Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00138
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/15/2007
PARCEL: 1 S 126BC -01506
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 520 ZONING: C -G
SUBDIVISION: ONE EMBASSY CENTER LOT: JURISDICTION: TIG
PROJECT: CHEMRAY INTERNATIONAL
Project Description: Low voltage for data.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
WYSE INVESTMENT SERVICES COMPANY ASHLAN COMMUNICATIONS INC.
111 SW 5TH AVENUE #1100 7534 N ELMORE AVE
PORTLAND, OR 97204 PORTLAND, OR 97217
Phone: 503 - 294 -0400 Contact #: PRI 503- 849 -9523
FAX 503- 286 -2158
FEES Reg #: ELE CLE -33
LIC 169323
Description Date Amount SUP LEB3333
[ELPRMT] ELR Permit 5/15/2007 $75.00
[TAX] 8% State Surcha 5/15/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notifi - '• • -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rule •r direct questions . • • C a 503.246.6699 or 1.800.332 2344.
Is. ued By: 1 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'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Application FOR O FFICE USE ONLY
,e - "� 7 City of Tigard Re I�Q I Permit No
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �� ��
14 C Phone 503 639 4171 Fax 503 598 1960 Date/By Other Permit
TI G A R D Inspection Line 503 639 4175 Date Ready/By See Page 2 for
Internet: www.tigard -or gov Notified/Method ! I i&- Supplemental Information
TYPE, OF .WORK PLAN . REVIEW ' •
,Z1 New construction 12 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 stones
❑ 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 denved system
❑ Addition of new motor load of ❑ "A ", "E ", "l - ", "I - ",
Job no.: Job site address: ! / / Q 100HP or more occupancy
9 oe� J W ' A,% - Ie d. ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: T , __.// O 4 f ❑ Health -care facilities ❑ Supply voltage for more than
d ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: S Project name: 0/1-0/49. ci ) 1Jr *-770 j /1. - ( p Service or feeder 600 amps or more
s. FEE' SCHEDULE
Cross street/directions to job site: Description I Ql3'. 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 145.15 4
Tax map /parcel no.: Ea. add] 500 sq. ft. or portion 33 40 1
Limited energy, residential 75 00 2
DESCRIPTION OF WORK . . (with above sq. R )
Limited energy, multi- family 75.00 - 2
' 7 /V ',,wlI loAr s44.//off /o.A residential (with above sq. ft.)'
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
- . ❑ PROPERTY, OWNER I-; - . ❑ - TENANT : • -. - - 201 amps to 400 amps 106 85 • 2
Name: 401 amps to 600 amps 160 60 2
601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts 454 65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
- Phone: ( ) I Fax: ( ) 200'amps or less 66.85 I
Owner installation: This installation is being made on property that l own which is not 201 amps to 400 amps 100 30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133 75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A Fee for branch circuits with
. . ❑',APPL ICANT - ' I: - ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6 65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46 85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90 90 2
Phone: ( ) Fax: : ( ) Reconnect only ' 66 85 2
E -mail: Pump or irrigation circle 53 40 - 2
- - --- ' CONTRACTOR • . Sign or outline lighting 53 40 2
/J // Signal circuit(s) or limited -
Business name:
/`/�h44 (a4t/Ylon /r - o.t .27/C. energy panel, alteration, or
extension Describe / Page,2 •7s' 2
Address:
752/ N• F / �vl° 4e.
City/State /ZIP: %,,.// J 6 , i f 9 _ Each additional inspection over allowable in any of the above
/ Per inspection 62 50
Phone: (fp ) 8y,- 9T1 I Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: 499323 I Electrical Lic.: _ 3 ' 1 Suprv. Lic.' /1-71 3333 Industnal plant per hour 73 75
• " ELECTRICAL PERMIT FEES. '
Suprv. Electrician signature, required: Subtotal: 7 5 - -
_C� /A/ / / Plan review (25% of permit fee).
Print name: / / !r Date: S
State surcharge (8% of permit fee). (p .60
Authorized signature: ., / �� s - TOTAL PERMIT FEE- 46 ( , e9+0
This permit application expires if a permit is not obtained within 180
Print name: �// j 1h, -4�� Date: -5 ; -A7 days after it has been accepted as complete.
• Number of inspections allowed per permit
P\Bu Iding\Permits\ELC- PermitApp doe 05/23/06 4404615T( I I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information .• `'
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
n Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Building\Permits'ELC- PermuApp doe 03/23/06
-CITY OF TIGARD •,
BUILDING DIVISION PERMIT #: ELR2007 -00138
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/15/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ilL
INSPECTION WORKSHEET FOR DATE: 5/16/2007 TIME: 7 :00AM PAGE: 68
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 520 CLASS OF WORK:
SUBDIVISION: ONE EMBASSY CENTER LOT #: TYPE OF USE:
PROJECT NAME: CHEMRAY INTERNATIONAL
DESCRIPTION: Low voltage for data.
OWNER: WYSE INVESTMENT SERVICES COMPANY, PHONE #: 503- 294 -0400
CONTRACTOR: ASHLAN COMMUNICATIONS INC. ( PHONE #: 503-849-9523
Inspection Request Scheduled For: Date: 5/16/2007 Pour Time:
Code # Inspection Description Confrm -# Contact # Message
135 _ow voltage "048355 -01 503. 849.9523 Y'
lict Cor - '. ns /Commen s ns •
uctions:
PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr N t1 Date: 511 bl Cr Phone #: (503) 718- Di%