Permit . r.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 C • COMMUNITY DEVELOPMENT Permit #: ELR2009 -00197
..TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/22/2009
Parcel: 2S113AC00103
Jurisdiction: Tigard
Site address: 7204 SW DURHAM RD 300
Subdivision: Lot: 0
Project: Consumer Cellular
Project Description: Install restricted energy for voice and data.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 07/22/2009 $75.00
#300 12% State Surcharge - Electrical 07/22/2009 $9.00
PHONE:
Contractor:
NETVERSANT SOLUTIONS III LLC
9740 SW NIMBUS AVE
BEAVERTON, OR 97008 •
PHONE: 503 - 646 -0533
FAX: 503- 641 -6613
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 Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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
952- 001 - 0010th ough._OAR 952- 00 1 -0100. You may obtain a cop of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344,
Issued By: ! 1_D Permittee Signature: L12
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 an inspection that business day.
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.
JUL 7,19-2009 (SUN) 22: 08 NETVERSANT CASCADES INC P.001/003
. „. .
,„..
Electrical Permit Applicati 10 r cE1X I tr n FOR OFFICE USE ONLY .
City of Tigard t C . v L.ala peacivior
Dateitivt ....4 Permit No.. - R2 -CO q "7
, " 13125 SW I-lall 131:1:11., Tigard, 0
, OR 97223 Plan Review -
: 1 -. Paine: SW
Fax: 363.59/1,195UL 2 0 Z0 , 00,,,,P4riait:
T iAn ' Inspection Linz 503.639.4175 1.2aIc iyttly: 1E7111 &I see Page 2 far
- 11111:rnett www,livatd-itt.pv
op OF TIGARD Notified/Method; 'ig _ a Supplemental Iniormation
)1,:1,!1!Fill'111:'1111fi'll'i li,111 ' 111i 1 .1 01'111 1 1,1A41.111 . 11;1:1111 . 1,,1 1 14.i*kt:1*'!.: , ! ! titilligItalVIViialit'llIkl!1, , j1;,,11:1;,,'',.1, V I . Yi1 . 1.:,..:i:,.;,.iii„.11..
0 New constmetion Addition/alteration/replacement 1.1.4sc viival: an Mat imply (submit ; r■ela OrI11111111W/IIEITI2 CIIEdird bcIoW):
CI Notvivo or ranter 40n amps or more 0 Building over three stories.
CI Demolition U Other: whet the available theft current OS/farina and boatyards.
' , •-• • • ' : ' • •'''W1.1.1'I'lli!diOteD10101:11•CiA:tiiiiii0loNI'fil!ii!!q:11'1'11111'1111'0-1111111,11,01'iriidi':;..;ili'i exceeds 10,000 amps at Io S sub 0 s nr Floating haildfngs,
less Io ground. ur iowein.lri Rua° 0 Colionereliii.mo iitrrienitimil
C:1 I. and 2.1amily dwelling j Commercial/industrial 0 Accessory building me. Mr ell miter installations. buildings.
0 Multi-family 0 Master builder 0 Other 0 rat pomp, CI lihnallation of 75 KVA at
CI Finetgeony sysiaitt itirger herhinaely ilerlvell sysieni,
!I '' " T l ' ! : :!.'1! . :' 1. !I 11 :iU V1'11 i1:1..14.011.$,I, :d liqS10..0,14t0..b$, 1 00 5 , "r:(0.04.i.;!Ndliii.::11 1;,..',;,,',.',1 1! 1111!1!!!11!1 I'll 10 t
' 7
1 ,.., ',within allow 1I1.1ur Ind tyl 0 "A","E",
inntIn or mom, Neig
' lob no. li t 2 L i job site addres 11 ° 1 4 S kli .I) til ( he PeA 0 Six or Marc residential uniti:. I:1 Retten tional vciiicte parks,
"
CI 1V/Sthtca. l I 1 P0)-1---1 aez, 1' 1 z, z o H.4101.41,, rociliti... ci su vuhatal cur mow awn
1 o114241,fi I 6o IN louthul.
cuit)bldgiurn. no.: 3 00, j Project name: ea4Sur (l_ 0 !krviee or ibedee 600 amps or mare.
fi
Cross greet/directions to job site: DocrIpllan - I 9q. L F-. J TONI I •
New residclithd DIN:le-or multi-family (livening unit.
-
Includes littoclicd garuge.
, ... ..
