Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a ' COMMUNITY DEVELOPMENT Permit#: ELR2014-00123
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/28/2014
Parcel: 1 S 126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 405
Project: Mutual of Omaha Subdivision:_CONDO,THE SUPPLEMENTAL PLAT Lot: 25-4
Project Description: Data telecommunications for TI.
Contractor: ADVANCED COMMUNICATIONS SERVICES INC Owner: WISCO REAL ESTATE EQUITY FUND I
PO BOX 231196 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97281-1196 PORTLAND, OR 97205
PHONE: 503-598-7082 PHONE:
FAX: 503-598-7320
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/28/2014 $75.00
12%State Surcharge-Electrical 05/28/2014 $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 13.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: i alOeb
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 ApplicatioJ E"Et v Et I t,IL 11I 1 1t 1 1 �1 ((.1 1
City of Tigard Received Q FLT , _�/a 3
2 Date/B : Permit N:
III • 13125 SW Hall Blvd.,Tigard,OR 97223MAY 2 8 2014 Plan Review 9�,
• Phone: 503.718.2439 Fax: 503.598.1960 AY Related Permit '�,y-e009 a
Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: turfs: 0 See Page 2 for
1 It. \I:I 1 Internet: www.tigard-or.gov Notified/Method: T/�� Supplemental Information
TYPE OF
WING DIVISION PLAN REVIEW
❑New construction ®Addition/alteration/replacement
Please check all that apply(submit j sets of plans w/items checked):
❑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.
❑ 1-and 2-family dwelling Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: p, jam'`- /_ ❑Addition of new motor load of system.
40.90 Sid aj /!/)4Fi7UN i7)Y'. l0OHP or more. ❑ E„ `l_2 l_3„
City/State/ZIP: ❑Six or more residential units. occupancy.
y ❑Recreational vehicle parks.
t.i ../ Did ❑Health-care facilities. P
Suite/bldg./apt.#: (/906. Project name: u G
- ,1 alil fan Aii.a. ❑Hazardous locations. ❑Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I =
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Lew__ , //// //� / (with above sq.ft.) 75.00 2
Ll�l.�vd iTCI CjL —�A ����tG/�/t'�}7 7�/./ Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 _ 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale, lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT I 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: t down d 6 i''e a u�ef-a- C - above service or feeder fee,
7.42 2
each branch circuit
Contact name: /wad& at", B.Fee for branch circuits without
p0, 667( service or feeder fee,first 56.18 2
Address: 2cl i�eo branch circuit
City/State/ZIP: dy fii Ot �i/ Each add'I branch circuit 7.42 2
7 (/� Miscellaneous(service or feeder not included)
Phone:(5p3) -q� Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: J/67&i&acvy�5e v piiYjr Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle _ 67.84 2
Business name: QM� Sign or outline lighting 67.84 _ 2
�/ Signal circuit(s)or limited-energy 1vfSee Page 2 2
Address: �+
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 66.25/hr
Email: Industrial plant(l hr min) 78.18/hr
-
n Inspections for which no fee is 90.00/hr
CCB Lic.:/79yf5' Electrical Lie.:CL 73 7 Suprv.Lic.: /9?7 specifically listed(%2 hr mm)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: tet//// Subtotal: 7,$-,Q-ZJ i
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 9
Authorized signature:
TOTAL PERMIT FEE: �y,,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\BuildingTermita\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 _ / /< 440-4615 (1 I/05/COM/WEB
/� e Y4I( do,.l
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
systems combined: $75.00 Description I Qty. I Each Total
Fee for all residential s
y Renewable electrical energy systems:
Check Type of Work Involved: 5 kva orless 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Garage Door Opener*g p >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
n V• acuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any_of the above:
Each additional inspection is 66.25/hr I
In O• ther: C w�
eal�w�=ii�.r. /� charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/]hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) Number of inspections allowed per permit.
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
14 Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nursc Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Total number of commercial systems: (
*No licenses are required. Licenses are required for all
other installations
L\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 04/21/2014
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9020 SW WASHINGTON SQUARE RD 405,
TIGARD, OR, 97223
Commercial - Electricial Limited Energy
199 Electrical final
PASS - No C of O
June 3, 2014 at 9:39:13 AM
ELR2014-00123
Jeff Grove
Violation Summary:
Inspector Contractor