Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 • COMMUNITY DEVELOPMENT Permit#: ELR2013-00190
T[G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/06/2013
Parcel: 1 S 134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 206
Project: DR DECASTRO Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Data telecommunications system.
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 08/06/2013 $75.00
12%State Surcharge-Electrical 08/06/2013 $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: fi —�_ Permittee Signature: _ _ .0
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 Applicat CEIVED FOR OFFICE USE ON''l.i-
Received
City of Tigard U G 1 2 013 DateB : . J Permit No.. 1 I . i
13125 SW Hall Blvd,,Tigard,OR 9 plan Review Other Permit: '
Phone: 503.718.2439 Fax: 503.5 Date/B
Tr�, .1-CD Inspection Line; 503.639.4175 1' OF TIGARD Date Ready/By: tuna: ® See Page 2 for
Internet: www.tigard-or.gov BUILDtf\IG DIUI ION Notified/Method: .ve.o Supplemental Information
I ii �t l�r 1 rl'l'. i:1';?^'.'�i C.'{jr:, I y. +:, :niy U��.i�.:rl:C:CICr1.J lull�,j if'"l; P e.. !1 ' iz;hly:l'}, t l 1. +4'.f,N =r.•,,, ,j 1 ).., i� l,ysnu• .,,It: fir.y MN:i e (0:71,7:77. �•
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❑New construction ®Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked below);
❑Service or feeder 400 amps or more ❑Building over three stories.
❑7,,Demolition ❑Other: _ where the available fault current ❑Marinas and boatyards.
g',1 t4 l,ii it , T�if.i!f fi LJ11q,�''R{tir�q'rv"5 C 1t 1; �:-T'9 )'r`rw--ri_r5 "Ir_i}ril't'.W6¢,4
ii 5 i ,is�,.dkar x };.4, ft, t'1.76.ciAriiit„$ tea tiv t',,�,..141, -ki"ts:,t'tt,�i'; imi•,! �c�L°,r.;fll';i• X15,1 exceeds 10,000 amps at 150 volts or ❑Floating Commercial-use a
lees to ground,or exceeds 14,000 ❑ eroial-use agricultural
❑ 1-and 2-family dwelling ®Contmercial/industrial ❑Accessory building amps for all other installations. buildings,
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
. 1r,„_ )}1 . ❑Emergency system.y . b�ti9 9 a l .1.'s„ a,l r�errL 1F1 �s n eef l, i L i wA ni, tl !I 5 7 ❑Additiol of new motor load of larger separately derived d system.
; l-' t l,d' ,,,-- L.ntr,.u.nn ;i:'i3t1,J„t:Ma.i ,. 9a, . - . `.. _A. .B .1-2","1-3",
1oo
Job no.:8282 Job site address:12442 SW Scholls Ferry 1001-7 or sacra. occupancy.
['Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:206 Project name:Scholls PMG Ste 206 ❑Service or feeder 600 amps or more,
.r..... ''r�jirr3�{rq�{llul J''lti ri�EJ j'�r (rrr`ltii it�7i'�I.i 9AR ., a t { lit.;:t ixr
= ���;}}H4,. ilr• L•�1,,�,e�t��;.a,In.,,�„/,a ri,f,l. a,J.Ji...r..,n....,,,r.itJ
Cross street/directions to job site:Scholls Ferry Rd/SW 125'h Ave Description cry. Fee. Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea:add'1500 sq.ft.-or portion - - M- 33.92---- -- -1-
1 Limited energy,residential
t t,•l7T ,Ir>C r nU" ``b,YN,BU ,{h p117-1 r!,1-1q 15;"ii 1 11;4'1.'1 1 with above ft. 75.�� 2
.[ „t*ni e,, :"4.1. 1 -r.ex is 3 w •. iFl, ! aJ Y i .d. .,1i11,.11i }j • ( , )
. S11.s, r.a' ..'t ,....L...,.._1,1a 1.�J.li:.rr.!rll�.,..A�dJIiHR}V.fi' ttfis� .i.d,>t ,e1 �,4�5,,:,,i ltl.¢L, ,ira., {i.�hl. ... =J Limited energy,multi-family .
