Permit 1 rt CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
°i r - COMMUNITY DEVELOPMENT Permit #: ELR2013 -00132
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/18/2013
Parcel: 2S110AB00200
Jurisdiction: Tigard
Site address: 14385 SW PACIFIC HWY
Project: Harbor Freight Tools Subdivision: CANTERBURY PLACE, AMENDED Lot: PTS 1-4
Project Description: (1) data telecommunications for tenant improvement
Contractor: AZIMUTH COMMUNICATIONS INC Owner: KOLVE, G C
PO BOX 508 ,14389 SW PACIFIC. HWY .._ ,
WILSONVILLE, OR 97070 TIGARD, OR 97224
PHONE: 503 - 639 -0110 PHONE:
FAX: 503 - 639 -0115
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/18/2013 $75.00
12% State Surcharge - Electrical 06/18/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data & Telecommunications: 1 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 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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: PermitteeSignature: ®� �,G /e9T v
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 603.639.4176 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.
To: 5035981960 From: Lindsey Schmitt 6 -17 -13 9:10am p. 3 of 4
Electrical Permit Application RECEIVE t l F k ;zj ol I i t �E < )` i g = u
City of Tigard 7 / p �_ P , No .:
3 = ,�"' `J g JUN 1 / Date/By: W I �� E � ®�-� wt/��- :_.
13125 SW Hall Blvd., Tigard, OR 97223 2 � '' Plan Review er �i3 dOO�a
°_4;s: .Phone: 503.718.2439 Fax: 503.598.1 o F � n � D a t e/B y: Other P Page Inspection Line: 503.639.4175 IIJJ Dat Ready/By: inns H See Pa e 2 for
• TlG4R11:
'ii Internet: www. or.gov BUIL DINr DN►.CIpN Notified/M ethod: 7 Supplemental Information
E 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 0 Other:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF. CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1 - and 2 - family dwelling Commercial /industrial ❑ Accesso building less o or installations. ons. ❑C ilding cial•use agricultural
rY g 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 ", "1 -2 ", "1 -3 ", 100HP or more. occupancy.
Job no.: I Job site address: J� T 2.LIL C/
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 11,6'0(1 � / 3 f5 ❑ Health -care facilities. ❑ Supply voltage for more than
J --� h _ T w ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: }O L(X - W I l � ❑ Service or feeder 600 amps or more.
` FEE SCHEDULE : .
Cross street/directions to job site: Dpcnptton I Qtv. 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'I 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.)
1 , I C ,,� '/ � L energy, multi - family
0 1W V �•' cA 1t ' residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PR RTY OWNER ❑ 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
Addre . Over 1,000 amps or volts I . 552.26 2
Temporary services or feeders installation, alteration, and /or
C /State /ZIP: relocation
• Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 - amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 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
❑ APPLICANT . I ❑ CONTACT. PERSON above service or feeder fee, 7A2 2
each branch circuit
Business name: Azimuth Communications B. Fee for branch circuits without
)� /l service or feeder fee, first 56.18 2
Contact name: gay k.„ P� (" branch circuit
f Each add branch circuit I 7.42 2
Address: 9560 SW Tualatin - Sherwood Rd. Miscellaneous (service or feeder not included)
City /State /ZIP: Tualatin, OR 97062 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 639 - 0110 i Fax:: (503) 639 -0110 Reconnect only 67.84 2
Pump or irrigation circle 67 84 2
E- mail: lndsey @azimuthcommunications.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Azimuth Communications panel, alteration or extension. ( Page2 2
Each additional inspection over allowable in any of the above
Address: 9560 SW Tualatin- Sherwood Rd. Additional inspection (l hr min) 66.25 / hr
Investigation (I hr min) 66.25/hr
City /State /ZIP: Tualatin, OR 97062 Industrial plant (I hr min) 78.18/ Itr - Phone: (503) 639 -0110 l Fax: (503) 639111 S Inspections for which no fee is 90.00 / hr
J specifically listed (%, hr min)
CCB Lic.: 145828 • Electrical Li .. 36 -94CLE Suprv. Lie.: 2312LEA ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / � Subtotal: '
G �'C''�� Plan review (25% of permit fee):
Print name: Brett Ulberg ,/� Date: b 117 1 21 I State surcharge (12 %of permit fee): 8
p� �� n � (/v TOTAL PERMIT FEE: l a 1 •
Authorized signature: (/ / /� T his p ermit application expires if a permit is not obtained within 180
' n .J
Print name: Brett Ulberg Date: days after it has been accepted as complete,
2.1)13 • Number of inspections allowed per permit.
t.1Building1Perrnits \ELC- PermitApp.doc 07/01/10 440-4615T( I I /05 /C0M/WEB
■
To: 5035981960 From: Lindsey Schmitt 6 -17 -13 9:10am p. 4 of 4
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*
El Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORE ONLY
Fee for each commercial $75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
El Clock Systems
d Data Telecommunicadoninatallation
El Fire Alarm Installation
❑ HVAC
0 Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ 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
1:1Bui1ding \Permi&.ELC- PermitApp.doc 07 /01/10
To: 5035981960 From: Lindsey Schmitt 6 -17 -13 9:10am p. 1 of 4
Fax
FACSIMILE
Date: 6/17/2013
To: 5035981960
From: Lindsey Schmitt
Subject: Permit Request
Lindsey Schmitt I Administrative Assistant I Azimuth Communications, Inc.
Physical Address: 9500 SW Tualatin - Sherwood Rd. Tualatin, OR 97062
Mailing Address: PO Box 508 Wilsonville, OR 97070 I Ph: 503 - 639 -0110 I Fax: 503 - 639 -0115
From: konica @azimuthcommunications.com [ mailto: konica @azimuthcommunications.com]
Sent: Monday, June 17, 2013 10:08 AM
To: Lindsey Schmitt
Subject: Message from KMBT_C360
1