Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00105
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/30/2008
PARCEL: 25101 DD -00101
SITE ADDRESS: 06975 SW SANDBURG ST 200 " ZONING: C -
SUBDIVISION: TIME SQUARE LOT: JURISDICTION: TIG
PROJECT: TIMES SQUARE
Project Description: Installing (1) low voltage data system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
AMERICAN PROPERTY MANAGEMENT CSHARK NETWORKS
2510 NE MULTNOMAH 5111 FIRWOOD DR.
PORTLAND, OR 97232 WEST LINN, OR 97068
Phone: 503- 284 -6133 Contact #: PRI 503- 697 -1818
FAX 503- 697 -1818
Reg #: ELE CLE23
FEES LIC 164236
Description Date Amount
[ELPRMT] ELR Permit 4/30/2008 $75.00
[TAX] 12% State Surch 4/30/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued B . ` Permittee Signature: Ad�� /
• - 4 010. — i / ri
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'N: 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 Application ® FoR OFFICE: usE oNl.l' . ,,,v4
I R
City of Tigard Dat , Permit No.: • ...a) w
13125 SW Hall Blvd., Tig. '(t:? ''k i. Plan Review ,
Phone: 503.639.4171 Fax: . 0.98.19 3 f��►� A DateB : Other Permit: // — c . J JI • LI
Inspection Line: 503.639.4175 V" P t� �lJ Date Ready/By: runs: ® See Page 2 for
TIGAK D �?
Internet: www.tigard or.gov ® ' C � � `� \ ® Notified/Method: Supplemental Information
TYPE OF it .11 nNG so t PLAN REVIEW
❑ New construction ® Addition/a1t� 1s. 11, eplacement
Please check all that apply (submit $ sets of plans w /items checked below):
VV °°'' ❑Service or feeder 400 amps or more 0 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 ❑ 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 ",
100HP or more. occupancy.
Job no.: Job site address: 6975 SW Sandburg Road, Ste 200 ❑ 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/bldg. /apt. no.: Ste 200 Project name - Serenity- I4eapice rA C ❑ Service or feeder 600 amps or more.
r/L!!a'"� FEE SCHEDULE
Cross street/directions to job site: 72 °d and 217 Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
for commercial remodel Limited energy, multi - family 75.00 2
Voice data cabling residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER 1 ® TENANT 201 amps to 400 amps 106.85 2
Name: Serenity Palliative Care and Hospice 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 12725 SW Milliken Way, Over 1,000 amps or volts 454.65 2
e•., inn
City/State /ZIP: Beaverton, OR 97005 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)906 -7906 Fax: (503)906 -7907 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ® CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: CShark Networks B. Fee for branch circuits
Contact name: Bev Backe without service or feeder fee, 46.85 2
first branch circuit
Address: 511 Firwood Drive Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: West Linn, OR 97068 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 697 -1818 Fax: : ( ) Reconnect only 66.85 2
E -mail: bev @cshark.net - Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal panel, or limited -
Business name: CShark Networks, LLC
energy p alteration, or
Address: 5111 Firwood Drive extension. Describe: 1 Page 2 75.00 2
Data Telecomm Instal
City/State /ZIP: West Linn, OR 97068 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 697 -1818 Fax: (503) 6974818 _ Investigation per hour (1 hr min) 62.50
CCB Lic.: 164236 Electrical Lic.: CLE23 Suprv. Lic.: 4406LEA Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
/
Suprv. Electrician signature, required `, `$ % � Subtotal: ' 5
Print name: Justin Stover r' �Z !!!/// � �Date: 4/30/08 Plan review (25% of permit fee):
State surcharge (12% of permit fee): Of l
Authorized signature: TOTAL PERMIT FEE: g 1
Print name: Bev Back /� Date: 4/30/08 This permit application expires if a permit is not obtained within 180
+�_ days after it has been accepted as complete.
■
• • Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM WEB
t.4, (►C.,. q 4 1 . 3
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELR2008.00105
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/30/2008
Phone: (503) 639 -4171 /amwd
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/19/2008 TIME: 7:00AM PAGE: 17
SITE ADDRESS: 06975 SW SANDBURG ST 200 CLASS OF WORK:
SUBDIVISION: TIME SQUARE LOT #: TYPE OF USE:
PROJECT NAME: TIMES SQUARE
DESCRIPTION: Installing (1) lawn voltage data system.
OWNER: AMERICAN PROPERTY MANAGEMENT, PHONE #: 503 - 2846133
CONTRACTOR: CSHARK NETWORKS `MAR`S W Q 14 PHONE #: 503 - 1618
Inspection Request Scheduled For: Date: 5/19 /2008 Pour Time:
Code # Inspection Description Confirm # • Contact # Message
199 Elect.iical final 070079 -01 503-969-2703 Y
Corrections/Comments/Instructions:
AM
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ( Date: slicti CI Phone #: (503) 718- 1—i ft
•
CITY OF TIGARD . ,
A lt,
BUILDING DIVISION PERMIT #: ELR200B -00105
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/30/20013
Phone: (503) 639 -4171 i��P i 1(
Inspection Requests (24 Hrs.): (503) 639 -4175 ..:' 1 1.1
INSPECTION WORKSHEET FOR DATE: 5/2/2008 TIME: 7:00AM PAGE: 35
SITE ADDRESS: 06975 SW SANDBURG ST 200 CLASS OF WORK:
SUBDIVISION: TIME SQUARE LOT #: TYPE OF USE:
PROJECT NAME: TIMES SQUARE
DESCRIPTION: Installing (1) low voltage data system.
OWNER: AMERICAN PROPERTY MANAGEMENT, PHONE #: 503. 2846133
CONTRACTOR: CSHARK NETWORKS PHONE #: 503 -697 -1818
Inspection Request Scheduled For: Date: 5/212008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 069228-01 503.309-0614 Y
Corrections /Comments /Instructions:
v \ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: cT v NOG LE Date: C1 lio Phone #: (503) 718 -144