Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 1111 1 C -• COMMUNITY DEVELOPMEN Permit #: ELR2013 -00176
Date Issued: 07/24/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 100
Project: Providence Medical Group Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Data telecommunications.
Contractor: XTREME COMMUNICATIONS INC Owner: PROVIDENCE HEALTH SYSTEM - OREGO
24023 NE SHEA LN #215 ATTN: REAL ESTATE & PROPERTY
WOOD VILLAGE, OR 97060 MANAGE
4400 NE HALSEY BLDG 1 STE 160
PORTLAND, OR 97213
PHONE: 503 - 618 -8816 PHONE:
FAX: 503 - 618 -9985
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/24/2013 $75.00
12% State Surcharge - Electrical 07/24/2013 $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 $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through 0 • : 952 -' • -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: P / Permittee Signature: 4,& 19--",L /69770AI
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date: •
LICENSE NO.
Call 603.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
Electrical Permit Applicatk ECENE FOR OFF ICE USE ()NIX 1 1 1! Received Permit No
City of Tigard DateB : ��/. �JO /76
131SW all vdTigard, OR 97223�UL 2 2 2013 Plan R Other Pennir.
Phone: 503.639.4171 Fax: 503.598.19 Date /B �/
T f C A R D Inspection Line: 503.639.4175 C i' I C C TII & D fl Date Ready/73y: rurigi� Id See Page 7 for
N n eth is Supplemental Information
Internet: www.cigazd- or.gov �+ o fied/M od: Su Ic a' n
` :TYPE (?Jr ph. raP :'1, {1�U«I4P�' - ;
Please check all that apply (submit a sets of plans w /items checked below):
El New construction cg Addition/alteration /replacement
0 Service or feeder 400 amps or more El Bmdlding over three stories.
❑ Demolition ❑ Other: where the available thult current ❑ Marinas and boatyards. •
CATEGORY : 'e6i$i§iw:41lON ` exceeds 10,000 amps at S50 volts or ❑ Floating buildings.
•'. .,'' less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling ,J Commercial/industrial ❑ Accessory building amps for all other installations, buildings,
❑
❑ Mu - family Master builder ❑ Other: CI Fire pump. 0 Installation of 75 KVA or
ID Emergoncy system, larger separately derived system.
: JOB SI,T * 00.0; 0 N ;AND; I�CI.GA°,>I'XO O Addition of new motor load of ❑ "A" "E" "1- 2 ° "`1 -3"
� i I — i .may ` f 744 � O r I � t�JI 100HP or more. occupancy.
Job no.: y V X,I C _ C K t { I Job site address: L 1(�
El Six or more residential units. ❑ Recreational vehicle parka.
City /Stare/ZIP: 'T . e ( Q 7''2. (11Iealth - care facilities, ❑ Supply voltage for more than
❑ Itaardous locations, 600 volts nominal.
Suite /bldg. /apt. no.: t ' ( Project name: ! '141.t , ( 00 W ,2 pyt ❑ Service or feeder 600 amps or more.
'.. REE' SC)Ff]EAUL)L • ; : °
Cross street1directions to job site: oercrytion I Oty- I ,„ Fee. I Totnl r -
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no,: 1,000 sq. ft. or less 168.54 a
Ea add'I 500sq. ft. or portion 33.92 1 M
Tax map /parcel no.: Limited energy, residential
75.00
'. ' (with above sq, ft.)
