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Permit I■J_ t\ CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit#: ELR2010-00006 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/20/2010 Parcel: 2S 101 AC01600 Jurisdiction: Tigard Site address: 7000 SW HAMPTON ST Subdivision: Lot: 0 Project: JDRF Project Description: Install restricted energy for voice/data. FEES Owner: NEIMEYER, JOHN Description Date Amount 15 82ND DR STE 210 Restricted Energy Permit 01/20/2010 $67.84 GLADSTONE, OR 97027 12% State Surcharge - Electrical 01/20/2010 $8.14 PHONE: Contractor: ORE COM TELECOMMUNICATIONS LLC 9828 E BURNSIDE ST STE 100 PORTLAND, OR 97216 PHONE: 503-597-3700 FAX: 503-953-8501 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 $75.98 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 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 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Perm ittee 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 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. Elehrill Permit A licatio pp ~ ECPIVFn City Received of Tigard Permit No.: DateB ° 13125 SW Hall Blvd., Tigard, OR 97223 JAN 1.. 4 2010 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juri ® See Page 2 for Internet: www.tigard-or.goV Notified/Method: Supplemental Information P1 III nlAln All n r_ - TYPE OF PLAN REVIEW Please check all that apply (submit 2 sets of plans w/items checked below): ❑ New construction Addition/alteration replacement ❑ 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 Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A", "E", "1-2", "1-3", 100 HP Job n0.: Job site address: / or more. occupancy. -MO ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: Q ~'Z3 El Health-care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: J An Project name: ~bFj= ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: NhDQ- j ~l dC , Description Qty. Fee. Total New residential single- or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1 Limited energy, residential 67.84 2 DESCRIPTION OF WORK with above s q. ft. Limited energy, multi-family 67.84 2 residential (with above sq, ft. 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: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: s B. Fee for branch circuits Contact name: without service or feeder fee, 56.18 2 first branch circuit Address: Each add'I branch circuit 7.42 2 Miscellaneous service or feeder not included City/State/ZIP: Each manufactured or modular dwelling, service and/or feeder 67.84 2 Phone: ( ) Fax: ( ) Reconnect only 67.84 2 E-mail: Pump or irrigation circle 67.84 2 CONTRACTOR tr Sign or outline lighting 67.84 2 ~-1-1A Signal circuit(s) or limited- Business name: ©1`^~-C_OAA -,i-t-L~eo "A A01,,j C ~ energy panel, alteration, or Address: $ E v~~St ~ oa extension. Describe: Page 2 2 City/State/ZIP: t s -7 7-1 Each additional inspection over allowable in an of the above ( lj 1 ' 3 7th Per inspection 66.25 Phone: b 3) g Fax: (1. 3) 1!53-,-05b) Investigation per hour (1 hr min) 66.25 CCB Lic.: SZ~3 Electrical Lic.: G~ Suprv. Lic.: 7 (,6A Industrial plant per hour 78.18 4- t`\ ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Print name: Date: -I -UV lo Plan review (25% of permit fee): State surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: 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:IBuildingNermits\ELC-PermitApp.doc 10/01/09 440-4615T(I1/ OM/WEB 50 , ~8► - -7 2,G4 - ca r