Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 , • COMMUNITY DEVELOPMENT Permit #: ELR2013 -00134
T [CARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/19/2013
Parcel: 1 S 135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 570
Project: Wave Connex Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Low voltage for data
Contractor: CAPITOL DATA & COMMUNICATIONS Owner: LINCOLN CENTER LLC
11401 NE MARX ST BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 -7121
•
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/19/2013 $75.00
12% State Surcharge - Electrical 06/19/2013 $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 (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 accor n ^e . h 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. ATTEN N: Oregon =w requires you to follow the rules adopted by the Oregon Utility Nofrficatio. enter. Those rules are set forth in OAR
952 - 001 -001 through OAR 952 -001 -1t • I. You may obtain a copy of the rules or direct questions to OUNC by Iline 03. 2. 987 or 1.800.332.2344,
Issued B 1 I P /L _■l i . Permittee Signatur . t' ' l C (J` r / 40
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.
06/18/2013 13:26 503255196 C D CAPITOL ELECTRIC PAGE 01
FOR Oil 1(1 (IA ONJw
Electrical PermitA,pplxcatiotiLN 1 8 2013 Received
y: 6. • . Permit no sc.2;1o/3- aa 13y
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City of Tigard OFTIGARD man xcvicv
w
W x3125 S Nall �Blvd., Tif 3rd, •.- r : Date/By' v
= Other Permit. �`„ �,��j!!� O a
Phone: 5173.639.4171 Fax: 5 t; '. " ! c ■ G DN ISION Data Ready/By: : lefts: wr ■ v ' c _ t•ne. a Ow
TI ;c�ARD t.nspcctiottLinc. 503.03..4175 Notified /Method: Supulemenrnllufbrmntlnn
Internet: wsy'sv.tigard -or goy
1 $4°'r L x 4 ayir; '' - ;tip' ? r ' r ' a a . '')C0. - -'-
New conslruetion El Addition /alteration /replacement Please check all that apply:
11 Demolition ❑ Other: Q Service over 225 amps. comm'I ❑ Hazardous location
`jtt11!',t ll',1tffjT 0455,w,ar'o x c o ; In ' 1 e nri 0 ', ' U Service over 320 amps - rating ❑ Building over 10,000 sq.ft.
LI 1- nod 2•I11mily dwelling U Commercial /industrial Li Accessory building of 1- and 2- famlly dwellings 4 or more new residential
LI Multi- famil I , _ Master Builder li Other U System over 600 volts nominal units In one structure
. ,1 '1%W .
-�,�,. �.' a :'n a° ya'ti?p],'.,�`-44 1,.:2L ,,j.,,,i..._,:,_.:_ U Building over three stories 0 Feeders, 400 amps or more
Job no.: C13404 JIM site address: 10220 SW Greenberg Rd. 0 Occupant load over 99 persons 0 Manufactured structures or
❑ Egress/lighting plan RV park
City/State/VP: Portland, OR. 97223 ❑ Hlealth-care facility 0 Other
Submit 2 sets of plans with any of the above,
Suite/bidg. /apt. no 570 IProicct name; WaveConnox
The above are not applicable to temporary construction service.
Crass Street /lirccl ions to job site: Description qty. r.� - n,hu
New residential - single or multi - Family dwelling unit.
Subdivision: i or nn,;
Includes attached garage.
1000 sc ft. or less $ 168.54 4
Tax map /parcel no.: En. Add'1 500 sq. f> or portion F 33.92 1
'!' T 12E E5Egoltirg ?if0_________.__,___„ __,_ Limited energy residential 5 75.00 2
Installation of cat5e cables for voice and data. Limited energy. non - residential 5 75.00 2
Each manufactured home or modular
t ;; 10!) . � g � • �e and /or feeder - o ■ is i.., ':`�t1..,_��,:_ .�t1„- :.'_...5,., dwelling, Service r S 67.84 2
,
Name: Service or feeders installation e lternlion. and /or relocation
200 amps or loss S 100.70 2
Address: 201 amps Co 400 amps S 133.56 2
401 amps to 600 am1ps S 200.34 2
City/State/7.1P; 601 amps to 1000 amps S 301.04 2
Over 1000 amps or volts S 552.26 2
Phone, Fax; Reconnect only S 67.34 2
503 - 295.5555 Temporary services or feeders installation, alteration, and /or
Owner installation: This installation is being made on property that I own which is not relocation
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 200 amps or less a 59.36 I 1
Owner signature: Date: 201 amps to 400 snips 5 125.08 2
I
401 snips to 599 amps 5 160.54
SIN_ 1lliU_IEIII Branch circuits - new, alteration, or extension, per panel
Business Name; A. Fee for branch circuits with
service or feeder fee, each
Contact name: branch circuit 5 7.42 2
B. Fee for branch circuits
Address:
without service or feeder fcc,
each branch circuit 5 56.10 2
City /slate /ZIP: Each additional branch circuit: _S 742 2
Miscellaneous (service or feeder not included)
Phone: Fax Pump or irrigation circl S 67 2
Sign or outline lighting s 67.84 2
E -mail: Signal circuitS(S) or limited.
.t;L:L..._,.:'.... . 2l.1' :...._ ;SSCiSlilia- e L 7 ai..;.:. __ energy panel, alteration, or
Business Name' Capitol Data &Communications, Inc. extension. Describe: Tele /Dub 1 75 76.00 2
Page 2
Contact name: Each additional inspection over allownhle In any of the above
,c r l) /d,_, S C Per inspection $ x,6,25
Address: 11401 NE arx Street investigation per hour (1 hrmin) $ 55.2.5
Industrial loot er hour S 73.IA
City/State!ZIP: Portland, Oregon 97220 Subtotal 75.00
Phone: 503- 255 -9488 Fax: 503- 267.7121 Plan review (25 °/n of permit f cc,
State surcharge ( 12% ofpermit fee) 9.00
CCB Lie.: 142457 LEIcem cni Lie.: 24 rnSICLE i Suprv. Lie.: 2757LEA TOTAL PERMIT FEE 84.00
Suprv. Electrician si P,nnlure, required; '--- / - �6e
nit rs. t npplicntinn expires If n permit Is not °htnlned within tan
(((��� � ,Inn, nRr it hop N.C. ocCenlad q °omplee
Print Name: Terry Brad ,------- y-..____ t. Date: 06/18/13 • Fee methodology act by Tri•Cnunty building lndnstry ,Service Rana!
signature: 1
J ••Number of inspections per permit allowed.
Print Name: Terry Branch
S13- 718.2433 IA F t. E I
06/18/2013 13: 26 5032551966 CAPITOL ELECTRIC PAGE 02
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
p
Fee for all residential l' 41_::: :.::.._......._. . ....._
esidential 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:
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
Data Telecommunication installation
❑ 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:
*No licenses are required. Licenses are required
for all other installations