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Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00078 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/4/2008 PARCEL: 25101 BB - 01500 SITE ADDRESS: 12242 SW GARDEN PL BLDG 1 ZONING: C -G SUBDIVISION: CROW PARK 217 LOT: 003 JURISDICTION: TIG PROJECT: INTEGRATED SERVICES Project Description: Installing (1) low voltage system for data / telecom. A. RESIDENTIAL B. COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT: GARAGE OPENER: • CLOCK: MEDICAL: HVAC: DATA/TELE COMM: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: — HVAC: -- - -- - — PROTECTIVE- SIGNAL:- INSTRUMENTATION: OTHER: TOTAL # OF SYSTEMS: 1 Owner: Contractor: SPIEKER PROPERTIES LP TELECOMM MANAGEMENT INC 4380 SW MACADAM AVE STE 100 15611 PARTRIDGE DR PORTLAND, OR 97201 LAKE OSWEGO, OR 97035 -3121 Phone: Contact #: PRI 503- 639 -8209 Reg #: ELE 3- 463CLE FEES LIC 135355 Description Date Amount [ELPRMT] ELR Permit 4/4/2008 $75.00 [TAX] 12% State Surch 4/4/2008 $9.00 REQUIRED ITEMS AND REPORTS Total $84.00 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952= 01 -0100. You may obtain copies of these rules or direct questi s to OUNC at 503.246.6699 or 1 800 332.2344. Issued By: Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application FOR O USE ONLY , City of Tigard Received _ No 14 - t 13125 SW Hall Blvd , Tigard, OR 9 a Date /By ©�� ' .�� 1�(/ --- _ �/ g �i Plan Review a Phone 503.639 4171 Fax 50 . kn , Date/By- Other Permit T lG ARD inspection Line: 503 639 4175 \'' y ,n$ Date Ready /By: lures ® See Page 2 for Internet www tigard -or gov 1,\,? K ( Notified /Method Supplemental Information '!YPE OF W,i,QRK C ➢F i rirr° `� . 0 ❑ New construction Addition /altgratio `� c ■1 PLAN' REVIEW ' . ❑Er -Ad r i< r� e t i�6v • Please check all that apply (submit 2 sets of plans w /items checked below) TS IX AIL El Service or feeder 400 amps or more ❑ Building over three stories ❑ Demolition ❑ Other: where the available fault current ❑ Mannas and boatyards CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ I- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations buildings ❑ Multi- family Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system larger separately derived system ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: ' •iZ 4 Z —CIA/ GeUrde K) 49/-- 10OHP or more occupancy ❑ ❑ Six or more residential units Recreational vehicle parks City /State /ZIP: f G. L 4 "1/1 00 / ? ,A2 3 ❑ Health -care facilities. ❑ Supply voltage for more than _ ❑ Hazardous locations 600 volts nominal Suite /bldg. /apt. no.: / Project name: , _ ❑ Service or feeder 600 amps or more FEE SCHEDULE Cross street/directions to job site: I� i J '- f t/1 r '� � Ci o/1 w _, Description I Qty. I F. I Total I • l New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq ft. or less 145.15 4 Ea add'I 500 sq ft or portion 33 40 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq ft ) 75 00 2 ( 4171 Limited energy, multi -family 75 00 2 S Z 07 residential (with above sq ft ) Services or feeders installation, alteration, and/or relocation 200 amps or less 80 30 2 OWNER ❑ TENANT 201 amps to 400 amps 106 85 2 )PROPERTY \ 401 amps to 600 amps 160 60 2 Name: - i C ( t� la .< r l� /� s 601 amps to 1,000 amps 240 60 2 Address: ( 5CJ �i , _( ) ` ° t .-v ` 1 te et C tea , 4--,7r LS / C--() Over 1,000 amps or volts 454 65 2 City /State /ZIP: 74 7",. � ' Temporary services or feeders installation, alteration, and/or �l relocation Phone: ( ) Fax: ( ) 200 amps or less 66 85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133 75 2 Branch circuits — new, alteration, or extension, i er panel Owner signature: Date: A Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6 65 2 each branch circuit Business name: B Fee,for branch circuits Contact name: wuhout service or feeder fee, 46 85 2 first branch circuit _ Address: Each add'I branch circuit 6 65 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular 90 90 2 dwelling, service and /or feeder Phone: ( ) Fax: : ( ) Reconnect only 66 85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53 40 2 � Lf/I�C Signal circuit(s) or limited - Business name: ihC� � �P� � &yt- . ibjG , / � energy panel, alteration, or _ Address: 1` 0 i g oe i273 U extension Describe. r Page 2 / S 2 f City /State /ZIP: La C a CA/ee U U4, 9' �v - .S Each additional inspection over allowable in any of the above ( / Per inspection 62 50 - Phone: ( ) 62q/-- d Fax: ( ) Investigation per hour (1 hr mm) 62.50 CCB Lic.: Ct_t, 13 S - 70 — Electrical Lic.: 20Z Suprv. Lie.: Industrial plant per hour 73 75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: .. Subtotal' •7 5 — ,d & Print name:D� i i (1 / ' Date: 0 � Plan review (25 % of permit fee) P A State surcharge (12% of permit fee) 9 Authorized signature: TOTAL PERMIT FEE t p y C This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I \Budding \Permrts\ELC- PermmApp doc 05/23/06 440- 4615T(11/05/COM/WEB b Electrical Permit Application - City of Tigard Page 2 - Supplemental Information • LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: H Audio and Stereo Systems* n Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* H Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls H Clock Systems n Data Telecommunication Installation n Fire Alarm Installation Fl HVAC ❑ Instrumentation Fl Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I \Buddmg\Permns\ELC- PermnApp doc 03/23/06