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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2010 -00276 T'GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/09/2010 Parcel: 1S134BC00401 Jurisdiction: Tigard Site address: 12442 SW SCHOLLS FERRY RD 202 Project: Scholls Ferry Rehab Subdivision: Lot: 0 Project Description: Low voltage for data. Contractor: XTREME COMMUNICATIONS, INC. Owner: PROVIDENCE HEALTH SYSTEM 24023 NE SHEA LANE, #215 4400 NE HALSEY BLDG 1 SUITE 160 WOOD VILLAGE, OR 97060 PORTLAND, OR 97213 PHONE: 503 - 618 -8816 PHONE: 503 - 215 -6282 FAX: 503 - 618 -9985 FEES Description Date Amount Specifics: Restricted Energy Permit 12/09/2010 $75.00 12% State Surcharge - Electrical 12/09/2010 $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 -00 rough OAR'952 -0 90. You may obtain a copy of the rules or direct questions to OUNC by 32.1987 or 1.800.332.2244. Issue By: Permittee Signat 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. 12/09/2010 12:57 5036189985 PAGE 01/03 Electrical Permit Application FOR OFFICE 1.1SE Or LY . . Rp _ a7 City of Tigard C L Q \Q t �, l �� y: / t y /� r ' crmitNo; ' CIf!IQ��O Y '1 SW lvd Ti dl OR 9'12 Plan Revi 13125 5 Hall R ar € 14 S Phone; .503.639:4171 l nx; 503.598.1960 �� � ® Datcf1 v. Other 1'101001. P [D �OD � Q Rand /13y: 30101: El Sec Pilau 2 for TiGARL7 Inspection Line: 503,039.4175 c' ` \ S� y sn) Icmentnl infnrmnfinn Internet: www,tigard- urges o ' otifed/Method: _ I P • !` i '. 1 irti 4i ot J ; !tt� -:: ,�. �' :;,..•:'.. .., 1. n:tANAR '. Plcnsc chock all ` that apply (submit 2 SOP of plans w /itc checked below); ❑ New construction cement crvlco or fccdcr 400 nm, Of' more ❑ Building over three fltnrics. Q Demolition ❑ Other: where Ilia available 1"1014 cnrrmtt 0 Marinas and bornyarda. •,,,.,, ,::... , ,..,, .:. - 150 voltser ['I Irinntfttgbuildinll • � cxccalc 10 000 maps nl I {. - Ines to ground, or exceeds 14,000 ❑ Commercl0l -use nrzricnlhu'nl ❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installONOns, buildings. P1rc pump. ❑ Inntnllntion of 75 KVA or 0 M0lti- family ID Master builder ❑Other: 0 Emergency system. Inrger scpnrncely derived syslcm, tti STi"t' �t1V'I�Oi I TA'fltol�F NfYrt; ,O :' •.''••'.1....!': • ,n � n motor Innd of ►Tl�iw � : , •, ❑ Addi)' r I'ncw ❑ ..�„ „ ,. A 1001-1P or more occupancy. ,lob no.; 5 Job site address; l 2 t'�' � �,� _. _ ID six or more resldential units, 0 Racrcniionnl vehicle perks. 0 Health-care I"nciI tot. 0 Supply voltngc tin. more than City/State/71P I r i (] l'lnrardoufl locations, 000 volts nominal. Suite: /bldg. /apt. no.; p Ptoject name: , !_`r D ,crvlco or fbccicr 000 01011140r more. .,.. e — ?Frr •SCU1v!M,rLiL° . Cross .street /direetionS to job site: n ___ 1 , MO= Trani - Ncw residential single- or multi- family dwelling unit'. Includes attached gnrnge. Subdivision: Lot no.: 1,000 sq. R. or less 168,54 4 En. oCld'I 500 sq. R. or portion 33.92 1 'Tax mop /parcel no.: Limited energy, residcntiul 75.00 2 • twSCtt1P•TXt7r O'T' *O.lfl4 (with allow sq. R.) "--"� Lin energy, multi - family , {/ �r -�W x- , .Ed r �• -- 1 T L 6 - residential (with above sq, fl;) 75,00 2 � n f �LG t= L 1 J V Services or feeders installation, alteration, and /or relocation 200 amps or loss 100,70 PFbl iti*Srri '1 , Q' TTNANT..: 201 amps to 400 amps _ 133.56 401 amps to 600 amps 200.34 Name: GU amps to 1,000 amps 301,04 _ 2 Address: Over 1,000 amps or volts 552,20 2 --• -- - - Temporary services or feeders installation, alteration, and /or City /State /ZIP: relocation Phone: ( ) .Pax: ( ) 7.00 amps er less 59.36 1 201 amps to 400 amps 125,05 2 Owner installation: This installation is being mad on property that J. own which is not 2 01 amps to 599 amps t 125,05 T 2 intended for sale, lease, rent, or exchange, according to ORS 447, 4. 9, 670. and 701. Brunch circuits uew, alteration, or extension, per panel Owner signature! Date; A, Ike for branch circuits with © above service or fccdcr ice, A; i?LICANT : : . - . ".. •.'.` . , - :. ' ' L- SN' Pit.. each branch circuit 0.42 2 iBusiness name 17, Fee for brunch circuits iolrho,,t service or feeder fee, first 56 I fl Contact name: branch circuit ^- Each ndd'I branch circuit 7,42 2 Address: Miscellaneous (service or fccdcr not II chided) Each lnanufhcturcd or modular (57.i34 2 City /State /ZIP: dwelling, service and /or feeder _ - ,,,_ , Phone: ( ) Fox:: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67, 81 2 i? - mail• in lighting 67 , 84 2 ".,::'.: .'::i<.;r;• '.:'':'; >'s'.iC rcu energy . ,gn or of tyNT,Krk'GTdtL ^ •: • ,:,`... • • Signal ci • Business name: ,t ie - Co M uN f , LT panel, alteration, or extension. • Page 2 2 X I1 �� ry ''�i''r'' 5 Each additional Inspection over Itllownble In any of the above Address; 7.-TO, b. Q Y 74.5"-- Additional inspection () lir min) 06.25/ hr • p / Vi, ,/ (� [rte Q Investigation (1 lir min) 66,25/ hr City /State /71P; MJmp/ Q(O r !`— I � Industrial plum (1 hr min) 78,1R/ hr — Phnnc: ( ) �� � '( � El El i_ LID "� ) IS Ci� Inapccliuhs for which no fbc is 90.00/ hr ff r '✓ specifically listed (' /a lir min) CCI3 Lie.: i li 7 Ve3 Electrical Lim.„ S'15G Suprv, ic.: 3 ; , •;a.t. iCi2ECTRi'CAL'_PEfMI,T FEES • . Off yy L lprv. S Electrician signature, required: _ J,(- - / /-- f Plan review (25% of permit fee): Print name: a t() lit ,, Date! : , L. to . f0 State surcharge (12% of permit fee): 1 y TOTAL PERMIT T'GL; O Authorized signature: This permit application expires if n permit is n nbtnined 10111h1 113A (lays after it ins been nmcrptcrl ns complete. Print name: Dfltc: Number of inspections nllowcd per permil, 1 U3uildinu\Pormltl\ELC -P0'01 npr,,l ^c 01/01/10 4n0 - 4n1 sr(, Vn .1/CC)M /bw.0 12/09/2010 12:57 5036189985 PAGE 02/03 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: n A udio and Stereo Systetns* n B urglar Alarm O Garage Door Opener* n 1= seating, Ventilation and Air. Conditioning System* n V acuum Systems* n Other: COMd1It'kE A :C9il ' 5: C:1 . ,_... Fee for each commercial, $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio a.nd Stereo Systems n Boiler Controls n C lock Systems D ata Telecommunication. Installation n Fire Alarm Installation i lV. C Instrumentation • in tercom and 'Paging Systems • Landscape Irrigation Control* n Medical O Nurse Calls • • n Outdoor Landscape Lighting* n I?rotective Sigiia E Other Total number or. commercial systems: J No licenses are required. ,Licenses ate required for all other installations 1a3uitdins ;\POrmiI \ELC•PCrrI[App.doC 07 /01 /10