Permit (45) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' N. COMMUNITY DEVELOPMENT Permit#: ELR2018 00071
Date Issued: 05/10/2018
T[ ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 120
Project: Ricoh Subdivision: None Lot: None
Project Description: data telecommunications system.
Contractor: LOW VOLTAGE SOLUTIONS OF OREGON Owner: TOWMAN ONE EMBASSY CENTRE LLC
PO BOX 883 BY TOWMAN LLC
GLENDALE, OR 97442 25425 BASCOM AVE STE 230
CAMPBELL, CA 95008
PHONE: 541-203-7582 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/10/2018 $75.00
12%State Surcharge-Electrical 05/10/2018 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Sjereo: 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 suspend- for more the 180
days. ATTENTION: Oregon law requires you to folio - r- -•-• -d by the Oregon Utility Notification Center. Those rul-- ,f set forth in OAR
952-001-0010 through
hOOAAAR ,,c--R 952-001-0090. You.� _ ;`y of the rules or dir= t questions to OUNC by calling 503.232.1987 or =- . 2.23,'.
Issued By: /> " - ��.- •• . - .•nature:
Ailfr!
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.
'`'ToiVr.�
3Electrical Permit Application Project#
Washington County,155 N.1"AV,Suite 350,MS 12,Hillsboro,OR 97124,
oitrco, Phone:503-846-3470,Fax:503-846-3993/lutbldg@co.washington.or.us Permit# 127-4/e-Pe I&l..) 7
Inspection Requests:503-846-3699/www.co.washington.or.us/piro ey,Ar'• •
TYPE OF WORK PI AN RE I t� �
KNew construction 0 Addition/alteration/replacement 0 Other: Please check all that apply:
0 Service or feeder 400 amps 0 Hazardous locations
or more where the available 0 Service orfeeder600amps armore
CATEGORY`' T CTION " fault current exceeds
1-and 2-familydwelling10,000 ampsat 150 volts or
mBarinas
overoat ae stories
❑ es 0Accessory building ❑ Marinas and boatyards
less to ground,or exceeds Floatin
❑Multi-family 0 Master builder0 g Commercial-use
0 Other: 14,000 amps for all other buildings
Job SITE INFORMATION
OAND
` LOC TION installations.
❑ Commercial-use agricultural
9(Oa„(d cU, r� � f } ' ❑ Fire pump
buildings
Job no.: Job address: �/((H Ch �j 0 Installation of 150 KVA or larger
J / !1 ) ❑ Emergency system separately derived system
City/State/ZIP: / ` r 1 7 0 Addition of new motor ❑ A,”" ,>,.I 2»„l-3„occupancy
/ �� ��� j�t� load of 100HP or more
Suite/bldg./apt.no.: I Project name: ❑ Six or more residential units ❑ Recreational vehicle parks
El Health-care facilities
0 Supply voltage for more than
600 volts nominal
Cross street/directions to job site:
FEE SCHEDULE
Description Qty. Fee Total *
Subdivision: Lot no.: , Residential single-or multi-family dwelling unit.
includes attached garage.
Tax map/parcel no.: 1,000 sq.ft.or less 167.00 4
DESCRIPTION of WORK Ea.add'I 500 sq.ft.or portion 47.00
Limited e40 ki W e //7r,9,( Ciera .4/9 /64/,4 • % _.9-' (withaboove versq,residential
107.00 2
Limited energy,multi-family
G .5 -g. G4 4 It° f(,iv C residential(with above sq.ft.) 107.00 2
0 PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
200 amps or less 107.00 2
Name:
201 amps to 400 amps 161.00 2
Address: 401 amps to 600 amps 214.00 2
City/State/ZIP: 601 amps to 1,000 amps 321.00 2
Over 1,000 amps or volts 642.00 2
Phone:( ) Fax:( ) Temporary services or feeders installation,alteration,and/or
re ocatian
Owner installation:This installation is being made on residential or farm property owned by me or a member of 200 amps or less 107.00 2
my immediate family. This property is not intended for sale,exchange or rent.(ORS 479.540(1)and 479.560(1). 201 amps t0 400 amps 161.00 2
Owner signature: Date:
401 amps to 599 amps 214.00 2
❑ APPLICANT - I 1❑:CONTACT PERSON Branch c rcuits—new,alteration,or=torsion.n,per panel
A.Fee for branch circuits with
Business name: �6 W O aealifil above service or feeder fee, 9.50
f �� each branch circuit 2
Contact name: L,° od B.F
/ for branch circuits
without service or feeder 107.00
Address: 3
fee,first branch circuit 2
City/State/ZIP: 6 )G 0 i\ I (/L Z Each add'I branch circuit 9.50
/ r ([mice or feeder not included)
Phone:(�/) 2. 74, .g733 Fax:( ) Each manufactured or modular
E-mail: z_\jS op o,t'� ` dwelling,service,and/or feeder 113.50 2
Reconnect only 107.00 I
1 ONTRAOcl. Pump or irrigation circle 107.00 2
Business name: ; / I/ J / ��' y Sign or outline lighting 107.00 2
Ili uu ��41/ Signal circuit(s)or limited-
Address: /O . r energy panel,alteration,or
1
extension.Describe:
City/State/ZIP: , / �, 0 i � 2— 2
Phone:(5-ti 1 ) 7,7 • Fax:( ) Each additional inspection over allowable in any of the above
Per inspection 107.00
Q�a E-mail: I/v 0-c 0 ,`� i� Cit ' CB lir.no.: i Investigation fee(See compliance)
ante)
�r Electric. lip. .o: l(� f .. or m�.lir.: Other:
ti 0 41 Supervis : "IT'cian w,t f' '� ELECTRICAL PI~I f FEES
signature,required: Subtotal75-.,°4-
714.
°4-
7 Print name. / R I C r �o .-e y Date: c /0 / Plan review(25%of permit fee)
Authorized State surcharge(12%of permit fee) ,.j p �'.`
TOTAL PERMIT FEE
67.."---
signature:
signature: P !!�
This permit application expires if a permit is not obtained
Print name. j/( L ,�4-- Coo,* - 1- Date: s /0 l8 within 180 days after it bas been accepted as complete
*Number of inspections allowed per permit. Revision 6/13