Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2012 -00187
13125 SW Hall Blvd.. Tigard OR 97223 503.718.2439 Date Issued: 08/14/2012
T [ GA.R. L� 9 Parcel: 25101 DA00101
Jurisdiction: TIGARD
Site address: 13190 SW 68TH PKWY 110
Project: Stearns Lending Subdivision: VARNS ACRES Lot: 9
Project Description: (1) limited energy panel for Data Telecommunications
Contractor: CAPITOL DATA & COMMUNICATIONS Owner: PACIFIC NW PROPERTIES LIMITED PA
11401 NE MARX ST STERN FAMILY LIMITED PARTNERSHIP
PORTLAND, OR 97220 STERN, HELEN R REVOCABLE TRUST
6600 SW 105TH AVE #175
BEAVERTON, OR 97008
PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 -7121
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/14/2012 $75.00
12% State Surcharge - Electrical 08/14/2012 $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 -009 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
2.1
Issued By: Permittee Signature: 0 "i PR.) e oki_
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.
08/13/2012 13:56 5032551966 CAPITOL ELECTRIC PAGE 01
•
r ri Electrical Permit Appiicatio , .- -i y I " Received FOR OFFICE t1Sl {t,Nl.,'
Li Q- S...to t-- - • Of t mtit nn.: /� 'f,v pmt • Dute/13y: I (!} P GL €. o . — tv�Q !
City of Tigard Ird
AUG 1 3 2012 Plan Review
II " 13125 SW Hall Blvd„ Tigard, OR 97223 U OtherPcm,i l
;ircllty; (k9(4/
Phone: 503.639.4171 Fax: 503.598.1UL �„ a pore Ready/By: Juris: I e r.cc z roc
Inspection I G A R T? spon Line: 503,639,4175 _I •••• i , p,;,,?.iii Nntiflcd/Meth 1 euppinmminl Information
Internet: www,tiganl g v 21.1ii, tr
_ TYPE OF WORK PL e.N xsvifiw
L Now construction U Addition /alteration/replacement Please check all that apply:
n Dcmnlitinn ❑ Other; ❑ Service Over 225 amps, comm'I El Hazardous location
CATEGORY OF CONSTRUCTION . L Service over 320 amps - rating n Building aver 10,000 sq.ft.
U 1. and 2 - family dwelling u Commercial /industrial L Accessory building of 1- and 2- family dwellings 4 or more new residential
El Multi lhmily ❑ Master Builder L Other ❑ System over 600 volts nominal units in one structure
JOB SITE 1NFORMATIOi4.ANULOCATION . . ' ❑ Building over three stories L Feeders, 400 amps or more
lob no.: C12370 Job site address: 13190 SW 68th Pkwy
CI Occupant bad over 99 persons CI Manufactured structures or
❑ Egress/lighting plan RV park
City/State/ZIP: Tigard, Or. 97223 11 Health-care facility U Other
Submit a sets of plans with any of the above.
Suite/bldg, /apt. no.: 110 Project name: Steams Lending
The above are not applicable to temporary construction service.
FEE SCHEDULE '
Cross Street/Directions to job site: Description I rpy. I pee._ I Taal 1 "
New residential - single or multi- family dwelling unit.
Subdivision; includes attached garage.
Lot no.: 1000 sq. ft. Or Icss $ 168.54 4
Tax map /parcel no,: Ea, Add'I 500 sq, fl or portion $ 33.92 1
• •
DESCRIPTIONOF WORK Limited energy residential S 75.00 2
Install Comeast Coax for distribution. Limited energy, non residential 5 75.110 2
Each manufactured home or modular
11 PROPERTY OWNER I Li TENANT dwelling. Service and/or feeder 3 07.64 _ 2
Nante: Service or feeders Installation, alteration, and/or relocation
200 amps or less $ 1 00.70 2
Address: 201 amps lo 400 amps $ 133.56 2
401 mops to 600 amps S 200.34 2
Cily /Stnl.e/lII'; 601 a pa to 1000 amps $ 301.04 2
Over 1000 amps or volts S 552.26 2
Phone: fax: Reconnect only ,S 67.84 _ 2
503- 295 -5555 temporary services or feeders installation, alteration, and /or
Owner installation: This installation is being made on property that I Own which is not relocation
intended for sole, lease, rent or exchange, according to ORS 447, 449, 670. and 701 200 amps or less $ 5936 1
Owner signature: Date; 201 amps to 400 amps S 125.08 _ 2
401 amps to 599 amps S 16/154 2
Li APPLICANT IJ CONTACT PERSON Branch circuits - new, aitershnn, or extension. per panel
Business NUM: A. Pcc for brunch circuits with
servICC or feeder fcc, each
Contact Warne; branch circuit $ 7,42 2
B. Fcc for branch circuits
AJJrtss; without service or [ceder fcc,
etch branch circuit $ 56.15 2
City/Suite/7.1P: Each additional branch Circuit; J 5 7.42 2
Miscellaneous (service or feeder not included)
Phone: Fax: Pump or irrigation circle S 67.84 2
Sign ornutline lighting $ 67.R4 2
E - mail: Signal circuits(s) or limited.
CONTRACTOR enemy panel, alteration. or
Business Name: Capitol Data & Communications, Inc. cxlcnsi0n, Ikstribe; TeldDale I 75 7590 2
Page 2
Contact name: Terry Brasch Each additional inspection over allowable in any of the above
Per inspection $ 6625
Address: 11401 NE Marx Street investigation per hour (I hr min) 5 66,25
Industrial plant per hour $ 75.18
City /State /ZIP: Portland, Oregon 97220 'ELECTRICAL PERMIT FEES!.
Subtotal 75.00
Phone: 503,255 -9488 Fax: 503.257 -7121 Plan review (25% of pcmtit fee)
State surcharge ( 12% of permit fcc) 9.00
,.P,CB I.ic.: 142457 E eel Lie.: 26.1fMCl.F, Suprv. Lie.: 2757LF.A TOTAL PERMIT FEE 84.00
Suprv. Electrician signature, required: 61".........__ (2.....g...._ Thlr permit nppllarbn t If • permit hod earalewl whhla ran
May% sloe It be, bee been accepted um compute
Print Name; lorry Brasch Date; 08/13/12 • Pcc methodology set by Tri- County Building Induetry Service Board
Authorized signature: • Tlumttcr of inspections per permit allowed.
Print Name: Terry Brasch
503 - 716 -2439
08/13/2012 13:56 5032551966 CAPITOL ELECTRIC PAGE 02
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
'I a A
Fee for all residential systesm combined $ 75.00
Check Type of work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
. ; 11!14II1113illin!r ,1l ljII i
Fee for each commercial sytem $ 75.00
(SEE OAR 918 -260 -260)
Check Type of Work Involved:
❑ , Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations