Permit it CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELR2011 -00206
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 09/14/2011
Parcel: 1 S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 120
Project: Server Logic Subdivision: Lot: 0
Project Description: Low voltage for data
Contractor: APPLIED TECHNICAL SYSTEMS INC Owner: WISCO REAL ESTATE EQUITY
7015 SW MCEWAN RD 1501 SW TAYLOR STREET, SUITE 100
LAKE OSWEGO, OR 97035 PORTLAND, OR 97205
PHONE 503 -684 -9611 PHONE' 503 - 294 -0400
FAX. 503 - 598 -0498
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/14/2011 $75.00
12% State Surcharge - Electrical 09/14/2011 $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 ATTENTIO gon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -0010 ough OAR 0 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503. 2.1987 or 1 800 332 2344
Issued B &I/kJ:2_44J. Permittee Signature: Ii t
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.
Sep, 14, 2011 1:09PM . � � il No. 8391 P, 2 tii L.
Electrical Permit Applic tion ` FOR OFFICE USE ONLY 1 4 201Q -
City of T igard n s .g47 n t No,: ; �l -0e9 R0 0.i
,IN 13125 SW Halt Blvd., Tigard 0Ry9t7223 Tir @ .trJ Plan Review
' ' Phone: 503.718.2439 Fax 503 598,19.60 r; g ,y \ - Data Other Permit:
p
Ins ectionLine: 503.639~17SL Llir8+ lLA I� (�;t� Date RcadyBy funs: � See Page 2for
TIGARU Noti0ed/Method: 5u lelncntal Information
Internet. WwW.tigard- or.gov pp
TAE 'OF ■44r0ItIC PLAN $E1?IW ;
El New construction Additlon/alteration/replacement Please check all that apply (submit; sets of plans whtems checked below).
r--t ❑ Service or feeder 400 amps or more ❑ Building over three stories,
❑ Demolition 0 Other: where the available fault current ❑ Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑ Floating buildings. Cr�I7;GOR7z OF CONS�UCTION less to ground, or exceeds 14,000 ❑ Commeroial• use agricultural
❑ l - and 2 dwelling Commercial/industrial Accessory bu ildin
y g Q ry $ amps for all other installations. buildings.
❑ Multi- family Master builder ❑Other: CI Fire now. ❑ Installation o f75 KVA or
, ❑ Emergency system. larger separately denvcd system.
JOB SITE INFORMATION AiND LOC ,TI,ON ' . , ❑Addition of new motor load of ❑ °A" "B" '1
Job no.: 6- 6 (7 fob site address: ?Q zv sue.) WAS�r 100HPormore occupancy.
0 Six or more residential units, ❑ Recreational vehicle parks.
City /State /ZIP: p 7-L p ca.. f 7 .7L (AA-f & . , .t ,i ❑
- 0 Supply vitege formore lhsn
1 ?, ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: r l20 I Project name: ,/,.r2/� toi 'C., ❑ Service or feeder 600 amps or more, -
TBB SCIIJCJO,VAE .
Cross street/directions to Job site: - uescrlpuoa 14ry. I Pee. I Teal r
New residential single- or multi - family dwelling unit,
Includes attached garage,
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'l 500 sq. ft. pr portion 33 92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION ,OF. W,01TK, - (with above sq. ft.) 75.00 2
�` T (1+ t0 + Limited energy, multi-family 75,00 2
residential (with above sq. ft.) _
Services or feeders installation, alteration, and /or relocation
200 amps or lass 100.70 2
❑ FYiOPEIix OWNER a TENANT ,..._
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 ^ 2
Name: 601 amps to 1,000 amps 301,04 • 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders Installation, alteration, and /or
City/State✓ZIP: relocation
Phone: ( ) Fax: ( ) 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
intended for sale, lease, rent, or exchange, according to ORS 447, 44 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: ,Date: A. Pee for branch circuits with
,E1•.�PP,LICAN�( • " 0 ■CONI'AGT PER30N: above service or feeder f8e, 7,42 2
each branch circuit _
Business name: z //,/ I J ow / r l^�- C B. Fee fbrbranch circuits without
` service or feeder feo, first 56.18 2
Contact name: //i� 4 _1t P L t 7 r ,/►S branch circuit _
l� "ti T 1 !' Each add'l branch circuit 7.42 2
Address: ') () 5` ma(.-) 4G C,J4 -w R ( - , /lt .0 Miscellaneous (service or feeder not Included)
City /State /ZIP: L„ k (S w . Q 0 0 70 Psch m serv and / r feeder 67.84 2
dwelling, service and/or feeder
Phone: (g,) j G? 9` f / 6
Pax (50S Q �� Reconnect only 67 -84 2
�� Pump or irrigation circle 67.84 2
p L , A r S $ a` . I>t��+" s • L C L....-,,, Sign or outline lighting 67.84 2
CON 'C:T,CR ,.' ', -- . Signal circuit(a) or limited- energy
Business elatne: Panel, alteration, or extension. -1 - Page 2 2
Each additional Inspection over allowable in any of the above
Address: ,/,} --, �1 .� Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP "t1 b
Jnvostigstton (1 hr mm) 66.25/ hr
Industrial plant (1 by min) 78 18/ hr
Phone: ( ) Fax: ( 7I ( lo b 11 Inspections for which no fee is 90,00/ hr
1 specifically listed (h hr min)
CCB Lie.: 3?5 131" Llectrical Lie.. 4--71 CLt; Suprv, Lie.: 2.997 (, &4 , • ; 'Eh1s,CTRICAL,'PERMIT FEES • , ' ' '
Subtotal:
Suprv. Electrician signature, required; /
tr Platt review (2 f permit fee):
Print Mime: 4, „ / r Date: �� State surcharge (12% of permit fee);
Authorizeclsignature: � t
, TOTALPBRMITFEE: 0
���� This permit application oxpiros If a permit is not obtainedwtthm 180
Print name: �� pate: ���� a days after It has been accepted as complain.
Number of Inspections allowed par permit.
r' tiolt ding1PennitOPf_C- Prrp 07/01/[0 410- 4615T111/05/COMAWO
Sep. 14. 2011 1:09PM No. 8391 P. 3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
P ESxI5Wrr, rA *,OO,), cii∎ILX:, ' , . , , ,
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
F,667 IME igiE - -.... — , 2 .. .. 1
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved;
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
yfi Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other,
Total number of commercial systems; f
*No licenses are required. Licenses are required
for all other installations
I -\Buildinglprrmdc\LLC- PermitApp doc D> /01/10