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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT t p I, COMMUNITY DEVELOPMENT Permit#: ELR2015-00208 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/08/2015 Parcel: 1S 134BC00200 Jurisdiction: Tigard Site address: 12196 SW SCHOLLS FERRY RD Project: Mod Pizza Subdivision: GREENWOOD TERRACE CONDO Lot: 17 Project Description: Low voltage for data Contractor: COLUMBIA TELEPHONE CO INC Owner: ATLAS GREENWAY LLC PO BOX 766 333 NW NINTH AVE, STE 1009 CLACKAMAS, OR 97015 PORTLAND, OR 97209 PHONE: 503-230-8899 PHONE: FAX: 503-305-6546 FEES Description Date Amount Specifics: Restricted Energy Permit 09/08/2015 $75.00 12%State Surcharge-Electrical 09/08/2015 $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 issue, ub ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done i• - cordance with -••roved 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. • TENTION: Oregon la • es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95. '01-0010 thro gh OAR 952-4• 0090. 'u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 r 1.800.33 .2344. � k Issued By: 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: Cof/s74 5 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 FOR OFFICE USE ONLY Mil City of Tigard Dateived 0 awn Permit#: gL 1S,t^0:9.01 N 13125 SW Hall Blvd.,Tigard, CEIVED plan Review Phone: 503.718.2439 Fax: 503. 8. DateB : Related Permit#: TIGARD Inspection Line: 503.639.4175 C P 7 1 Ready Date/By: Juris: E1 See Page 2 for Internet: www.tigard-or.gov 5 Notified/Method. Supplemental Information TYPE OF IW'RK, •.• PLAN REVIEW ®New construction El Addition/ ntion/replacement Please check all that apply(submit 2 sets of plans w/items checked): nav ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition El 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 El Commercial/industrial El Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑ Multi-family El Master builder El Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: 12196 SW SCHOLLS FERRY RD 100HP or more. ❑"A","E","l-2","t-3", City/State/ZIP:TIGARD OR 9200 970-9-3 ❑Six or more residential units. occupancy. ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name:MOD PIZZA ❑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. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 I DESCRIPTION OF WORK Limited energy,residential 75.00 2 PONE AND DATA CABLE (with above sq.ft.) Limited energy,multi-family 7500 2 residential(with above sq.ft.) Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER I ❑ 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 I 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 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email:ming @columbiatelephone.com Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:COLUMBIA TELEPHONE CO,INC Sign or outline lighting 67.84 2 Address: 15140 SE 82l DR SUITE 310 Signal circuit(s)or limited-energy ® Page 2 75.06 2 panel,alteration,or extension. City/State/ZIP:CLACKAMAS OR 97015 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503)230-8899 Fax:(503)305-6546 Investigation(1 hr min) 90.00/hr Email:ming @columbiatelephone.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: 99500 Electrical Lic.: 26-940c1 Suprv.Lic.: 1812Ieb specifically listed(%z hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: 'C Subtotal: .75"cm() Print name: MING CHUM Date: 09-08-2015 ❑Plan Review Required(25%of permit fee): 1 ' - State surcharge(12%of permit fee): q-pa Authorized signature: TOTAL PERMIT FEE: Sq.00 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:\Building\Perini ts\EL.C_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined: $75.00 Description I Qty. I Each Total I • y Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 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* >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 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(1/2 hr min) ELECTRICAL PERMIT FEES COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 4, Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ® Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: _ *No licenses are required. Licenses are required for all other installations t.\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 12196 SW SCHOLLS FERRY RD, TIGARD, OR, 97223 Commercial - Electrical Limited Energy 198 Low voltage ﬁnal PASS - No C of O ELR2015-00208 Herb Stabenow Violation Summary: Inspector Contractor