Permit _ CITY OF TIGARD ELECTRICAL PERMIT
1 COMMUNITY DEVELOPMEN Permit #: ELC2010 00618
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2011
Parcel: 2S112DB00700
Jurisdiction: Tigard
Site address: 15245 SW 74TH AVE
Project: Comcast Subdivision: Lot: 11
Project Description: Electrical for equipment building for new service hub. Low voltage for data, fire alarm, & HVAC.
Contractor: LEGACY WIRELESS SERVICES INC Owner: HUEWE, ERIC J & JENNIFER E
15580 SE FOR MOR CT 1199 FAIRWAY RD
CLACKAMAS, OR 97015 LAKE OSWEGO, OR 97034
P
PHONE: 503 - 968 -5450
PHONE: 503 - 656 -5300
FAX: 503 - 656 -5305
FEES
Quantity Description Date Amount
4 ea Services or Feeders - 201 to 04/15/2011 $534.24
Specifics: 400 amps
3 ea Services or Feeders - 601 to 04/15/2011 $903.12
Type of Use: 1000 amps
Class of Work: 46 crt Branch Circuits w /Purchase 04/15/2011 $341.32
Service or Feeder
Type of Const: 3 ea Signal circuit or Limited 04/15/2011 $225.00
Occupancy Grp: Energy Panel
1 ea 12% State Surcharge - 04/15/2011 $240.44
Electrical
Total $2,244.12
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Cod and all other applicable I -. . All work will
be done in ance wit - • •roved •fans. This permit will expire if work is not started within 180 days of issue or work is suspende- • more the 180
days. AT NTION: Oregon la -qui - •u to follow the rules adopted by the Oregon Utility Notification - nter. Those rules - - - t forth i • OAR
952 -001- 010 through OAR 952 -y,j -0090 ou ay obtain a copy of the rules or direct questions to OUNC by calling • .2 987 •' 1.800.332.23/
Issu d By: J %'- � /LL _/ / Permittee Signature: N L e - — .emu
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' � r / 7 , 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.
• 0 Apr. 15,_2011 Wi reless Services No. OF TIGARD N °, 0213 P 1 81/01
• v (-1 u l r�tkr6Y /
Electrical Permit ApplicitkRE 1.01i till l( '1 I .1: ON 1.1
City of Tigard vo a l/ /O . Petmir No.: t�Le ap /e)- t?p/ i
13125 SW Hail Blvd., Tigard, OR 97223;.QV q V r � p►pn Ro�iow `
k. Phone: 503.039.4171 Fox, 501,598.1960 1)a : CY.�.....11•I�t elm, 1
Inspection Line; 503.639,4175 cf x OV Data Rcndy/By: ® see Pnge 2 for
I nternet: www,ligard•or.gov IVIS. o(c �� Supplcn
1 \0D 10N NotilloNMerh cmral tnforma lion
1$1 Nowconslrut:t(on Ill Addition /alteration/replacement ?jean chock all that apply ( eubml1 1 ems ofplanawflkm e olicokcd beloWn
p service or feeder 460 amps or moro (,l Building over thwo voila,
❑ Demolition ❑ Othor; where the available Nile cu - rent Q Morton and borryarda.
CATEGORY OF CONSTRUCTION &teoeda 10,000 amps at 150 vole or El Floating bulidletu,
• less to rpnund, or oxoceda 14,000 ❑ Commercial -use agdeuliuval
❑ (- and 2•famlly dwelling / Mommercinl /industrial❑ Acccssoty building amps for au other !mutilations. buildings.
❑Multl•tamlly ❑ Master builder ❑ Other; ❑Frro pump, NI fnlaallatfonor75KVA
JOB SITE INFORmA•FIONC AItD -LOCATION 0 neldi gc of n w mien, Inr 'Y 'B'.1 - 2l , 4 ".d srrtam,
. ❑ Addilinn af nnW lnOtOriOad ef d "A "�' °t•2 ", ") "-
Job no.: Job 81te oddre6s: 15245 5V11 74'" Avenue I ix or or mare, oceupa
l] Six or more mitienllnl trod;. Rem/dime vehicle puke.
City/State/ZIP; Tigard, OR LI Heath-earn fbalidee. 0 Supply wimp) fm• more than
❑ nnmrdous fowtioi n. 600 vottanominat.
Suite/bldg./apt, no,: I fretact riamc: Comonst'I Huh Till Service: or foedor 600 am •s or more,
P E SCHEDULE
Croeo strcer/direcclons to Job site: sW 74" Avenue N. & SW I)urhsm Road Deurt. tl , iMiNCINIII1 Toad p
New residential single- or multi - family dwelling unit.
Includcn attached forage.
Subdivision: Lot no 1,000 re, ft, or loss 168.54 4
- Tax map/parcel no.: Wash Co 281 12DB 700 Be. i iced ne y, e 2. de portion 33 - 92 1
Limited energ residential 7100 2
. DESCIIirTIDiN Oar WORK (with above sq, PL)
Limited energy, mulli•(hmily 75.00 2
Commutation of n +/- 090 SF unoccupied CMV block and metal roof equipment building with HVAC Agars, inn rrsidenlial (with above sq, ft.)
services or teedgrs instnllation aid/or relocation
gravel and renew compound nlso comaining backup power genem(er end root oak for COMM sorto07o nroa. 200 amps or less 100.70 1 2
..lg. PiXOPBRTY owi iER j ] TENANT 201 romps t o 400 amps - 133,56 3 1 0 . L 5 - 2
Name: Rio Hume 401 amps to 600 amps 200 34 , - 2
401 amps to 1,000 amps 3 —1-, 301.04 901:94 2
Address: PO fox 2026 Over 1.000 amps or volts 552.26 2
City/State/ZIP: /5tntrl7.IP: Lake Oswego, OR 97035 r' 'Temporary services Or feeder; inatallotion, alteration, and /or
tY 8 P01000000
Phone: (503)968 - 5450 Fax: (S03)5895474 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation Is being made on property that I own which is not 401 amps to 599 amps (68,54 2
intended for solo, lotlso, rent, or exchange, occotding to ORS 447, 449, 670, and 701.
Branch circuits — new , _vitt , . , n ,or nine!
Owner signature: w , Date: A. Fee for branch elroulls with
' .13i 1!►PPLICAIV'I' I - ti CONTACT PERSON above serviceor feedcrfee, 46
7.42 241.32 il
each branch circuit
Rusinoss name; legacy %Vlroros, Services, Inc, B. Fee for branch circuits rvi row
service nr feeder fee, first
.56.1 8 -I
CORIilct ndmo; JRHw6- koAraar 00,41,/ i -.ii 1 - 79 1 bmnchcircuit
Each add': branch circuit 7.42 Q
Address: 15580 SE for nor Court ivllscel(aneous (service or feeder not Included)
City /Slate/ZIP: Cliakama,, OR 97015 Each manufactured ormodular 67.84 7
dwelling,service and/or feeder
Phone: (503) 804.9202 Fax: : (503) 06 -5305 Reconnect only 67.94 2
- Pump or irrigation circle 67,04 2
E•malI: kramar•(legacy- wIrele
- - Sign or outline lighting MI 67.84 El
COl3TRACTd1. ,' J Signal circuit(s) or fimfted•encrgy } r
/ . ., l 1 r , and alteration or carte i ■ n
_ e 5 5 _ Each additional inspection over allowableof the above
13usinets name c V
Address: - / 55 - es SE I C7 Z_ tivid e_ 0 ( . Additional inspection (I hr min 66.29/hr
Invesligolion(1 hr min) Mi®1111=11111
ty C I pl GACQ,Iu QS M r (pl industrial plant 0 hr min) 11111111.11131 MI
Phone CB is 5 $ '� Q — 0 5 a • • :£cal Inspections for which no fee Is III inspections hr ,
listed Yr hr min
CCII t,lc - : 5'P .. Li 5 a Suprv. Lie.: y/g ys .. • ELECTRICAL PERMIT' FEU • . • •
5uprv. Electrician slgnnturo, requited; _ ■ subtotal: N I
&Ad ' Plan review (25% of permit fee)'
Print name; r i ., r G k. F. � in.J .. Dore; j 2 0 1 Slate surcharge (12% ofpermit fee): 4 14
Authorized aignaluro: TOTAL PERMIT FSE: • 411, j
This permit agplloadoh exDlrps Ira permit is net obtained within IRO
days after tt to. hero a In oornpte to,
Print name: Dare: + Number er tntpcod0ns. allowed per permit.
5 :\8vodIna∎PermIMEt c-rnrtxltnpp.doo 07d01/10 440461 S t(l l ios!COMtwbe
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n A • udio and Stereo Systems*
❑ Burglar Alarm
Fl G arage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
Fl B • oiler Controls
❑ C lock Systems
® Data Telecommunication Installation
® Fire Alarm Installation
® HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 3
*No licenses are required. Licenses are required
for all other installations
1: \ Building \Permits\ELC- PermitApp.doc 07/01/10