Voice&Data residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
ATJ i' 1 "1 ^1� s��1;r2i v E t• i- J1 t``y�ral(ljrer •*14 1, "A• li lr t' k 200 amps or less 100.70 2
,I,i i n 1.„., -,,r hrt.':1cd fpx1111)/D 3 kt 1. J��d6a� ,. .S'A .Z.Z .(4± ..1.3 ..t. i�?.!l ••4. ilr
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
City/State/ZIP: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1 l
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for salt,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: ' Branch circuits-new,alteration,or extension, er panel
1'I il uai+. -+'i E l r11r{;+f�Jr , f•11.4}i!.�r�i f,r,n tl.:`M':1n r6 ',1�r1x cam- dct�t;.- i,.i A.Fee for branch circuits with
Iii., ' J' r r 1 itr t ` i I�IP ?iu.
above service or feeder fee, 7.42 2
Business name:Xtreme Communications,Inc. each branch circuit
- - B.Fee for branch circuits without
Contact name:Lance Dillon service or feeder fee,first 56.18 2
branch circuit
Address:24023 NE Shea Ln Suite 215 Each add'l branch circuit - 7,42 2
City/State/ZIP:Wood Village,OR 97060 Miscellaneous(service or feeder not included)
Each manufactured or modular 67,84 2
Phone;(503)710-6932 l Fax: :(503)618-9985 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:lance @xtremecabling.com Pump or irrigation circle 67,84 2
i°F ..6r �p n 1!1ln..I�xsty y lirl{ If��r �Si4L1�t „ i,1/1 J!f 1rt Intft! E,1rJ171r i {r�'t1
-s ` �,11�1r.). '•? IMI Et�.�.��4liiN._ tm",t.,ld„t .,:>k,EI -1 I Pik„-R. !'}TEiuitV'li;lf EJ11a!ti;�.�'-'ItfftL`:11111. Sign or outline lighting 67.84 2
Business name:Xtreme Communicatons,ln.c Signal circuit(s)or limited-energy 1 $Ce 75.00
panel,alteration,or extension. Page 2 2
Address:24023 NE Shea Lane Suite 215 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Wood Village,OR 97060 Investigation(I hr min) 66.25/hr
Phone:(503)618-8816 / I Fax:(503)618-9985 )ndustrial plant(1 hr rain) 78.18/hr
✓ /Inspections for which no fee is
90.00/hr
CCB Lic.: 147263 1 Electrical Lic.: 3-515CLE Suprv,Lic.: 3387LEA ,/ si ificaliy listed 1 hr min
., a d i' gil;)y3CrMR YZIPI'f}g t 171 J ":ZLJI
F
Suprv.Electrician signature,required:
Subtotal: 75.00
Print name: Bill Mildfelt Date: 8/1/13 Plan review(25%of permit fee):
State surcharge(12%of permit fee): 9.00•
Authorized signature: 44,44 TOTAL PERMIT FEE: 84.00
Print name: Loci Lovell / Date: 8/1/13 This permit application expires if a permit is not obtained within 180
days after it bas been accepted as complete.
" Number of inspections allowed per permit.
t:leuildiag\Permits\ELC PermitApp doe Rev 05/ , 013 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: ���� �y G Renewable Energy Permit Fees:
n tt .'��. 1'r �'a•'�. G'I:!;S1, gi rig.:cfi).11 t }R^�'�{.p'.� U��P ",u'�� 1�jr�.€ , i,r, ! i,
'ti h34�a:;:at{`i"r:t:F.",' �,��.w„ ""_�'.���.'6�'. fi,'�J'�.��-�iW, fi E:�^�S',i.°r�� ,!'• ��
Fee for all residential systems combined $75.00 Description Qv. Fee Total
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*
A 1 15.01 to 25 kva 200.34 _ 2
Wi
❑ Burglar Alarm Wind generation systems in excess of 25 ltva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with
❑ Heating,Ventilation and Air Conditioning
OAR 918-309-0040) 552.26 2
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7,42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
❑ Each
Other:
Each
additi additional onal inspection over allowable in any of the above:
inspection is 66,25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
(1
specifically listed(1I1
t hr minl)
1itiOi P r i11
Or•, i U''` .`�;;
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 has bees accepted as complete.
Number 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
I:1BuUdieg\Permitsmc_PennitAPP-BULen,doc ltev 0S/2l//A13
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 206, TIGARD,
OR, 97223
Commercial - Electricial Limited Energy
199 Electrical final
2013-11-14 (null)
ELR2013-00190
PASS - No C of O
Violation Summary:
Inspector Contractor