Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I , COMMUNITY DEVELOPMENT Permit#: ELR2015-00136
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/20/2015
Parcel: 25101 BD00100
Jurisdiction: Tigard
Site address: 7650 SW BEVELAND RD 130
Project: HR Answers Subdivision: 1994-025 PARTITION PLAT Lot: 2
Project Description: Data telecommunications system.
Contractor: COLUMBIA TELEPHONE CO INC Owner: PNWP LLC#2
PO BOX 766 PO BOX 2206
CLACKAMAS, OR 97015 BEAVERTON, OR 97075
PHONE: 503-230-8899 PHONE:
FAX: 503-305-6546
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/20/2015 $75.00
12%State Surcharge-Electrical 05/20/2015 $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 • . 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= •- • or direct questions to OUNC by calling 503.232.1987 or 1.800.332. 344.
Issued B Permittee Signature:
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 Application I O R O I i I t 1 1 .1 O\I 1
City of Tigard ` Received Permit No.: '� p
: • 13125 SW Hall Blvd.,Tigard,OR 97223 �evlewR ��//S _ 'f`z2d`5"� 1�Phone: 503.718.2439 Fax: 503.598. G �J pmt : Other Permit: ` p Iit ..�. , 0
i ,„1) Inspection Line: 503.639.4175 q r� rL Date Ready/By: 0 See Page 2 for
Internet: www.tigard-or.gov ` Y e ! . 'fied/Method: r�. Supplemental Information
TYPE OF WORK 1\G \'�WB PLAN REVIEW
❑New construction ®Addition/alteration/10,11 00 O\� Please check all that apply(submit ii sets of plans w/items checked below):
Other: i3\3 \\' ❑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 0 Floating buildings.
❑ 1-and 2-family dwelling less to ground,or exceeds 14,000 0 Commercial-use agricultural
y g ®Commercial/industrial ❑Accessory building 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 system.
❑Addition of new motor load of ❑"A "E","1-2","1-3
Job no.: Job site address:7650 SW BEVELAND STREET lOOHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/Z1P:TIGARD,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 130 Project name:HR Answers,Inc. ❑Service or feeder 600 amps or more.
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'l 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.)
DATA CABLING Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Eaerpl 0 See Page 2
Services or feeders installation,alteration,and/or relocation_
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
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
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
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 sale,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 ex tension,per panel
❑ APPLICANT 1 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: rtr Selal._) each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first
branch circuit 56.18 2
Address: Each add'l branch circuit 7.42 _ 2
Miscellaneous(service or feeder not included) _
City/State/ZIP: Each manufactured or modular
Phone:( ) Fax: :( )
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:COLUMBIA TELEPHONE CO INC Signal circuit(s)or limited-energy 1 See cS'4"panel,alteration,or extension. Page 2 �S` 2
Address: 15140 SE 82ND DR SUITE 310 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:97015 Investigation(1 hr min) 66.25/hr
Phone:(503)230-8899 Fax:(503)305-6546 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
C
90.00/iv
CB Lic.: 99500 Electrical Lic.: 26-940CL Suprv.Lic.: 1812LEB specifically listed(Vs hr min)
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES Subtotal: -?5.,
Print name: MING CHUM Date: 05-19-2015 Plan review(25%of permit fee): —
State surcharge(12%of permit fee): `),...
Authorized signature: TOTAL PERMIT FEE: I b il_a,
Print name: This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\BuildingWermits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440-46151(11/05/COM/WEB