SubdiviMon: 1 Lot no.; I ,uuU sq, It, nr less 145.15 4
—
- En. adtP1500 sq. 11., or portion 33.•t1 1
Tax limp/parcel no,:
Limited energy, residential
37 .00
li il. II li ! !!!!'l!IIIIII . IIIIII!Illil I IIIIIIII ft rwitli.above.q ft.,
— • — Cllird rtieray. mulii•laTriliy --
75,00 1
Voji,L___1 — - ELL residential Witt above si.n.)
Services or,F■:et1ers installation, alters inn, andinr relocation
206 amps or less 1 ---- 14r1.30 2
„1:1 '1!iidtEi4h0.1!1•0.0i l'W 'LI' I'll'il ill!,1.11 il 1111i 41!,111,,l'i.;!1:' A:r 4,11111111111111 :!! I i I
i , -1, ,..): ,,,,,,,,I,,:,.1.1, ,:,:!li,I. :01 amps to 400 tangs 10fi,t4$ n
.,
--....
4W amps to son amps 160.60 2
Name:
001 [mina 10 1,000 ups 2■10,110 2
---____
Marco: Over 1,on0 amps or volts 434,63 q
.
,..-------
—
City/StnteZiPt Temporary berviees or fectlerlilnittaltation, niteratinn, antlicir
-. rcluention
_
Phone: ( 1 Fax: ( ) 2110 amps or less 66,85 1
Owner installation: This installation is being mode on property that I own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701. •01 amps to -599 autos J 133.75 2
linnet' c1rcultx- now. alteratiun, ur extension. p,er ?and
Owner signature: Date:
- A Fee for brunch circuits with
:: i: 11 i!.,:o.:Api.4tic,;,soi'11.1:1 4 1 1 . 01 1 !Ill i'V11. ::1 1 1,: Ini Pr l''.0.00[4,S,q41.1ajciIIIIII:I.I.:1:;in!I above survieu u Feeder ree,
6,65 2
eachirranch circuit
Business mime:
Li, Fee Ihr branch circuits —
without service ur feeder rec,
Conflict num: •0,85 2
first branch circuit
. .
Address: Gash add brunch circuit 0.65 __± _
Mkeella neunt, „SbervIer or t(74,7i. not Included)
City/State/ZIP; Each main ithclu red or modular
9090
_dwelling, service and/or reciter , 2
Phone: ( ) Fax: : ( ) Reconnect only 6ti,85 2
. _ .
li•muil: Pump or Irrigation ofrcle 5140 • 2
' ' • : • ; ' . : ' ' . , j . .. ' 1 ' : : ! • : ! - : : : 1 1 I l l l i i . 1 1 , 1 . 1 o'coNTRACTok.11 1 1 1 . . 1 . i i ! , . . ' .! H11 11:'11!111 11 1 11 1 11 i.:: : ,.'.1'., ;I! i 11,1HT Sign or outlinc lighting 53,40
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Slum! ciroains) or limited
_1311sltle/...V:±V‘Z.2ciB.±......50 (4,,fiGISS j LI L-I.-L-- energ! mulch alteration.
Address: CI 91/ 0 51, iv i 0, b vi s pl yko,.0 42 .r......, exiensidn. Describe: [ Page 2 75
City/Statc/Z11 et‘,.. ite4 --f n i riy< ( 7cl 6 s Each additional Inspection over allowable In any,rci). above
- ` - ` — . Per inspection 62.50
Phone; (5b3 )6 it cc, - 0.5 3. Fax: (,1 5)6Lit —Ce Ce 61, Investigation per hour (I hr mint
.
6230
,
CCI3 Lie.: igi ( 4loctricaf 1,1c.: Le i I Suprv. Lie,: e7 10 1.44k 1 Industrial plant per hour 73,75 .
Suprv, Electrt&in tiar
r( uee, required: 1
• - , k . 7 1 10 ( ( k .,..,J,III.i : ,::.,:;., i. :iiiirra • .,. 1 i
Sit Subtabil:
.
, / ' 1,4
Print name: b 6rt a 1›__pchric Date: 1 i 0 e., ,. _ ur Plan review RS% ra pcmilt fee): 'If/
State surcharge (12% uf permit fee): 1 . 0 0
r
Authorized signatUret . • TOTAL PERM rr Fix: ig 0 (,)
•
25 i Date: - 7/ 21 i. 0 4-) TIlli permit alttilleatioo ostdrns li a ilerml is not obtained **WI 150
days after It has Mien seentried &la aiirnoictc,
. Manlier In :inspections allowed per permit.
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