Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Permit #: ELR2011 -00114
" ' COMMUNITY TY DEVELOPMENT Date Issued: 05/20/2011
TIGARD . .. 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 281 0/2011 800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 130 Lot: 0
Project: Yecuris Subdivision:
Project Description:
Contractor: CAPITOL DATA & COMMUNICATIONS Owner: PACIFIC REALTY ASSOCIATES
11401 NE MARX ST 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97220 PORTLAND, OR 97224
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PHONE: 503 - 255 -9488 PHONE: 503 - 624 -6300
FAX: 503 - 257 -7121
FEES
. Description Date Amount
Specifics: Restricted Energy Permit 05/20/2011 $75.00
12% State Surcharge - Electrical 05/20/2011 $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
Z4.------
952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:
j — Permittee Signature: ./V /? - / ‘'5 A/
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.
Electrical Permit Application Received FOR OFFICE'USE ONLY
City of Tigard \, \�,� � Date/Br-Tilly/7 ,min,o. :��� 7A / / — //y
Plan Review ,(/
Ill II A Other Permit'
13125 SW Hall Blvd., Tigard, OR 97223' �� Date /By: 13G1f SOD y!�
Phone: 503.639.4171 Fax: 503.5 8. 9G0 '
� I , ® 1, Date Ready /By: Juris: / �' Dee rose 2 for
TIGARD. Inspection Line: 503.634.4175 . ,0 ` Notified /Method: ' j ill Supplemental Information
Internet: MM -ongov ® ®® `\ \ \CP' ` ()\a • TYPE OF WORK ��`` ri� i *�\ PLAN REVIEW
Li New construction U Addition /alteration /replacement G�� ��.V Please check all that apply:
❑ Demolition 111 Other: ��\ C] Service over 225 amps, comm'l ❑ Hazardous location
CATEGORY OF CONSTRUCTION �� ❑ Service over 320 amps - rating ❑ Building over 10,000 sq.ft.
U I- and 2- family dwelling U Commercial /industrial U Accessory building of 1- and 2- family dwellings 4 or more new residential
❑ Multi- family ❑ Master Builder ❑ Other ❑ System over 600 volts nominal units in one structure
JOB SITE INFORMATION AND LOCATION ❑ Building over three stories ❑ Feeders, 400 amps or more
Job no.: C11138 Job site address: 15055 SW Sequoia PRKWY ❑ Occupant load over 99 persons ❑ Manufactured structures or
❑ Egress /lighting plan RV park
City /State /ZIP: Portland, Or. 97224 CI Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
Suite/bldg. /apt. no.: f O Project name: Yecuris The above are not applicable to temporary construction service.
/ FEE SCHEDULE
Cross Street/Directions to job site: Description I Qty. I Fee. .1 Total . 1 ••
New residential - single or multi - family dwelling unit.
Subdivision: Lot no.: Includes attached garage.
1000 sq. ft. or less $ 168.54 4
Tax map /parcel no.: Ea. Add'I 500 sq. ft or portion 5 33.92 1
DESCRIPTION OF WORK Limited energy residential $ 75.00 2
Voice and data install Limited energy, non- residential $ 75.00 2
Each manufactured home or modular
U PROPERTY OWNER I H TENANT dwelling, Service and /or feeder 5 67.84 2
Name: Service or feeders installation, alteration, and /or relocation
200 amps or less S 100.70 2
Address: 201 amps to 400 amps $ 133.56 2
401 amps to 600 amps S 200.34 2
C ity /State / "LIP: 601 amps to 1000 amps $ 301.04 2
Over 1000 amps or volts $ 552.26 2
Phone: Fax:
Reconnect only S 67.84 2
503- 295 -5555 Temporary services or feeders installation, alteration, and /or
Owner installation: This installation is being made on property that I own which is not relocation
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 200 amps or less $ 59.36 I
Owner signature: Date: 201 amps to 400 amps S 125.08 2
401 amps to 599 amps S 168.54 2
U APPLICANT I Li CONTACT PERSON Branch circuits - new, alteration, or extension, per panel
Business Name: A. Fee for branch circuits with
service or feeder fee, each
Contact name: branch circuit 5 7.42 2
B. Fee for branch circuits
Address: without service or feeder fee,
each branch circuit $ 56.18 2
Each additional branch circuit: S 7.42 2
City /State /ZIP: Miscellaneous (service ar feeder not included)
Phone: Fax
Pump or irrigation circle $ 67.84 2
Sign or outline lighting S 67.84 2
E -mail: Signal circuits(s) or limited -
CONTRACTOR energy panel, alteration, or
Business Name: Capitol Data & Communications, Inc. extension. Describe: Tcle /Data 1 75 75.00 2
Page 2
Contact name: Hillary Porter Each additional inspection over allowable in any of the above
Per inspection 5 66.25
Address: 11401 NE Marx Street Investigation per hour (I hr min) S 66.25
Industrial plant per hour S 78.18
City /State /ZIP: Portland, Oregon 97220 ELECTRICAL PERMIT FEES*
Subtotal 75.00
P one: 503 255 - 9488 Fax: 503 257 - 7121 Plan review (25% of permit fee)
1 n / / State surcharge ( 12% of permit fee) 9.00
• CCB Lic.: 142457 Electrical Lie.: 26 - CLE Suprv. Lic.: 2757LEA TOTAL PERMIT FEE 84.00
Suprv. Electrician signature, required: 1 This permit application expires ifa permit is nut obtained within 180
I i_./.. - _ days after it has been accepted as complete
Print Name: Terry Brasch �. / Date: 05/19/11 * Fee methodology set by Tri- County Building Industry Service Board
Authorized signature:
<?.---.----_. * *Number of inspections per permit allowed.
Print Name: Terry Brasch
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