Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' = COMMUNITY DEVELOPMENT Permit #: ELR2013 00084
T t G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2013
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 365
Project: Future Electronics Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: (1) low voltage for Data/Telecommunications
Contractor: ADVANCED COMMUNICATIONS SERVICES INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 231196 ATTN: N PIVEN
PORTLAND, OR 97281 -1196 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 598 -7082 PHONE:
FAX: 503 - 598 -7320
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04 /15/2013 $75.00
12% State Surcharge - Electrical 04/15/2013 $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 coop of the rules or direct questions to OUNC by calling 503.23287 or 1800.33 .2344.
Issued By: QOAAl k _ tL 1 t 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 Application RECEIV FOR Oi FR I t SF ONLY
IIIII City of Tigard APR 15 2013 D q (,5' 3 " Permit No a„„.,e ? 3- oohs`/'
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Other Permit • ► 901 3 - o0 0 381
Phone: 503.718.2439 Fax: 503.598.1960 Plan R :
Inspection Line: 503.639.4175 BUILDING . C � ITY OF TIGARD Date Ready/By: Duns: 0 See Page 2 for
I l 1 h ! BUILDING DIVISIO Notified/Method: Su lemental Information
Internet: www.tigard-or.gov PP
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 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 6650 SW REDWOOD LN. #365 IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: TIGARD, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 365 Project name: FUTURE ELECTRONICS ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I QD. 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 I ❑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
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
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. Fcc for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name:
B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name:
branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City / State/ZIP: 67.84 2 dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: ADVANCED COMMUNICATIONS SERVICES, INC. panel, alteration, or extension. 1 Page 2 75.00 _ 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 ('h hr min)
CCB Lie.: 179445 Electrical Lic.: CLE139 Suprv. Lic.: 4578LEA ELECTRICAL PERMIT FEES
Subtotal: 75.00
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: BRIAN KUNISHIGE Date: 03/25/2013 State surcharge (12% of permit fee): 9.00
TOTAL PERMIT FEE: 84.00
Authorized signature. This permit application expires if a permit is not obtained within 180
ter days after it has been accepted as complete.
Print name: l�s r Date: * Number of inspections allowed per permit
1:\& nlding \Permits\E 07/01/10 440- 4615T(11/05/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*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n A udio and Stereo Systems
n Boiler Controls
n C lock Systems
® Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ N urse Calls
❑ O utdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
L\ Buulding\ Permits \ELC- PennitApp.doc 07/01/10