Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II I COMMUNITY DEVELOPMENT Permit#: ELR2013-00259
t G AR L� 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/15/2013
T
Parcel: 1 S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 220
Project: Dairy Queen Subdivision:E CONDO,THE SUPPLEMENTAL PLAT Lot: 25-4
Project Description: Data telecommunications system.
Contractor: CAPITOL DATA&COMMUNICATIONS Owner: WISCO REAL ESTATE EQUITY FUND I
11401 NE MARX ST 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97220 PORTLAND,OR 97205
PHONE: 503-255-9488 PHONE:
FAX: 503-257-7121
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/15/2013 $75.00
12%State Surcharge-Electrical 10/15/2013 $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 t�direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: Lri�L .
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.
10/14/2013 10:09 5032551966 CAPITOL ELECTRIC PAGE 01
lica�ol, �i -,rte,_ � ;,�- .
FOK OFFICE 11SF ONLY
Electrical Permit App c.: �;it . Recoivcd _
N 1
permit no.: r'�fj� �3
CIty of•Tigard Plan Review Other Permit:,13125 SW T•lati Blvd.,Tigard,OR 97223 OCT 1 4 2013 Date/Ry:
Ill z' Phoney 503,639.4171 Pax: 503.598.1960 Date Ready/By. Juts: Lee No arnr
TIGARD Inspection Line: 503.639.4175 �y j,• NoUlled/Method: 1-� S+nnlernn+:,i,ntnrmnilnn
Internet: www_tigard-or.gov �� Y ��u h: ���
'.,,Ncw'con;truclinn Addition/aiterOtion/rcplaccment Please check all that apply:
_...4 Demo!;lion 0 Other: ❑ Service aver 225 amps,comm9 ❑ Hazardous location
7t;+rctn,0,1= fa1 ❑ Service over 320 amps•rating ❑Building over 10,000 sq.ft.
L i-and2-f,imily dwelling U Commercial/industrial Accessory building of 1-and 2-family dwellings 4 or more new residential
H Multi-family Li Mastcr Builder H usher CJ System over 600 volts nominal units in one structure
Wit..° ...s7`w?tR'•+y;;i";70 tai •- ❑ Building over three stories ❑Feeders,400 amps or more
r 9020 SW Wash S Rd ❑ Occupant load over 99 persons 1=1 Manufactured structures or
Job no.: C13678 [Job site address: p ❑ Egress/lighting plan I RV park
—
El Hlealth•care facility L Other:
City/State/7.1P: Portland,Or.97223-4436 _ Submlt2 sets of plans with any of the above.
The above are not a••likable to lem torary construction service.
Suilc/bldg,/apt.no.: 220 !Project name: Dairy Queen cable , 11 , .:'is s tNiig mil i�.l:.,:;::_.':..�.. ,:41,,; ems,,Y.i(,,,•
Cross Street/Direction;10 job site:
Drscrlptinn Qry, I'ec. 7oini
New residentinl-single er n•tdli-Illmily dwelling unit.
— T - includes altncbed Enrage.
Subclivision Lot 10.: _ 1000 sq It.or less $ 1Ca.54 4
Ea.Addl 500 set.ft or portion S 57.02 i .
fax mil,/Parcel no.: 75,00 2
i4;;::tiul';iS�' .rtiart.t)p.',;, Ctit grie 63RLF!tI1 yliz E�fp Limited energy residential S
' 75,00 lnstallatIon of Comeast coax Limited energy,non•residential 5
Each manufactured home or modular
dwellin 7 Service and/or feeder b 67.84 2
I,zK, ![ j ?EROi RR)S41OWN I�I Service or feeders Installation.alteration,and/Or relocation
Name: 200 amps or less S 100.70 -
201 ampsto400Omps t 13156 2
Address; 401 amps to 600 amps $ 200.34 2
601 amps to 1001 amps S 201.04 2
Caly/$ta1G7.iP: Over 1000 amps or volts $ 552.26 2
Reconnect onl $ 67.94 2
Phone: 503-295.5555 I ax. Temporary services or feeders installation,altorai on,and/or
Owner intrnllatlon: This losla1131inn is being made on property that 1.own which is not relocation
intended fur sale.lease,rent or exchange,according to ORS 447,449,670,and 701 200 amps or less $ 5936 1
Owner signature Date; 201 amps to 400 amps $ 125,05 2
401 amps to 599 amps S 101,54 2
71'T ,. _ v. ... new,alteration,or ex tendon,jicrlanel
�, Branch circuits-n
A. Fee for branch circuits with
1usiness Name: service or feeder ice,COCK
branch circuit x 7.42 2
Conl act name. B. Fee for branch circuits
• without service Or feeder fcc,
Address: _ each branch circuit c 50.15 2
Each additional branch circuit: $ 7,42 2 ,
City/Slate/7.IP: Miscellaneous(service or feeder not imam ed)
Pump or irrigation circle 1 j$ ci7,R4 1 2
Phone, bar: Sign or outline lighting S 07,54 2
C•mail; Signal circuits(s)or Iimitecl-
/ 'e• 1 .., energy anel,aitcration,or
extension, Describe: TeteiDnrn I 75 00 2
Business Name: Capitol Data&Communications,Inc. Piyc 2
Each additional inspection over allowable in any nrthc above
Contact name! Terry Branch _
Per inspection $ 66.25 .- ,
Investigation per hour(I hr min) $ 66.25
Address: 11401 NE Marx Street Industrial•lanl•er hour S 78.18
_.._- 1,_i,, ;rl^u c'gal;`irks 1i t letai< ,. :;a ::. ,t
City/State/7TP Portland,Oregon 97220
Subtotal 75.00
Plan review(25%o�crmit fee
phone: 503-255.9488 Pax: 503-257-7121 — Stale surehargc, 12% of permit fee) 9.00 ✓/•
CCB Lie.; 142467 Eleerricni Lie..26-IOS4C1E . Su rv.Lie,: 27S7LEA, TOTAL PERMIT FEE 84,00
✓'•' Thin p.+zntt npplicntlnn cxaires all perndt s nor obmined within ion
Supra.L'ICC[fiGian air;ntdaYC,required: r! ��•. � ,._ days after is her heed accepted 55 comptele
Print Name: Tery y Branch Date: 10/14/13 • Fee methodology set by Tni-County Building Industry Service Benrrl
"'tvwnbcr of impactions per permit allowed.
Authorized signature: h7,-...f ..
Print NUM Terry BraSOh
50'3.718-2537
U. F ED
10/14/2013 10:09 5032551966 CAPITOL ELECTRIC PAGE 02
Electrical Permit Application - City of Tigard
Page 2-Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systesm combined $ 75.00
Check Type of work Involved:
. ❑ Audio and Stereo Systems"
U Burglar Alarm
n Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System* •
❑ Vacuum Systems*
Li Other:
Fee for each commercial sytem $ 75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
❑ Data Telecommunication installation
❑ Fire Alarm Installation
Ll
1-IVAC
❑ Instrumentation
❑ Intercom and Paging Systems
•
❑ Landscape Irrigation Control*
El Medical
O Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations