 20i amps to 400 amps 100.3 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 _.
2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date
A. Fee for branch circuits with
r st�+c _
4 a i , i; : a.. ? J i M ; l ? E mil I V6 r ne r •- _ , above service or feeder fee,
each branch circuit 6.65 2
Business name: Fire Protection Services Inc B. Fee for branch circuits
without service or feeder fee,
Contact name: David M Phipps first branch circuit 46.85 2
Address: 5573 SW Arctic Dr Each add'l branch circuit 6,65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Beaverton Or 97005 Each manufactured or modular
90.90 2
dwelling, service and /or feeder
Phone: (503) 590 - 3732 Fax: : (503) 628 - 6214 Reconnect only 66.85 2
E -mail: phipps®fpsnw.com Pump or irrigation circle 53.40 2
,� „„ r 1 t '' i;"3-' • . t,at #E P k'---f-aariir" Si or nut' ne 'Piing 53.40 2
Signal circuit(s) or limited -
Business name: Fire Protedtion Services Inc
ener gy panel, alteration, or
Address: 5573 SW Arctic Dr extension. Describe: 1 Page 2 75'00 2
City /State/ZIP: Beaverton Or 97005 Each additional inspection over allowable In any of the above
Per inspec 62.50
Phone: (503) 590 -3732 Fax: (503) 628 -6214
Investigation pe hour (1 hr min) 62. SU
CCB Lie.: 154333 Electrical Lic . CLE34 :8 uprv. Lie.: 44' i ' • Industrial plant per hour 73.75
Suprv. Electrician signature, required: ;k«,,.
P g 9 �' r 4 Subtotal: 75.00
r Plan review (25% of permit fee):
Print name: Brad Gordon i — Date 12/06/ State surc (12% of permit fee): 9.00
/ %
Authorized signature: i ' TOTAL PERMIT FEE: 84.00
This permit application expires if a permit is not obtained within NO
Print name: Brad Gordon Date: 12/06/10 days after it has been accepted as complete.
' Number of inspections allowed per permit.
1, \BuildinglPerrnits\ELC-Permitapp.doe 05/29/06 440 4615T(I 1!05 /COM/WEa
Dec 06 2010 5:31PM Fire Protection Services 503 628 -6214 p.2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
Vacuum Systems*
❑ other:
=�, � y ��yg �6,uyC} e.,s�m. i q3 9 @j iaa r ,�s : $rye ,. m.
'6'�` �' g 3i °3d .e+jlJC°' Ydh,YY `k4 Y3 8 4 �"- lH �i K
xT2T RR� �� c. 3 RA :Lb: i� ..nW %G"
Fee for each commercial $75.00
system
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
�] Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1a BuildineermitslELC- PermitA.pp.doc 03,23/06