E�c>i xzolv,: qF wbltit ,
(( • L f g' ec + Limited energy, multi- family 75,00 2
Lug C- it residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
-
' e ;)ROPE ''fl' cwNE* � ?TEN.A,N�'.; 201• amps to 400 amps 133.56 2
.. 401 amps to 600 stops 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /.ZIP: relocation
—
Phone: ( ) Fax: ( ) 200 amps or less 59.36 l
201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 16854 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: _ A. Fee for branch circuits with
r above service or feeder fee, 7.42 2
" APPI ICA II ] C Ok� AG... , 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') branch circuit 7,42 2
Address: _
- Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) g :: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E _
Sign or outline lighting 67.84 2
Cd1+TTt RACTo t.' . , Signal circuit(s) or limited : --
r panel alteration. or extension, r Page 2 7 2
Business name: (fe �
, ci�tin;c J / Vi C ,
,,{_ Each additional inspection over allowable in any of the above
Address: 2"I a 2-3 Ale �Ik,. ladle_ t't 2 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: G(�DO Vt /142 CV — q1-6(0 0 Industrial plant (I hr min) 78:18/ hr
Phone:
(a�o3) 0i $ � v 000000 ) inspections for which no fee is 90.00 / hr
J
s eci(ca11 listed 'r 4 hr min)
CB Lie,: ( � Electrical Lic, — ,,5 ' : Suprv, Lic.: 3 ., $F7- E CU:ICA;I PERM III • EES
S • J r 0 f Subtotal: 3- `
Suprv. Elect tan al required: / / " • Plan review (25% of permit fee):
Print name: / ( �/ / / - pate: Z 3 State surcharge (12% of permit fee):
w TOTAL PERMIT FED: $H ---i,
Authorized signature: This permit application expires if a permit is not obtained with4n 180
days after It has been Accepted as complete,
Print name: bate: • N of inspections allowed per permit.
I: 1HuitdingTermi talELC- PermitApp.do4 07 /01 40 440-4613T(11/05/COMM E13
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
WV-44014'4 `!G .,.. ,....,R...:'Y 4 r w Y . _ _
�!y
Q � J � Eli °V 1 El F 'I . 4 F� r r5 et „ axx q�,��.t:�� r (�' J.'.�'�...a]t �
�? s 7S! 2k"Gd '� �.*�'+
..�+°'r.e. `t�::�dw..;�.n. � .f��``j�9F�ui�'iv, >�, w; a��'L"�A` :�. Ei� .t�Ei�+ "r`�
Fee for all residential systems combined... $75.00 Aeacripuo' qty. Pio Tsai •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 to 25 kva 200,34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva Me in accordance with 552.26 2
7 Heating, Ventilation and Air Conditioning OAR 918- 309 -0040)
System* Solar generation systems In excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 lcva —no additional charge 0.0 3
•
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/ hr
charged at an hourly (1 hr min)
Inspections for which no fee is 90.00 / hr
{ 7 �q ,,), specifically listed (14 hr min)
l . fd2 C 1 ,r a.{�' �� °v3 i4 h1 1a } j�i+'"G,4' a'a� �.'�� o' . ryc� ' ^ S ' A! s r i ii iF t tJ�' 3 e ' r .3 S J 1 fY N C+U° l .e r ' " t •
M1..a.... .w.x.�i. :..w d -.cT.. �3.....,x.,.,,.�u. ,°W.�. �.i� r..,�..�7A.A..'a....�,.�.. "f�. }..y`a :�'��. d..�.�..vs.. A. �ay. .y... � ., � - r•� ._ nY.�� .c....a.
Fee for each commercial system $75.00. Subtotal:
(SEE OAR. 918-309-0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
❑ This permit application expires if a permit is not obtained within 180
Audio and Stereo Systems days after it bas been accepted as complete.
" Dumber of inspections allowed per permit.
❑ 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
L16uitdicg\Permi1elELc permhApp_ELR BRE.doe Rev 05/2112013
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12442 SW SCHOLLS FERRY RD 100, TIGARD,
OR, 97223
Commercial - Electricial Limited Energy
135 Low voltage
2013-11-14 00:00:00
ELR2013-00176
PASS
Is now 199 final electrical inspection
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12442 SW SCHOLLS FERRY RD 100, TIGARD,
OR, 97223
Commercial - Electricial Limited Energy
199 Electrical final
2013-11-14 (null)
ELR2013-00176
PASS - No C of O
Violation Summary:
Inspector Contractor