Permit
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit ELR2010-00024
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/04/2010
Parcel: 1 S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 100
Subdivision: Lot: 0
Project: Pacific NW Title
Project Description: Phone and data circuits to 34 stations.
FEES
Owner:
WISCO REAL ESTATE EQUITY Description Date Amount
FUND I LTD PARTNERSHIP, BY WYSE Restricted Energy Permit 02/04/2010 $135.68
INVESTMENT SRVS CO, 1501 SW TAYLOR ST 12% State Surcharge - Electrical 02/04/2010 $16.28
PHONE:
Contractor:
TEAM ELECTRIC
9400 SE CLACKAMAS RD.
CLACKAMAS, OR 97015
PHONE: 503-557-7180
FAX: 503-557-8201
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $151.96
Intercom/Paging: N Landscape/Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 a ardance wiE 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. A NTION: Oregon r-0 es ou to follow the rules adopted by the Oregon Utility Notfication Center. Those rules are set forth in OAR
952-0 0010 through DAR 952o may obtain a copy of the rules or direct questions to OUNC Zbycallin7 2 6.6699 r 1 800.332.2344A /
Is ued By: Permittee Si a!~v
V Or
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 an inspection that business day.
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.
J I
01-03-1 0; 1 7: 1 8 ; Teary E I ec r r i s 503. 557. 8201 # 1/ 3
Electrical Permit Application 1. is ioD FOR OFFICE VSF ONLY
City of Tigard Received PermitNo.: EL Q
'/IO ld-e~
• 13125 SW Hall Blvd., Tigard, OR 97223 Date/13y: - Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960FEB O 4 2010 Date/B : Other Permit: 3
Inspection Line: 503.639.41.75 Date Ready/By: luris: 0 See Page 2 for
Internet: www.tigard-or.gov clTy F TIGARD Notified/Method: Supplemental Information
TYPE OF VfWADING DIVISION PLAN REVIEW
® New construction ® Add ition/alteration/replacement Please check all that apply (submit 2 sets of plans wlitems checked below):
❑ 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 ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1- and 2-family dwelling ® CommerciaUindustrial ❑ Accessory building amps for all other installations, buildings.
❑Multi-family ❑Masterbuilder ❑Other: ❑Firepump. ❑Installationof75KVAor
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.: 4059 Job site address: 9020 Sw Washington Sq. rd. I00HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard Or 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bidg./apt. no.: 100 Project name: Pacific NW Title ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description Qty. Fcc Total
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'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft. 67.84 2
Phone and Data Circuits to 34 stations Limited energy, multi-family residential (with above sq. ft.) 6784 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 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
Branch circuits- new, alteration, or extension, er panel
Owner signature: Dale: A. Fee for branch circuits ivirh
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7'42 2
Business name: B. Fee for branch circuits
tviihoul service or feeder fee,
Contact name: first branch circuit 56.18 2
Address: Each add'] branch circuit 7.42 2
Miscellaneous service or feeder not included)
City/State/ZIP: Each manufactured or modular dwellin , service and/or feeder 67.84 2
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
limited-
Business name: Team Electric Company Signal circuit(s) or limited-
energy panel, alteration, or
Address: 9400 SE Clackamas Rd extension. Describe: 2 Page 2 135.68 2
34 stations
City/State/ZIP: Clackamas Or. 97015 Each additional inspection over allowable in any of the above
Per inspection
Phone: (503) 557-7180 Fax: (503) 557-8201 66.25
Investigation per hour hr min) 66.25
CCB Lie.: 173043 t 141to Electrical Lie.: 3-225C Suprv. Lie.: 4416 S Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: j,3&-gg /3 Q
Plan review (25% of permit fee)
Print name: Mike Trusheim Date: 213110
State surcharge (12% of permit fee): 16 3t'" /(a. R~
Authorized signature: TOTAL PERMIT FEE: jS24"15/ ~P
This permit application expires if a permit is not obtained within ISO
Print name; Mike Trusheim Date: 2/3/10 days after it has been accepted as complete.
•� 0U -03 -10 ;17:18 ;Team Electric ;503.557.8201 # 2/ 3
I
•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 2
*No licenses are required. Licenses are required
for all other installations