Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2012 -00118
T [GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012
Parcel: 1 S126BC01506 —
Jurisdiction: TIGARD
Site address: 9020 SW WASHINGTON SQUARE RD 500
Project: Datalink Cable Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: (1) data Communications
Contractor: TELESPHERE Owner: WISCO REAL ESTATE EQUITY FUND I
449 SW ALDERWOOD 1501 SW TAYLOR ST STE 100 •
WEST LINN, OR 97068 PORTLAND, OR 97205
PHONE: 503 - 880 -9412 . PHONE:
FAX: 503 - 638 -9286
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/11/2012 $75.00
12% State Surcharge - Electrical 06/11/2012 $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 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 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 23 322,11987 or 1
4. , - l I
Issued By: Permittee Signature: M A rP�C4 [
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 603.639.4175 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.
•
Jun 06 12 11:39p Telesphere 5036389286 p.2 C
Electrical Permit Application RECEIV p - FOR OFFICE USE ONLY
Tigard of Ti
City o dCt' d
City g D eceive : �mmit e
13125 SW Hall Blvd., Tigard, OR 97223 JUN 0 7 2012 4 (( its- Si S j �( .- DD((S
gn Plan R cvi w
Phone: 503.718.2439 Fax: 503.598.1960 DatcBv: Mar Peonit.
-1- 1 G A it D Inspection Line: 503.639.4175 CITY OF TIGA� ii Dare ReadyB �
y: 1u: El See Page 2 for
t
Internet: aww.tigtrd or.gov R'' IL OF t� 9 REVIEW Notifed dethod: Supplemental information
•
TYPE OF w0IDING DIVISI. i - • PLAN REVIEW
❑ New construction ® Addition/alteration/replacement I Please check all that apply (submit 2 sets of plans wiitems checked below):
❑ Service or feeder 4t)0ampsormore 0 Buildin over three stories.
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION .. I exceeds 10.0ot1 amps at ISO volts or ❑ Flatting buildings.
less to ground, ur cxceccs 14,00:) ❑ Cornmercia( -us.t agricultural
❑ 1- and 2- family dwelling ® Commenia1industrial ❑ Accessory building amps for all other installations :.uildings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Instillation of 75 KV A or
"JOB SITE INFORMATION AND. LOCATION - ❑Lae Berry system larger separately derived system.
_ ❑ Addition of now motor land or ❑ "A ", - L• ", "] -T'. - i -3
Job no.: 6612 Job site address: 9020 SW Washington Sq Rd in i tto mrmar` occupancy.
❑ Sit in more asidenial - Jails. ❑ Recreational vehicle pa-1a.
City/State/ZIP: 97223 ❑ Health -care f acilitirs. ❑ Supply voltage for more than
❑ Hazardous locations. 6(10 oohs n_mirat.
Suite/bldg. /apt. no.: 500 I Project name: Datalinit cable ❑ Service or feeder 600 amps or mote.
PEE SCHEDULE
• Cross street/directions to job site: SW Scholls Ferry Rd and Washington Sq Rd inscription I Ric- I Fee. i Total I •
North of Washi tun Sq 114a11 New residential single- or multi-family dwellinp unit.
n`e 9 Inehdts attached garage
Subdit•ision: Lot no.: 1.000 sq. IL or less 168.54 4
Ea. add', 500 sq. It or portion 33.92 l
' Tax map /parcel no.: Limited env f residential
. DESCRIPTION OF... WORK - . (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Data cable for approx 25 location residential with above sq. ft.)
Services or feeders installation, alterntion, and/or relocation _
200 amps or lets 100.70 2
Q PROPERTY OWNER , . - .❑ TENANT 201 amps to 4110 amps 13336 2 • 401 amps to 600 amps 20034 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 4110 amps 125.0K 2
Owner installation: This installation is being made on property that I own which is not
401 amps s to 599 a 4 166.53 2
intended for sale, lease, tent, or exchange. according to ORS 447, 449, 670, and 701. P p
Branch circuits - new, alteration, or extension, panel
Owner signature: Date: A Fee for branch circuits with
above =mice or feeder fcc.
El APPLICANT • I El CONTACT PERSON each branch circuit
2
• Business name: B. Fee for branch circuits without
service or feeder for, first
56.10 2
Contact flame: branch circuit
Pack add"! branch circuit I 7.42 2
Address: Miscellaneous (service or feeder not Included)
Each manufactured or modular
CityiStateiZIP: 67.54 2
dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Plump or inri circle 67.84 2
E - mail: Sign or outline lighting 67.84 2 •
CONTRACTOR Signal circuit(s) or limited -energy"
• Business name: Telesphere panel, alteration, or odeasion I Page 2 _ 7y 2
Each additional inspection over allowable in any of the above
Address: 449 SW Alderwood Dr Additional immpection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /StateiZIP: West Linn, OR 97068 Industrial plant (1 hr min) 78.18.' hr
Phone: (503 -) 880 -9412 Fax: (503) 638-9286 inspections for which no fcc is
90.00/ hr
specifically listed (Vi br min)
CCD Lie.: 149154 CAI Electrical Lie.: CLE l 18 Suprv. Lie 4551LEB ELECTRICAL PERIIIIT FEES
,�
Suprv. Electrician signature, required: ,��t � % t �t � Subtotal:
Plan review (25% of permit fee): I
Print name: Michael Ciccotelli /� Date: 6-7 -12 State surcharge (12%ot' permit fox): 9
gnture: �� ��ct< f/ = TOTAL. a permit FEE: 84
AuthoriTed sia
This permit application expires if a permit Is not obtained within 180
days utter it has beers accepted as complete.
Print name: Frederic Ciccotelli Date: 6 -7 -12 • Member of inspections all owed per petal:
r?aniklitrgtPetmiwtLC PeanitApp doe 0'01'10 440.4615T(I 1 /05:COtVWE13