Permit Ipi CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t COMMUNITY DEVELOPMENT Permit #: ELR2011 -00096
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/29/2011
Parcel: 1S135DD03301
Jurisdiction: Tigard
Site address: 11945 SW PACIFIC HWY 206
Project: Wells Wigs Subdivision:PARK PLACE GARDEN APARTMENTS Lot:
Project Description: Data telecommunications system.
Contractor: ORE COM TELECOMMUNICATIONS LLC Owner: TIGARD PLAZA LLC
9828 E BURNSIDE ST STE 100 8320 NW HWY 99
PORTLAND, OR 97216 VANCOUVER, WA 98665
PHONE: 503 - 597 -3700 PHONE:
FAX: 503 - 953 -8501
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/29/2011 $75.00
12% State Surcharge - Electrical 04/29/2011 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N 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 issu- ce, or i • k is suspended for more the 150
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification ter. i se rules are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0090. You ma • • • - :n �y��= questions to OUNC by calling 503.23. •.77 or ' : r r - .2344.
Issued By4— — / — �� _ Permittee Signature: J.
C 6 — OWNER INSTALLATION ONLY 1
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 I OR 01 11( T. 1 SL 0 \1.1
1 Received � / �9C, City of Tigard 1v � Dateiv (t VI Permit No.: ._ _
lig 13125 SW Hall Blvd., Tigard, OR 97223 ((�� Plan Review
Phone: 503.718.2439 Fax 503.59 .9tJ� DateB y' Other Permit:
YY A Q�
T I �; \ K D Inspection Line: 503.639 q J Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard or.gov Q O V ��� , Notified/Method: i Supplemental Information
TYPE OF WOR C � � 0 - . •• \` ,,O PLAN REVIEW
❑ New construction dditio p 1st Please check all that apply (submit 2 sets of plans w /items checked below):
D emolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ 0 '' 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 ", "I -3 ",
p 100HP or more. occupancy.
Job no.: Job site address: ' hi 4 iq.Cd R ` H7 f ❑ Six or more residential units. ❑ Recreational vehicle l 6 - 11 - Z parks.
� � ! ❑ Health -care facilities.
0 locations. ❑ Supply voltage for more than
City/State /ZIP: 1 p t R '7 2 _ 2 7 600 volts nominal.
t I J
Suite/bldg. /apt. no.: ZoC Project name: I (s ( , �
N (/I 13 Service or feeder 600 amps or more.
lJ FEE SCHEDULE
Cross street/directions to job site: I I n t , / /V
t^it A t Description Qty. Fee. I Total I *
/ t 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
Le 110ZrC7LC vo I € J c L) A'� residential (with above sq. ft.)
t e /1 Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER f ❑ 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
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT El 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'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State /ZIP: 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
p �, panel, alteration, or extension. I Page 2 75, " ' 2
Business name:
Dte* ,, C C?M/l 7Z_ 44 thy/ r...'17 a>4),‘ Each additional inspection over allowable in any of the above
Address: 9s L R &.--. ,4,,,,e„.., ,6 p-- S v�"��_ - I b 0 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: PTP -_iZ. 1.P Os 7'-((e Industrial plant (1 hr min) 78.18/ hr
Phone: ( 0 .9 0?-3 F ax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed ('h hr min)
CCB Lic.: 1 S 2 8 3 1 Electrical Lic.: 36 ( CJ.. ' Suprv. Lic.: 3� S'� ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 7 >L
Plan review (25% of permit fee):
Print name: 1 42_ Date: y/_/ � /// State surcharge (12% of permit fee): { q y
Authorized signature: / ( TOTAL PERMIT FEE: ly '54
This permit application expires if a permit is not o tained within 180
Print name: Date: days after it has been accepted as complete.
Num of inspections allowed per permit.
1:\ Building 'Permits\ELC- PermitApp.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- PermitApp.doc 07/01/10