Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
.14 a COMMUNITY DEVELOPMENT Permit #: ELR2010 00178
T i G A R L) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/09/2010
Parcel: 1S136DD00900
Jurisdiction: Tigard
Site address: 6830 SW ATLANTA ST 100
Subdivision: HAINES CROSSING II Lot: 0
Project: BrokerTec
Project Description: Install low voltage for voice and data.
FEES
Owner:
ATLANTA STREET LLC Description Date Amount
15400 SW BOONES FERRY RD Restricted Energy Permit 09/09/2010 $75.00
LAKE OSWEGO, OR 97035 12% State Surcharge - Electrical 09/09/2010 $9.00
PHONE:
Contractor:
ASHLAN COMMUNICATIONS INC.
7534 N ELMORE AVE
PORTLAND, OR 97217
PHONE: 503 - 849 -9523
FAX: 503 - 286 -2158
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 $84.00
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 perm' - issued subject • e regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don in accordance with appro = • pla . 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 re• : es o • follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-101-0010 throu. h OAR 952 -00 .101. Y•u ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Is ued By: � -�� �� � 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 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.
Electrical Permit Applica ' '\j D Ftllt c>rF►ci.: list: um.)
Received
City and
g
DateB : f //� f- e of Ti Per mit No.: /� .. l 7 8
0
:� • 13125 SW Hall Blvd., Tigard, OR 972�3c Q 9 2
p 1
9l � Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
r i _ RI Inspection Line: 503.639.4175 0 f l'GA�D Date Ready/By: Jurls: ® See Page 2 for
Internet: www.tigard- or.gov ��,,C��1��� G D � v 'L+,OCa Notified/Method: Supplemental Information
TYPE OF Blc � v7 PLAN REVIEW
agNew construction ❑ Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w /items 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 ('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 ",
Job no.: Job site address: 6 e Jt.J 1' 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: R e //eL. d (1 9 72.2 3 ❑ Health -care facilities. ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: /6i0 Project name: zc etcke,- -7-7-e-A ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: / / / y P3' %f / a+ ,eg Description 1 Qty. 1 Fee. 1 Total 1 •
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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
.2' ^ / r / /€r 1,C„ 4/ ( 1/c46° AA residential (with above sq. ft.) - -
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
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
tY 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 ex_ tension, per panel _
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 _ 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( )
Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: /1/14A (D4ie44141,'1 //'Y.Oq f z� — e- panel, alteration, or extension. / Page 2 7 � 2
Each additional inspection over allowable in any of the above
Address: '75 3 y 'V �/� 4 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: �j // 0 / &� �7/� -7 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( - ,3) E 1'T' 95: Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
CCB Lic.: /6 932 3 Electrical Lic.: a ,3 Suprv. Lic.: 3353 L E Q ELECTRICAL PERMIT FEES
yy/�st i /s / / /// Subtotal: 1�.�
Suprv. Electric e, required: s .. - Plan review (25% of permit fee): ..
Print name: ,, .mil S / /� / Date: 9/94) State surcharge (12% of permit fee): ,,)
D f�"
TOTAL PERMIT FEE:
Authorized signature: �j rZ� This permit application expires if a permit is not obtained ithin 180
Print name: /9 j _.,,,,,4.,/- Date: !� /0 •
days after it has allowed per accepted as complete
Q • Number of inspections a llowed r
1:\ Building \Permits\ELC- PennitApp.doc 07/01 /10 440.4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
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 $75.00
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
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PennitApp.doc 07/01/10