Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN V
S COMMUNITY DEVELOPMENT Permit#: ELR2013-00192
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/06/2013
Parcel: 1 S 126BC01506
Jurisdiction: TIGARD
Site address: 9020 SW WASHINGTON SQUARE RD 350
Project: Primary Residential Mortgage Subdivision:_CONDO,THE SUPPLEMENTAL PLAT Lot: 25-4
Project Description: Low voltage for voice and data
Contractor: CASCADE UTILITIES INC Owner: WISCO REAL ESTATE EQUITY FUND I
301 SW BROADWAY 1501 SW TAYLOR ST STE 100
ESTACADA, OR 97023 PORTLAND, OR 97205
PHONE: 503-630-8312 PHONE:
FAX: 503-630-6638
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 issued su•': t to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes an• - r other applicable law. All work will
be don n accordance with -••roved : -'s. This permit will expire if work is not started within 180 days of issuance, •. ork is suspended for more the 180
days. ATTENTION: Oregon la -quires ou • follow the rules adopted by the Oregon Utility Notification Tho rules ar: - forth in *AR
952- 01-0010 thro f h OAR 952-01 0090. You ,ay o stain a copy of the rules or direct questions to OUNC by calling 503.2 • 1.8'• '32.2344.
Is ued By: �� ��_......441.2—....a / Permittee Signature: i // ` /
OWNER INSTALLATION ONLY I
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 Applicati0EC'EIVEED FOR OFFICE USE ONLY
City of Tigard Received 61 pi E� oi3—L30/FA
Permit No.:
v 13125 SW Hall Blvd.,Tigard,OR 9722,A11G 6 2913 Plan Review y P
. C ` • Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit: 6Q6i3-DO/F
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris. El See Page 2 for
TIGARD
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
. TYPE 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 stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
�O ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","l-3",
Job no.: glob site address: 90 20_s(41 �t Six or or more more. occupancy. parks.
V! ❑Six or more residential units. ❑Recreational vehicle arks.
City/State/ZIP: a/t O �ot 3 ❑Health-care facilities. ❑Supply voltage for more than
l I 111 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 3 Q I Project name:Pr i /��l ��..r� fI f, Q/ / ❑Service or feeder 600 amps or more.
K FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 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.)
Limited energy,multi-family
���—�� residential(with above sq.ft.) 75.00 2
�� Services or feeders installation,alteration,and/or relocation
�[' 200 amps or less 100.70 2
PROPERTY OWNER /[ ENANT 201 amps to 400 amps 133.56 2
�1— (
A.
1 401 amps to 600 amps 200.34 2
Name: / I mQ�`y �QS/�//I�q 10;/ R�
601 amps to 1,000 amps 301.04 2
Address: et of c s� w79//j f „r O Over 1,000 amps or volts 552.26 2
City/State/ZIP: / Q it Oe, 7223 Temporary services or feeders installation,alteration,and/or
relocation
Phone:(cc/3 7 6.70 Z Fax:c.03) 506, 7yq 0 200 amps or less 59.36 1
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 168.54 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
APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
, each branch circuit
Business name: c S 4/ J/4 1 c — B.Fee for branch circuits without
service or feeder fee,first
Contact name: d eSQf'vy branch circuit 56.18 2
Each add'l branch circuit 7.42 2
Address: 30( �s OQ I C4 c I/,� Miscellaneous(service or feeder not included)
) �c CLf _ r 1 7�z 3 Each manufactured or modular 67.84 2
City/State/ZIP: dwelling,service and/or feeder
Phone:( 3 .3o .3� 2 Fax: :93 ) 65 66?g Reconnect only 67.84 2
y e F Pump or irrigation circle 67.84 2
E-mail: u11 '2St 11 V 1 C 04 Q C< SS /62--f Sign or outline lighting 67.84 2
CONTRACTOR/ Cfjx,�p� kfICJ T1� !/ Signal circuit(s)or limited-energy
Business name cK ca ��636G-r panel,alteration,or extension. ' Page 2 76700 2
' /`Q�lX� S Each additional inspection over allowable in any of the above
Address:SO( S k oq,C c,,,,(,/ Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: E--3 n c / 702-3 Investigation(I hr min) 66.25/hr
Industrial plant(1 hr ) 78.18/hr
Phone:03 69o2- F�3) C3 O C'g Insppections for which no
fee is 90.00/hr
specifically listed(%T hr min)
CCB Lic.:/ ./ ¢yl, Electrical Lic.:`3—L 1 Suprv.Lic.: 3d�//`t�A. ELECTRICAL PERMIT FEES
(,s gn !+e' 1507040 t�)` te!/i y Subtotal:
Suprv.Electrician s gna ure,required: ` r49'�/ Plan review(25%of permit fee):
Print name: K 1,5tL(o' l-F- Date: State surcharge(12%of permit fee): 1,00
TOTAL PERMIT FEE: 8 ,�J
Authorized signature/ , '
This permit application expires if a permit is not obtained within 180
Print namet��'` ��f.GK /i uC i 7/ Dater 20� 3 * days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\Permits\ELC-PermitApp doe 07/01/10 440-4615T(It/05/COM/WEB