Permit ,, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
! . '- COMMUNITY DEVELOPMENT Permit #: ELR2011 -00207
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Date Issued: 09/22/2011
Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 450
Project: River City Travel Subdivision: Lot:
Project Description: Low voltage for voice & data
Contractor: VALLEY TEL SERVICES, INC Owner: WISCO REAL ESTATE EQUITY FUND I
195 CAP CT SUITE 1 1501 SW TAYLOR ST STE 100
EUGENE, OR 97402 PORTLAND, OR 97205
PHONE 541 - 342 -7850 PHONE
FAX: 541 - 434 -0376
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/22/2011 $75.00
12% State Surcharge - Electrical 09/22/2011 $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 accord -. - - ' • 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 ATTENT aN Oregon =w requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -001 r through OAR 952: -0190 You may obtain a copy of the rules or direct questions to OUNC by calla . - .1987 or 1.800 332.2344!
1 A
Issued : y: / I t / Permittee Signatur ,_,111 f ' (B_`_-
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 /22/2011/THU 11:47 AM VALLEY TEL SERVICE FAX No, 1 888 459 1610 P, 001
,.�
EIectrical Permit Application , lflruc <rILr urJnn ° l,. V '
City of Tigard . , �•�� Date/13 ! ? A' 4 ' ParmitNo.: eL ?of /- V- d7
13125 SW Hall Blvd., Tigard 97223 ` 1 . Plan ReVlew . /
C Other Permit; //
P h one: 503.718.2439 Fax: , �� *5 DeteB : ��� !C�
i. l c l n rt • • Inspection Line: 503.6394175 CJ� {` j !
,∎ i ,.,,,k\ Date Ready/13y• ruda' till See Page 2 for
)
Internet: www.tigard or.gov e 1 i s`?' , \ „7' Notified/Method: Supplemental Information
!`'4iail c is 'fir ; i ,m 4.:... , Nis 1 t '! ll cla si;('� ' } h1 ;, Ni { u , p� { � (, Q p u M. x f .
(y� q}y}�1 A ry.l'. 4 } ( ' 7 + ` �,�y� Q " , . . e, e S e I .i g• � n� � (” tlr �iir }, ?d e w, 9 t? � f il•1it,fNyliC, q ty{y�7{ t o r;
i) �i:V ;! ^ �� � < �r . . .'Ii AI' r�m4�!�;�1t.'r l.. ,, ,'...A•0%, . �, ,1 �1���� ,Iii., � [ rb „ t , • N1 L IPl ,�i � of plans w
� ip���G +•��G16i��17f��
e� e - ' " please cheek all that apply (submit sets /items checked below):
12 Now consttuetion ❑Addition /alter tion/rcplaeement
�'� ❑Service or feeder 400 amps pC rAOre 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
: a . ,,.w ,
{ u r an E `.,; i exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to mound, or csaeeda 34,000 ❑ Coxoxpercial_uge agricultural
[] 1- and 2- family dwellitg 'Commercial/industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
��,���� G p� -• r• ^�. v �.. {. ❑ Emergency syste larger separately derived system.
P YV', ' I a Yl�f"rt,► Q ��•� ` �V tt ir� - I �i` Wei
Y
"I;[t,BLR` ` k , ,C ' t_ ::Ri �, w ;�s +'i a „ . t e,.. � A �n , 1 s 1r i ' ❑ Ad dition o new motor load of ❑ "A ". `7 -. " 1,2 ", ` „ ,
looHp or more. occupancy.
Job no. n Job site address: [ IX
`r d SLR A r hf, rl ST 4 / K 171 Six or more residential units. ['Recreational vehicle parks.
