Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' . COMMUNITY DEVELOPMENT Permit #: ELR2012 -00191
T f G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/14/2012
Parcel: 2S112DD00701
Jurisdiction: Tigard
Site address: 15806 SW UPPER BOONES FERRY RD
Project: Transitions for Health Subdivision: 1994 -006 PARTITION PLAT Lot: 2
Project Description: Low voltage for data
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Contractor: CAPITOL DATA & COMMUNICATIONS Owner: PACIFIC REALTY TRUST
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11401 NE MARX ST ATTN: N PIVEN
PORTLAND, OR 97220 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
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PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 -7121
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/14/2012 $75.00
Type of Use: COM 12% State Surcharge - Electrical 08/14/2012 $9.00
Class of Work: ALT
Total Number of Systems:
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 503.232.1987 or 1.800.332.2344.
Issued By: I A � Permittee Signature: 0 NI A-1)( L CA Y.'c nJ
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 10:38 5032551966 RECEIVED ELECTRIC PAGE 01
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Electrical Permit Application jEI V E FON FICE USE ti
Received
City of Ta and -I'� F Permit no.: `
.�t� 1..x. �1U1 a1 - CM) 1 g
g AUG 13 2012 PladReview �- -,
i 13125 SW Hall Bl v d. , Fisatd OR 97223 DetcJBy: Other Permit:
503.639.4 Fax: 503.598.19yp��,
O a tdBy
T 1 G A Ct D Inspection Line: 503.639.4175 l.11 OFTIGARI� etc Rudy /By; turi. `� Lea rag r�,
Internet: ww,tigard- or.gov BUILDING DIVISION Not
w fcd/Method: _ - , Srryplanental Inrnrroadua
•TYPEOF 'WORK.' `: : ... .. .°'.' .'.: •..:..•. :•.PL1411R8V/Ew' .
U Ncw coasin ction El Addition/alteration /replacement Please check all that apply:
.. ] Demolition ❑ Other: ❑ Service over 225 amps. comm'I 0 Hazardous location
'r CATEGORY OF CONSTRUCTION r [I SeMco over 320 amps - rating ❑ Building over 10,000 sq,ft.
I—I I- and 2- hltnily dwelling I Commcrcialtindusirinl C J Accessory building of 1- and 2- family dwellings 4 or more new residential
, El Multi - Family ❑ Muster Builder ❑Other ❑ System over 600 volts nominal units in one structure
308 SiIEnvFORMATION AND LOCATION ❑ Building over three stories El Feeders, 400 amps or more
lob no.; C12354 Job site addrcsa: 15806 Upper 800nes Ferry Rd ❑ Occupant load over 99 porsons ❑ Manufactured structures or
��G42� ❑ EgressAlghting plan RV park
City/State/ZIP: �r, ❑Health Care facility U Other:
r Submit 2 sets of plans with any of the above.
Suite/bldg. /apt. no.: I Project name: Albert Construction The above are not applicable to temporary construction service,
Cross Street /Directions to job site: Dcatrlplon ( Qty. I Fee. I Tetal '
New residential - stogie or multi-family dwelling trait.
Subdivision: Lot no.: Includes attached garag
1000 so. ft. or lass $ 182.54 4
Tax neap /parcel no.; Ea. Add'I 500 so. ft orportion _ $ 33.92 1
DBSCRIPTION OP WORK'• , Limited energy residential S 75.110 z
Installation of Comeast Coax Limited energy, non - residential S 75.00 2
Each manufactured home or modular
_ U PROPERTY OWNER I U TENANT dwelling, Service and/or feeler S 67.84 _ _ 2
Name: Service or feeders installation, alteration. and /or relocation
200 amps or Ices $ 1nn.7n ' 2
Address; 201 am.: to 400am.s 5 133.56 2
401 amps to 600 amps S 200.34 2
City /Stale/71P; 601 amps to 1000 amps f 301.04 2
Over 1000 amps or volts S 552.26 2
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Phone: Fa.: Reconnect only s 61,84 2
503. 295 -5565 Temporary services or feeders installation, alteration, and/or
Owner Installation: This installation is being made on property that] own which is not relocation
intended for sale, lease, rent Or exchange, according to ORS 447, 449. 670. and 701 200 amps or less S 59.36 1
Owner signature: Date; 201 amps to 400 amps 5 125.08 2
401 amps to 599 amps S 168.54 2
U APPLICANT .LJ CONTACT PERSON branch circuits - new, alteration, or extension, per panel
Business Name: A. Fee for branch circuits with
service or feeder fcc, each
Contact name: branch circuit S 7.42 2
B. Fee for branch Circuits
Address: • without service or feeder fee
each branch circuit S 56.18 7,
(icy /51:11c/ZIP: Each additional branch circuit: 5 7,42 2
Mbeeilaneous (service or feeder rot inttnd
Phone: Fax; Pump or irrigation circle I ( S 67.84 - 2
E -mail: Sign or outline lighting 5 67.84 2
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.. Signal Circuits(s) or limited-
CONTRACTOR. energy panel, alteration. or
Business Name: Capitol Data & Communications, inc. extension. Describe: Te1GDala 1 75 73.00 2
Page 2
Contact name: Each additional inspection aver allowable in any of tb c above
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Per inycctinn _ $ 66.25
Address: 11401 NE Marx Street
Investigation per hour (I hr min) - _S 66.25
Industrial plant per hour S 78.18
City /Statc/ZiP: Portland. Oregon 97220 8ClrC I'RICAE PSRNlI1`F6fi$ _
Subtotal 75.00
Phone: 503.255.9488 Fax: 503.257.7121 Plan review (25% ofpcnnit fcc)
57-7121 surcharge ( 12% of permit fcc) 9.00
CCB Lie.: 142457 Nieman! Lic.: V Suprv. Lie.: 27571.F.A TOTAL PERMIT PEE 84.00
Suprv. Eleerricinn signature, required C2 Trna pared' npplkatlan expire. Ira permit he oat abratoed within lea
K-__ _ dm arum h,,
n It a e. accepted at cumulate
Print Name: Terry Braschr/ Date: 08113/12 _ • Fee methodology see by Tr1 County Building Industry Service Board
Authorized si gnature: rl ' mix r inspections per penult alluvial.
Print Name: Terry Brno
503 -712 -2439 •
08/13/2012 10:38 5032551966 CAPITOL ELECTRIC PAGE 02
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systesm combined
$ 75.00
Check Type of work Involved:
❑ Audio and Stereo Systems'
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems'
❑ Other:
O MER I O 41LIiWO,RK,ONLX' "`I' 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
El Data Telecommunication installation
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❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of Commercial systems; 1
'No licenses are required. Licenses are required
for all other installations