Permit � z
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2020-00011
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/21/2020
Parcel: 1 S 134BC00200
Jurisdiction: Tigard
Site address: 12180 SW SCHOLLS FERRY RD
Project: One Medical Group Subdivision: None Lot: None
Project Description: Install(64)CAT6 circuits for data,voice and wireless access.
Contractor: TELESPHERE INC Owner: ATLAS GREENWAY LLC
449 SW ALDERWOOD DR 333 NW NINTH AVE, STE 1009
WEST LINN, OR 97068 PORTLAND, OR 97209
PHONE: 971-678-6344 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/21/2020 $75.00
12%State Surcharge-Electrical 01/21/2020 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
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 $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue Permittee Signature: ` h �
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE O\LI
City of Tigard RECEIVED Date/Bed: /42 i i2v ' Permit#:El/La �oo 000/
14 is 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review
II Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 JAN 21 2020 Ready Date/By: Juris. 1$ See Page 2 for
1IC'ARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
0 New construction ®Addition/altera i Ire;aCement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more ['Building over three stories.
0 Demolition 0 Other: • where the available fault current ['Marinas and boatyards.
r exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
Multi-familyMaster builderOther: amps for all other installations. buildings.
❑ 0 0 0 Fire pump. 0 Installation of 150 KVA or
s„ „* 1T' ;14D'Loci4TION_ _ ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job Site address.
12180 SW Scholls Ferry Rd. 100HP or more. ❑"A","E","1-2","I-3",
City/State/ZIP: ❑Six or more residential units. occupancy.
ty Tigard, OR 97223
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:One Medical ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:Located across from Whoe Foods , K. ..,:x;
Description Qty. Each Total I "
New residential single-or multi-family dwelling unit.
Subdivision: 1 Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
11 DESCRIPTION OF WORK , r Limited energy,residential
(withsq.ft.) 75.00 2
above
Install (64) CAT6 circuits for data, voice and wireless access. Limited abovenergy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
El PROPERTY OWNER' la 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 1
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
Branch circuits—new,alteration,or extension, er panel
" -r _ " ICANT ,, CONTACT PERSON _
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: Reconnect only 67.84 2
s Pump or irrigation circle 67.84 2
Business name:Telesphere, INC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy See Page 2 2
Address:449 SW Alderwood Dr. panel,alteration,or extension.
City/State/ZIP:West Linn, OR 97068 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( 5031880-9412 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:Fred@telesphere.cc Inspections for which no fee is
CCB Lic.:223167 Electrical Lic.:CLE 537 Suprv.Lic.:4551LEB
s.ecificall listed %hr min 90.00/hr
Suprv.Electrician signature,required: Subtotal: $75.00
Print name:Mike C i ccotel l i Date:1-10-19 0 Plan Review Required(25%of permit fee):
/� State surcharge(12%of permit fee): $9.00
Authorized signature: `� V TOTAL PERMIT FEE: $84.00
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.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
REST ENTIAL'WORK ONL'Y:, `'N,6,1 1 E SCHEDI LE
Fee for all residential systems combined: $75.00 Description I Qty. I Each Total I *
yRenewable 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
with OAR 918-309-0040) 552.26 2
I I 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:
I I Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Az hr min)
COMMERCIAL WORK taNL s' ELECrRI AL PERMIT.FEET;
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
I I Boiler Controls
❑ Clock Systems
• Data Telecommunication Installation
U Fire Alarm Installation
�I H• VAC
U Instrumentation
❑ Intercom and Paging Systems
Landscape Irrigation Control*
❑ Medical
n N• urse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n O• ther:
Total number of commercial systems: /
*No licenses are required. Licenses are required for all
other installations
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