City/State/ZIP! 0 ,4 1 y r 2 I ” U ❑ Health -care facilities ❑ Supply voltage far more than
['Hazardous locations. 600 volts nominal,
Suite/bldg. /apt. no.: LAS Project name: 'IUe.r l.4.1.1 \ (r� e1`e A ❑Servico orfeeder600 amps ormore,
s �41}�P�il uldt7br{mRO���t�ny�t5b P ` P 54 2 :, F �RIFI , t
tl t �- �, 71 1 �}�, i'� l!"'1 ',l"iF���
Cross street/directions t4 job Site ueaottptbn QL Pee. „ t.1
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
— Tax map/parcel no.: Ea, add'1500 sq, ft. or portion 33.92 1
Limited energy, residential
p m y ,, f� r ee,�p r 75.00 2
G `''7+ i l .ii ai 1 1 ' t H i� t� ' .7.1;,..1#4,' i / : .E f ' v (with bove Sq. ft -)
, � r t ; ti t�s.t 1 st ... • ,t i i, � .c , . �,lv , W la . I,E Io sr. o Limited energy, multi-family
Lou VOt,4.e , vok r . Q -4- ci e. �, residential (with above sq, ft.) 75.00 2
D V S Services or tbeders installation, alteration, and/or relocation
200 amps or less 100.70 2
ii �fir � � � t,1 �y;�{ ,} ` ��' 'il' ](I y$1 i J � (' 20 1 amps t° 4°C) amps 133,56 2
h � dl, e . �4 ,... . 2?r7S! t�:ti`C4I� '' , a a. • '�, � �y,4�} {,�,
401 amps to 600 amps 200.34 2
Name: _
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
. Temporary services or feeders installation, alteration, and /Or
City /State /ZIP: relocation
Phone: ( ) 1 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.06 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 am 168.54 2
Branch circuits- new, alteration, or extension, per panel
Owner signature: ' Date: A. Fee for branch circuits with
�t�k r o ; r J" a,, N above service or feeder fee,
`3k "fit Si, r! el 1 , t » � nS11T + fe�Et t, each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
- Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Cl /State/ZIP: Each manufactured or modular 67 84 2
City/State/ZIP: dwelling, service and/or ibeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67,84 2
E -mail: signor outline lighting 67.84 2
�4 � i 'n 1� , ^� ' BO 1. t
:a,, � n, /,M�}�_° `� � �y� r "t��e t " ��}��,�e`. „ �„ �{`s���l���. �r�h€f 3 .��1�.,- "f S113ne1 circuits) or limited-energy
Business name: 11 L `� �, t panel, alteration, or extension. I Page 2 2
Each additional inspection over allowable in any of the above
AddreSS: ) ' ,G4a. 6._.. , ( Additional inspection (1 hr min) 66.25/ hr - •
City /State /ZIP: A A r, gy p• ) , e ) C C1140
Investigation t hr min) 66.25/ hr
` ° e.1 1 industrial p lapt (1 hr mm) 78.181 hr
Phone: (�5 4 `) 3 r .p. ' 7 (3, t~ Fax: ( 4 I ) 3 C�. �. e -1 ( Inspections for which no foe is 90.001 hr
UJt / saecificall listed tAhr min
CCB Lie.: • Electrical Lie.: & _.4 - Suprv. Lic.: q , Le i► l v gwc,,4$','= ; , p' li AL" F, I`It ESt l St`'',+
1 5 t ' 7 , /y /40 /4 subtotal: 1 --
Suprv- Electrician signa c, • gaited: �tirt,__ - Plan review (25% of permit fee): - .
Print name: e 4411A_ , Date: q a C State surcharge (12% of permit fee): el. 00
TOTAL PERMIT FEE: 84
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after is has been accepted as complete
Number of inspections allowed per permit.
I;\ Building \Permirs\5LC- PermttApp.doc 07 /01 /10 4404515r(11/5S/COMMP -B
SEP /22/2011/THU 11:47 AM VALLEY TEL SERVICE FAX No. 1 888 459 1610 P.002
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Era a, s ‘.41k,go
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:
Fee for gash commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑
•
Boiler Controls
❑ Clock Systems
TX , Data Telecommunication Installation
❑ Fite Alarm Installation
❑ ,HV"AC
❑ Instrumentation
LI Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
blit ldin$1PermitaLC- PerxnitApp doc 07/01/10