Permit (154) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
8. COMMUNITY DEVELOPMENT Permit#: ELR2018 00014
TI CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/29/2018
Parcel: 2S101AC01600
Site address: 7100 SW HAMPTON ST 212 Jurisdiction: Tigard
Project: Todd Albert Construction Subdivision: None
Project Description: Data telecommunications system. Lot: None
Contractor: COLUMBIA TELEPHONE CO INC Owner: NEIMEYER, JOHN
PO BOX 766 1582ND DR STE 210
CLACKAMAS, OR 97015 GLADSTONE, OR 97027
PHONE: 503-230-8899 PHONE:
FAX: 503-305-6546
FEES
Description Date Amount
Specifics:
Restricted Energy Permit 01/29/2018 $75.00
Type of Use: COM 12%State Surcharge-Electrical 01/29/2018 $9.00
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 503.232.1987 or 1.800.332.2344.
ZIssued By: /�/a� a-L 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.
-V ''''t
iVSIN
Electrical Permit Application `` FOR OFFICE USE ONLY
(y �l Received
City of Tigard \?�`F Date/B > > % I — t
13125 SW Hall Blvd.,Tigard,OR 97223 ,0 ° Related Permit#:
i Phone: 503.718.2439 Fax: 503.598.1960 t+ & s 0 see Page 2 for
Inspection Line: 503.639.4175 {' to/By:
-� '' y a Y ��• � r Supplemental Information
'i.'.. ll A Ir,,r z a.. ethod:
Internet: www.tigard-or.gov �L , - } .
TYPE OF WORK 41. JPLAN REVIEW
Please that apply(submit 2 sets of plans w/items checked):
❑New construction ®Addition/alteration/repacementor
❑ase checke allfeeder 400 amps 2 more 0 plans
it over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
El and 2-family dwelling ®Commercial/industrial El Accessory building amps for all other installations. buildings.
ID Multi-family ElMaster builder 1=IOther: 0 Fire pump. 0 Installation of 150 KVA or
JOB 9rrE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job site address:7100 SW Hampton IOOHP or more. 0"A","E","1-2","1-3",
Job#: occupancy.
❑Six or more residential units.
City/State/ZIP:Tigard OR 97223 0 Health-care facilities. 0 Recreational vehicle parks.
0Supply voltage for more than
locations
Suite/bldg./apt.#:212 I Project name:Todd Albert Construction 0 Hazardous . 600 volts nominal.
El Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Lot#: Includes attached garage.
Subdivision: 1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF �1l1ORK Limited energy,residential 75.00 2
(with above sq.ft.)
Data cabling Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name:
200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: 401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
or less 59.36 1 s
Owner installation:This installation is being made on property that I own which is not 200 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 168.54 2
Date: 401 amps to 599 amps
Owner signature: Branch circuits—new,alteration,or extension,per panel
0I CONTACT PERSONAPPLICANT I A.Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first
56.18 2
Address: branch circuit
Each add'l branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: 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
Signal circuit(s)or limited-energy ® See Page 2 737 cis' 2
Address: 15021 SE 94th ave panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:clackamas OR 97015 Additional inspection(1 hr min) 66.25/hr
Phone:(503)230-8899 Fax:(503)305-6546 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:ming@columbiatelephone.com Inspections for which no fee is 90.00/hr
listed(Y=hr min)cificall
CCB Lic.: 99500 I Electrical Lic.: 26940cle II Suprv.Lie.: 1812leb specifically ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: `rk� --+. t Subtotal: >.44-
Print name: ming chum I Date: 01/29/18 0 Plan Review Required(25%of permit fee):
....._
State surcharge(12%of permit fee): 1,
dr
TOTAL PERMIT FEE: /'g`(,
Authorized signature:
This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
Print name: I I * Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
dfimited 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 I Total j *
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
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
Heating, Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
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
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is
specifically listed(Y:hr min) 90.00/hr
COIMIERCIAL 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:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
® 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
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