Permit EV1SED
CITY OF TIGARD /a/3c��y�t ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2014-00274
Date Issued: 11/26/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S 26/201 0101
Jurisdiction: Tigard
Site address: 12000 SW 66TH AVE
Project: Landmark Ford Fiber Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Install fiber optic tie cable from MDF to IDF(75441). 12/30/2014: REPRINT permit to add(1)Cat 6 cable to scope
of work.
Contractor: E C COMPANY Owner: CORLISS, JAMES L&CORA K
PO BOX 10286 LEASE TO: FORD LEASING
PORTLAND, OR 97296 DEVELOPMENT COMPANY
PO BOX 23970
TIGARD, OR 97281
PHONE: 503-224-3511 PHONE:
FAX: 503-295-3012
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/26/2014 $75.00
12%State Surcharge-Electrical 11/26/2014 $9.00
Type of Use: COM Restricted Energy Permit 12/30/2014 $75.00
Class of Work: ADD 12%State Surcharge-Electrical 12/30/2014 $9.00
Total Number of Systems: 2
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 2 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 $168.00
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 O•R 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: - ��2///. Permittee Signature: d A/ , -/ /.°C-✓(7f}`77CAJ'
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.
Dec. 30. 2014 7: 22AM No. 6582 F, 1
Electrical Permit ApplicigREIVEU
City of Tigard I Received Pert, tN
Illig ty g I C 3 0 20:1 Davy_ 1,2/30v any i 00;179
13125 SW Hall Blvd.,Tigard,OR 9T23 pew Review
Phone: 503.639.4171 Fax 503 (�(� Dateny:
Other Panto:
t 1 li,1 It Ll Inspection Line: 503.639.4175 ' �1��r7ti ttU Date Ready/By: bait: ® Sec Page 2 fur
Internet_ wvr<v.tigard-or,gov ']1� f I131I��/�t' Notified/Method: Supplemental Information
OF WORK ll 1► PLAN REVIEW
❑New construction 0 Addition/alteration/replacement
check all that apply(submit 2 se s of pions w/items checked below);
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Den1014100 ❑Other: whcm tie available fault current E)Marinas and boatyards,
CATEGORY OF CONSTRUCTION csccrAs 10.000 amps at 150 voles or ❑Floating buildings_
Iris to ground,or exceeds 14.000 ❑Connnercial-use agricultural
❑ I.and 2-family dwelling ®Colmnercial/industrial 0 Accessory building amps for all other installations, buildings,
❑Multi-family ❑Master builder ❑Other: ❑Fire pip, ❑Installation of 75 1cvA or
M
JOB SITE INFORMATION AND LOCATION ID Emergency system. larger separrtely derived system.
❑Addition ornew motor load of ❑"A" "E" 't-2 "l-1
Job no.; 75441 Job site address' 12000 SW 66th Ave 10011P or more. occupancy_
-- Ca Sla or more residential units. Q Recreational vehicle parks,
City/State/ZIP: Tigard OR ❑Health-care facilities, ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: Landmark Cat6 D Scivicv or freder 600 amiss or more.
"` FEE SCHEDULE
Cross street/directions to job site; Darrepuoa Q . lira. rain, I •_
— New residential single-or multi-Family dwelling unit,
Includes attached garage.
Subdivision: w Lot too,: 1,000 sq.IL or less 162.54 4
Ea.add',500 sq.It.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK -M (with above sq_n.)
Limited energy,multi-family —
Install Cat6 cables (please add to permit# ELR2014-00274) residential(with above sq.R.) 7500 2
Service or feeders installation,alteration,and/or relocation
Ce ki6-/N f} PE-XMrr f(/45 --. Ft I?a Er— 6 G¢6ti 20o amps orless 100.70 2
❑ PROPERTY OWNER?'ER 0 TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: ..r. 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:( ) Pax:( ) 200 amps or less 59.36 1
Owner Installation:'Phis installation is being made on property that I own which is not 201 amps to 400 amps ,„ 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps l0 599 amps 168.54 2
Branch circuits-new,ultcrationi or extension,per panel
Owner signature; -- Date: A.Fez for branch circuits with
® APPLICANT I above service or feeds fee,
❑ CONTACT PERSON each branch circuit 7,42 2
Business name; EC company B.t=ee rot branch circuits wfrhour
`—
service or feeder fee,first
56.18 z
Contact name: Kathy Kelley — _branch circuit
—
Each add'I branch circuit 7.42 2
Address; PO Box 10286 Mlstcllancoua(service or feeder not included)
Each City/State/ZIP: Portland, OR 97296 dwChmg servicetuuullorfcedcr 67.84 2
Phone:( 503) 224-3511 Fax::(503) 295-3012 Reconnect only 67.84 2
— Pump or irrigation circle 67-14 2
E-mail: kathyk@e-o-co . com
Sign or outline lig,hting 67,84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name: EC Company . panel,alteration,or eatentton, 1 Pale 2 75.00 2
Each additional inspection over allowable in any of the above_
Address: PO Box 10286 Additional inspection(I hr min) 66.251 hr
City/State/ZIP: Portland, OR 97296 Investigation(]hrmin) 66.25/hr
_,_._._ - Industrial plant(I hr min) 71,11/Iv
Phone;(5031 2 2 4-3 511 Fax:(503) 295-3012 Inspections for which no fee is- 90.00/hr
specifically listed(%hr min) I
CCD Lie.: 49737 Electrical Lie.;2 6 C�__ Suprv.Lic.5 9 1 ELECTRICAL PERMIT FEES
. iffi,i L ( Pc Suhiora,: t ,e'?
•Suprv.Electrician signature,require
Ai! Plan roview 25°b of rmit fee):
Print name: Jeff barb /I Date: 12--30-14 Slatcsurcharge(12%°ofpermil fee): 9.`'�
i w TOTAL,PERMIT FEE: ' j.'
Authorized signature: AV This comet application erplrea if a permit Is not obtained ci within 180
days lifter It bas been accepted as complete.
Print name: Anna He t t Date: 12-3 0-14 + Ntanber of inspections allowed per permit
1 1.V)uitdinetl'emits\ELC-reerMApp.dvc 07/01/10 41046151111/05/COM1Vrai
Dec. 30. 2014 7:23AM No. 6582 P. 2
Electrical Permit Application - City of Tigard
Page 2-Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY;
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for&hi commercial $75.00
system
(SPJ OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
�] Boiler Controls
❑ Clock Systems
g, 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: 1
*No licenses are required. Licenses are required
for all other installations
M ePumkb\El.C-ren;uyo.e«07/01/10