Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
` 7: :7 COMMUNITY DEVELOPMENT Permit#: ELR2012 -00229
T IGA-RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/01/2012
Parcel: 25101 AB01604
Jurisdiction: Tigard
Site address: 7307 SW BEVELAND RD 110
Project: American Solutions Subdivision: HERMOSO PARK Lot: 16
Project Description: (1) data telecommunication
Contractor: ADVANCED COMMUNICATIONS SERVICES INC Owner: BEVELAND LLC
PO BOX 231196 7307 SW BEVELAND ST
PORTLAND, OR 97281 -1196 TIGARD, OR 97223
PHONE: 503 - 598 -7082 PHONE:
FAX: 503 - 598 -7320
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/01/2012 $75.00
12% State Surcharge - Electrical 10/01/2012 $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 - 00 -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: A/ 7 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' 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 ApplicationRECE "V FOR OFFICE USE ONLY
III City of Tigard 0 f T 01 2012 Received
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' Phone: 503.718.2439 Fax: 503.598.1 /� DateB : Other Permite4,, / c2 _ea,
Inspection Line: 503.639.4175 ' ' OF TIv�RD Date Ready/By: 111M 0 See Page 2 for
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Internet: wvvw.ti g ard - or. ov Da llotified/Method: g B UII.I�INGDIVISION
Read Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas 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
❑ 1- 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 ❑ Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 "I -3 ",
Job no.: Job site address: 7307 SW Beveland Rd.1401! 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
/"Suite/bldg. /apt. : 110 Project name: American Solutions ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
75.00 2
low voltage voice and data residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 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 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
0 above service or feeder fee
APPLICANT ❑CONTACT PERSON
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included) I
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Advanced Communications Services, Inc panel, alteration or extension. I Page 2 2
Each additional inspection over allowable in any of the above
Address: PO Box 231196 Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Portland, OR 97281 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 598 - 7082 Fax: (503) 746 - 4384 Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CCB Lic.: 179445 Electrical Lic.: CLE139 Su rv. Lic.: 4578LEA ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: AVIA (,t Subtotal: 2s';
Plan review (25% of permit fee):
Print name: Brian Kunishige Date: 10/01/2012 State surcharge (12% of permit fee): 9,
i I TOTAL PERMIT FEE: /
Authorized signature � . This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: pj 4 � Date: /(>-/ / + Number of inspections allowed per permit.
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
-RESIDENTIAL WORK ONLY: " k , .71
Fee for all residential systems 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:
COMMERCIAL WORK ONLY: . l •
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
® Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n L andscape Irrigation Control*
n Medical
❑ N urse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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