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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ' 11111 /1 C OMMUNITY DEVELOPMENT Permit #: ELR2011 -00185 T_I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/03/2011 Parcel: 1 S126CA00100 Jurisdiction: Tigard Site address: 9225 SW HALL BLVD F Project: Ideal Image Subdivision: Lot: Project Description: Data telecommunications system. Contractor: XTREME COMMUNICATIONS, INC. Owner: GREENBURG CORNERS LLC 24023 NE SHEA LANE, #215 BY MENASHE, R BARRY WOOD VILLAGE, OR 97060 621 SW ALDER, SUITE 605 PORTLAND, OR 97205 PHONE: 503 - 618 -8816 PHONE: FAX: 503 - 618 -9985 FEES Description Date Amount Specifics: Restricted Energy Permit 08/03/2011 $75.00 12% State Surcharge - Electrical 08/03/2011 $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 ru - adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OA: •52- 001 -0090. You may obtain a c. • of the rules o • irect questions to OUNC by calling 503.232.1987 or 1.800.332.2344. • — � Issued B ' Permittee Signature: % J.�iirl� 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. 08/02/2011 12:10 5036189995 PAGE 01/02 . Electrical Permit Application, r f FOR O1 F1( 1, i. h. <trtil;1 City of Tigard '\ Deceived - 1 , I I ry f� • 1.3125 SW Nall Bivd., Tigard, OR 9 p 1 ' � � . ' Phone: 503,718.2439 Fax: 503,59 arse lo ® Other Permit! l i t.' n 1t n inspection Line: 503.639.41.75 + �c'' v�:,0 a pete rtendy /By; E see Page z for Internet: www.tigard- or.gov (�‘ ,,,,A\.-1 Notified/Method ) / Supplemental Information , , �.. + r. , . , .. : ] u .. �. .. i.�,. . , ...,.r. 1 �,) a ..,, •:'l " .. � i � .� ' S1'�� i C. r .Y l ji N. Jii , n,.j l .. : .2: ' ,�' . .^ N y J.�iL ' R? . i ...I.i : .:. 1 I. ... w ,� x . �. -. .:. ...... .. .... � r... � .r V{'. ., x i 1. , .�,} ,l i'. - :i` , . . I' A <�. � + :1 � ,...,.,�,�: -�..,: �,�a. ....I •, .J. I q.J:, <I' . ait�, - ,., ., .1..,. - , , .. ...: � .. , :.0,2 •�,� .. M, � k - ,� , . . . ; + ,. S,. .. ;; r �� 5 . �,y:;i „ ?.'1 0 New construction Kil Addition /alteration /re umement µ Please check till that 1pply (9nhmit 2 sots of plans w /items chocked below): • Q) y' ❑ Service or feeder 400 amps or more 0 Building over three stories. In Demolition ❑ Other: where lie avaflnblo Ihult anent Q Manna% and boatyards. iy i, .i (i }' � ' !'i' y� ter yll;f ; "I moo* 10.000 amps at 150 volts or 0 Floating buildings. r' ..d . i, 11.. � Y', .,yf��a.,. 6l." G` �f.i''.T. p w I' i'1C. . ; f , ', . " -: -• i'Ci�l 'I'ia ,,. e !A4 V ' ' b i .' -. ' ` i ' : i - leas to ground, or exoccds 14,000 ©Cammerernbrtsa agricultural ❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings, 0 Multi -family ❑ Master builder ❑ Other: ID Flra ptnnp, 0 Installation of75 KVA or „ - D Add gcn o system. larger rarely derived s stem, �' "�i'�' >;�ar�r++�;, e, yy,11:' ' P', n - y y(,�' t „t},oy,��yr� ,y�1�:;;��'c. :r:::..;.- r.{:;:,�:1; Rte' Y ,4',n` ii,;!• 7 ;•i,''� ' ; N . ireful iL..l'L� iti t'ienfiIIV ^.ARi 'A1:1i11” ie \7PI :.,.1 '�,'�:': "E","1-2°', .. ,., morel. load of 1- .. N .. ite addre 9225 SW Hap .. :..:..:::.: .... .. +,i. %' :,.{: ?'I ",:x ❑Additionnfnow .. Y. 3 ", lob no.: . :.." Job s ,,. ,, ,.� � . „ -. ;� .,. S5: Blvd Suitt F I OOHP or more, age "pnneY• 0 six or more residential units. ❑ Recreational vehicle parks, City/State/ZIP: Tigard OR 0 Henith - care facilities, 0 Supply voltage fbr more than • D Hazardous locations. 600 volts nominal, Suite/bldg. /apt, no.: F Project name: ideal ua itr El Service or feeder 600 amps or more. ,., --. -- ;O' J ,'S h W ! ' ' ''' :;iv:.l; " '? 'SY ° • " ; :i � , k, .Cli'f Id/ �yY'Vf :C':;, iiF'il � Cross street/directions to job site: Greenburg Rd ascription j ott, I FCC. i ' ` TOW • " New residential single- or multi- family dwelling unit. Includes attached garage, Subdivision: NA Lot no.: NA 1.000 sq. ft. or less 168,54 4 Tax map/parcel no.: ... ". Es. add'l 500 sq, ft, or portion 33,92 1 Limited energy, residential 75,00 2 ,�:6 ', ,,� a• ... - ..N -, with nhmc s lIii } '.6 ft r ` ?11Yi �'i"C`fi�'�i�fl'�,''�i'll 'i+' I, �, ;i�o�i�� 1. r airr nl �.. %12"1 ' ': „• , f..�.i . 0 4 ” ^• 'i ,: �,n ;.p'. 'I "'"i ": . 1 , S ..� ,. . am ,..,. ..... . ; � ss `� ": '�' ; `� � Limited energy, multi- family 75.00 2 Installation of voice & data low voltage cabling residential (with above sq, ft) - - '--' Services or feeders Installation, alterntion relocation 200 amps or less 100.70 2 ''L;. ' . 1 '. �i; r.- ; "h 1:Y,* 'y.;,. s 133.56 2 201 amps to 400 am a " ' ; �,:. . �3rt{t`.�lt'1f"I;''r'�L'>l ; ;. , ��' i!wgf? , �:; ?;. i 'r�' P D ,' At .. r . � . r ��r._ r, nc xNr !., i c �/ y . � 6� "l a��,-� .r.�l,'. ,r.yn .,f, ,Idu !!., r,� Name 4tl1 amps to 600 amps 200.34 2 — 60I amps to 1,000 amps 301,04 2 Address: Over 1,000 amps or volts 552.26 2 Tempora services or feeders installation, alteration, and /or - City /State /ZIP: relocation Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on properly that T own which is not 401 amps to 599 amps 168,54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 .. e Branch new, a iteration extension, per panel Owner signature: Dote: A, .fee fbr branch circuits with ; ; :\ - ',r .; ,: ,r, 7 ;.,',, .;.is shave service nr feeder fcc c "' '' - irI ;:'"''' ? -. a...,1 ."''' ,°, . 7.42 2 r � „�' .....:....:.. �� ,.��t i� „ a •.'-,J,.•. w'�i; ,•� each �• • ' ' • • 1, circuit ” , Business name: Xtreme Communications B, Fcc for branch circuiiv without service or feeder fee, first 56,18 2 Contact name: Carl Rickert branch circuit - ` -• Each add'i branch circuit 7,42 2 Address: 24023 NE Rita Lane #215 Miscellaneous (service or fbeder not Included) Each manufactured or modular City /State/ZIP: Wood Village, OR 97060 67,84 2 dwellin scrvicc andior feeder Phone: (503) 710 -1480 I Fax:: (503) 61.8 -9985 Reconnect only 67.84 2 Pump or Irrigation circle 67,84 2 E-mail: Sign or outli lighting , ,• ;, ',, .. 67.84 . ,.. ..,,. . . ,t . , ':, _, ,.., , ', -, ! > ' N; g;>-T:j, >. r r , a' �:1::':;,,•:!V:.,:,:.;; ::.,; Signal circult(s) or limited-energy 75 ,00 Business name: Xtreme Communications panel., alteration, or =tension, Pa c 2 2 " Each additional inspection over allowable in antof the above Address: Same as above Additional inspection (1 hr min) 66,25/ hr City /State /ZIP: - investigation (1 hr min) 66.25/ hr industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90,0 / hr CC13 T is : 1 9 72 3 T:lectrtcal Lie.:3 3, j,5 33 snecu Ica1 y listed __:, �i hr min �' Saplw. Lie.: �.�tt'9 ,�'�,: ,i'�hp,.:,:. _)I�liiilri�w- ','��'�1�i` �y t "tL ":.;:')'t Subtotal: 75,00 Suprv. Electrician signature, required: Plan review (25% of permit fee): — Print name: 3 0 Al - .,1d-F€ I 4— Date: g —z _ 1 i State surcharge 02% of permit tee): /) � 1, TOTAL PERMIT FEE; 84.00 <. Authorized signature: � This permit application aspires if a permit is not obtained within 1110 days after been accepted as enntplete. Print name: Date: • Number of Insncctlona ellowcd per permit, 08/02/2011 12:10 5036189985 PAGE 02/02 Electrical Permit Application - City of Tigard Page 2 - Supplennerital Information . LIMITED ENERGY PERMIT FEES: i F y 'f , wGr ";Ti " ^ �.� i r t '.arS ,�t,� 4� ..' � - . n' 1. � ., , .. ^ Jf " ":�,J -ti..li i �d' �:,I7P' f„ �'!' ��pAr ',',n''nY',,�ii�'C'V,i7r,,, 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: r ' r ���. Yi. 1iL, W:f�'F�W'a, \�+F:'•�,,. ,',r..,rl "r �f..''I[:'y:'�� !, :'IS�Ji Fee for ,eagh commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems • Data Telecommunication Installation ❑ Fire Alarm Installation ❑ FrvAc ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ . Medical, ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: L *No licenses are required. Licenses are required for all other installations