Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 .- -; °'- COMMUNITY DEVELOPMENT Permit #: ELR2012 -00005
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/10/2012
Parcel: 1S126DCO3300
Jurisdiction: Tigard
Site address: 9900 SW GREENBURG RD 290
Project: Children's Nursery Specialties Inc Subdivision: LEHMANN ACRE TRACT Lot: 4 -5
Project Description: Low voltage for data.
Contractor: CABLE RUNNERS Owner: ATHERTON REALTY PARTNERSHIP
10500 SW BOONES FERRY RD 2100 S WOLF
PORTLAND, OR 97219 DES PLAINES, IL 60018
PHONE: 503 - 245 -3669 PHONE:
FAX: 503 - 245 -5705
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/10/2012 $75.00
12% State Surcharge - Electrical 01/10/2012 $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 - -: _ " • e 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. ' ENTION: Oreg•• law r ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 through OAR 95 -. -00••u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332 2344.
II %' 7 atiP
Issu -. By: Perm Signat
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.
Electrical Permit Applicaqi ; cE\jED rycNED
1 FOR OFFICE USE ONLY �y�
City of Tigard Date/B o 1 5 �� Permit No.: ��p2'..�1 5—
11 - n 13125 SW Hall Blvd., Tigard, OR 9722 Pl Review
Phone: 503.718.2439 Fax: 503.598.1 �� 1 2OVI. a
1 Date /By: ❑ 0 0 0 Other Permit: 0000 0
T I G A RD V
Inspection Line: 503.639.4175 Date Ready/By: 00000 Inns: See Page 2 for
Internet: www.tigard -or.gov ' i, TIGA t�D Notified/Method: 0 0000 II 00 Supplemental Information
TYPE OF, ' k1331'+ti U��l����3 Print name: ❑ ❑ ❑ ❑ ❑
U New construction U Addition /alteration /replacement
El Demolition El Other: 00000 PLAN. _REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
CATEGORY OF CONSTRUCTION
El Service or feeder 400 amps or more ❑ Building over three
Li 1- and 2- family dwelling U Commercial /industrial U Accessory building where the available fault current stories.
exceeds 10,000 amps at 150 volts or ❑ Marinas and boatyards.
❑ Multi family ❑ Master builder ill Other: 00000
less to ground, or exceeds 14,000 Ill
JOB SITE INFORMATION AND LOCATION ' , amps for all other installations . Floating buildings.
III
Job Job no.: [DEED Job site address: 9900 SW Greenburg Rd ❑ Fire pump. agricultural
El Emergency system. buildings.
City /State /ZIP: Portland, OR 97223 ❑Addition of new motor load of ❑ Installation of 75 KVA
100HP or more. or
Suite /bldg. /apt. no.: Suite 290 Project name: Children's Nursing Services larger separately derived system.
El Six or more residential units
Cross street/directions to job site: 00000 ❑ Health -care facilities.
occupancy.
❑ Hazardous locations.
0 0 ❑ 0 ❑ ❑ Recreational vehicle
❑ Service or feeder 600 parks.
Subdivision: 00000 Lot no.: DEED 0 amps or more. ❑ Supply voltage for
Tax map /parcel no.: 00000 more than
600 volts nominal.
DESCRIPTION OF WORK
Data Telecom FEE SCHEDULE
Description I Qty. I Fee. I Total 1*
ODD 0 0 New residential single- or multi - family dwelling unit.
Includes attached garage.
❑ PROPERTY OWNER ❑ TENANT 1,000 sq. ft. or less 0 ❑ 168.54 00000 4
Name: 00000 Ea. add'I 500 sq. ft. or portion 00 33.92 00000 1
Limited energy, residential ❑ 0 75.00 00000 2
Address: 0 0 0 ❑ 0 (with above sq. ft.)
Limited energy, multi - family 0 75 00 00000 2
City /State /ZIP: 00000 residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
Phone: (00000)00000 Fax: (0000D)0 00 00 200 amps or less 0 100.70 00000 2
Owner installation: This installation is being made on property that I own which is not 201 amps to400 amps 00 133.56 00000 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps ❑ ❑ 200.34 00000 2
Owner signature: Date: 601 amps to 1,000 amps ❑ 0 301.04 ❑ 0 00 ❑ 2
❑ APPLICANT I ❑ CONTACT PERSON Over 1,000 amps or volts 00 552.26 00000 2
Temporary services or feeders installation, alteration, and /or
Business name: 00000 relocation
200 amps or less E 59.36 00 00 0 I
Contact name: 0 ❑ 0 0 0 201 amps to 400 amps ❑ ❑ 125.08 00000 2
Address: 00000 401 amps to 599 amps 0 0 168.54 00000 2
Branch circuits - new, alteration, or extension, per panel
City /State /ZIP: 0 0 0 0 0 A. Fee for branch circuits with
above service or feeder fee, 00 00 7 42 0 0 0 2
Phone: (OD000) ❑D❑ ❑D Fax: : (00❑00) 0D 000 each branch circuit
E - mail: 00000 B. Fee for branch circuits without
service or feeder fee, first 0 0 56.18 0 0 0 0 0 2
' CONTRACTOR branch circuit
Each add'I branch circuit 0 7.42 00 000 2
Business name: Cable Runners
Miscellaneous (service or feeder not included)
Address: 10500 SW Boones Ferry Rd Each manufactured or modular ❑ ❑ 67.84 00.000 2
dwelling, service and/or feeder
City /State /ZIP: Portland, OR 97219 Reconnect only 0 67.84 00 000 2
Phone: Pump or irrigation circle ❑ ❑ 67.84 00000 2
hone: (503) 245 -3669 Fax: (503) 245 - 5705
Sign or outline lighting 00 67.84 011000 2
CCB Lie.: 26 951CLE Electrical Lie.: 2827LEA Suprv. Lie.: 2827LEA Signal circuit(s) or limited energy I G� 2
panel, alteration, or extension. Page 2
Suprv. Electrician signature, required: Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 00 66.25/ hr 0 C ❑ ❑
Print name: Phil White Date: 1/10/12 0
ii7C)
�— Investigation (1 hr min) 0 ❑ 66.25/ hr 0
Authorized signature: 0 ❑00
Industrial plant (1 hr min) 0 ❑ 78.18 / hr
d 0
00