Permit r,
• n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
g,-' COMMUNITY DEVELOPMENT Permit #: ELR2013 -00136
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/20/2013
Parcel: 2S113AB00300
• Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 100
Project: Simpson Property Group Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: Add conference room and coffee bar
•
Contractor: CAPITOL DATA & COMMUNICATIONS Owner. OREGON STATE BAR, THE
11401 NE MARX ST 16037 SW UPPER BOONES FERRY RD
PORTLAND, OR 97220 TIGARD, OR 97224 -
PHONE: 503 - 255 -9488 PHONE: 503 - 620 -0222
FAX: 503 - 257 -7121
FEES
Description Date Amount
Specifics: Restricted Energy Permit 0 $75.00
12% State Surcharge - Electrical 06/20/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data & Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom /Paging: 0 Landscape /Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: Required items and Reports (Cpnditions)
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. Tho6e 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 ^ �I,�' Permittee Signature: OA/ ���G / �� /�O �C /
CC 4 7 1
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.
06/19/2013 09:47 5032551966 CAPITOL ELECTRIC PAGE 01
Electrical Permit Ap_plicatioRECEIVE D FOROFFIC.E:tESEE:ONLY
Tigard tecClvCd
City of J. X 'dad I n
Da
� n R c� /3 - SA.' nit n � WS Do�3�
r 131_5 SW Hail Blvd., Tigard, OR 97 223 -, U N 1 9 :. ,.13 Date/F3y: Other Pcrn� �v3 _
' S ' Phone: 503.639.4171 Fax: 5033.598:1960
Ins ection Line: 503,639.4175 CITY OFTIGARD Date Ready /ray: er ra¢e d rm.
Tt G.ARD p Notified /Method: Sngnnnrn,mtnrn,., .]inn
Internet: www.tigard- or.&ov r
i. 1 L ' ,
_ _
New construction d Addition /alteration /replacement Please check all that apply:
• Demolition S Other: ❑ Service over 225 amps. comm'i ❑ Hazardous location
-_ - I ;pt} n ,,tnstl +f .11::;11a1„„,,;,..., a _ _ ❑ Service over 320 amps - rating ❑ Building over 10,000 sq.ft.
•.:
1- and 2- family dwelling ei Commercial /industrial Accessory building of 1- and 2-family dwellings 4 or more new residential
❑ Multi- family ❑ Master Builder ❑ Other ❑ System ever 600 volts nominal units in one structure
7 1= 1 ,29; akt 'i'i-- i r •t ,1 , ea ; r ,, rcai;L_.. ;,__:.:.._ ___ _ , 9 ❑ Feeders, 400 amps or more
`' `.._ -�._� ❑ Building over three stones F
Job no.: C13414 fob site address: 16037 Upper Booties Pastry Rd. ❑ Occupant load over 99 persons U Manufactured structures or
❑ Egressllighting plan RV park
City/Stale/71P: ❑ Health-care facility U Other:
/,— _. Submit 2 sets of plans with any of the above,
Suite /bldg. /apt. no.: C 100 _)f Prgiect name: Simpson Phones The above are not applicable 10 tern .ore construction service.
II _
Cross Strcct/Dircctinns rn job site: ncserlpl;on Qty. res. Total
New residential - single or multi- family dwelling unit_
includes attached garage.
Subdivision: J I Lot no 1000 sq. fl. or less g 168,54 4
-
Tax map /parer] no,', Ea. Add'I 500 sq. fl Or portion S 3392 1
" IB Limited energy residential $ 75,no 7
Installation of Comcast phone lines, _ Limited energy. non - residential $ 75,nn 2
l ach manufactured home or modular
... :il'IP.0'. RToSGlON OB .,:L I, ,1;', "' : .::_:1 '!i + ci _LL__,,.1.:. �:,:::- dwelling. Service and /or feeder S 67,84 2
Name: Service Or feeders installation, alteration, and /or relncaIlou
200 amps or less x 1nn,70 2
Address: 201 amps to 400 amps x in3,56 2
401 amps to 600 amps 5 20014 2
City /StaIe/Z[P: 601 amps to 1000 amps s 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 proper y tint f own which is not relocation
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 200 amps or less 5 59.36 I
Owner signature' . Date: 201 amps to 400 amps s 125.08 2
401 amps to 599 amps S 168,54 2
='!"11 ,E> �Ii .' ! U Branch circuits - new, alterntion, or extension, per pnnel
Business Name: A. FCC for branch circuits with
service or feeder fcc, each
Contact name branch circuit $ 7,42 2
13. Fee for branch circuits
Address:
without service or feeder fcc,
each branch circuit 5 36.IR 2
City/Slate/ZIP: Fa ch additional branch Circuit: S 7.42 t 2
-- MI..cellnneou6 (service Or feeder not included)
Phone: Fax:
Pump or irrigation circle s 67.84 2.
Sign or outline lighting 5 67,84 2
E-mail: Signal circuits(s) or limited -
ener panel, alteration, or
Business Name: Capitol Data & Communications, Inc, extension, Describe: TclelDala 1 75 76.00 2
Page 2
Contact name, Each additional inspection over allowable in any of the above
Pcr inspection $ 66.25
Address: 11401 NE Marx Street Investigation per hour (I hr min) S 66.25
fncluslrial •!ant •cc hour S 7R,IR
1 = :LI r"1i17J 1:1.1'71.11' I' ' ...
City/State/7.TP; Portland, Oregon 97220 s .._ � a ti
:. r. � �. .... ; .; .i
Subtotal 75.00
Phone: 503-255-9483 FAX: 503- 257 -7121 Plan review (25% of permit I'cc
State surcharge ( 12% of permit fcc) 9.00
V CCB Lie.: 142457 'Electrical Lie.: 26.1 Suprv. Lie.: 2757LEA TOTAL PERMIT FEE 84.00
$uprv, 1'lecrrician signature, required: e„...„ T hin pr•+nit nppllentan expires If n perntii is sot aelninrd within IRO
any" after It has been accepted an complete
Print Namc: Terry Brasch Onto: 06!19!13 • Pee mahodolok• sec by Tri- Cnuniy nnilding industry Saralee Board
Authorized signature; '•Nnmherof inspections per permit allowed.
Print Name' Terry Braach
507- 719 -2439 13 �
06/19/2013 09:47 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 $ 75M0
Check Type of work Involved:
❑ Audio and Stereo Systems*
• Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems`
❑ Other:
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
A Data Telecommunication installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El 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