Permit ��
% u' CITY OF TIGAR® ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00004
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/3/2008
PARCEL: 1 S 126BC -01506
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 450 ZONING: C - G
SUBDIVISION: ONE EMBASSY CENTER LOT: JURISDICTION: TIG
PROJECT: ARTIELLE
Project Description: Data /Telecommunications
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:
PORTLAND OFFICE ASSOCIATES G G TELECOMMUNICATION CO
BY TC PORTLAND, INC 121 SW SALMON ST
8930 SW GEMINI DR STE F -1
BEAVERTON, OR 97008 PORTLAND, OR 97204
Phone: Contact #: pRI 503- 295 -2922
FEES Reg #: ELE 34- 248CLE
LIC 59692
Description Date Amount
[ELPRMT] ELR Permit 1/3/2008 $75.00
[TAX] 8% State Surcha 1/3/2008 $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 By: ' a /77
ry---
Permittee Signature: r . �,� �,
i 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 ApplicatiBECCI FOR OFFICE USE ONLY
City of Tigard Received
/ t 2008 Date/By j Permit No ' ,2410 / - 7 • — 6t�Cf r
13125 SW Hall Blvd , Tigard, OR 9722 03 Plan Revie
' C Phone 503 639 4171 Fax 503 59/0 OF r Date/By y Other Permit 7 - Op( c0 0
T I G A IL D Inspection Line 503 639 4175 IGAHU Date Ready /By inns la See Page 2 for
Internet www.tigard-or gov BUILDING DIVISION Notified/Method Supplemental Information
TYPE OF WORK 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 stones
❑ 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 El 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 ",
Job no.: Job site address: g02,0 pi £D 5 . IOO or more ❑ R R c r eatioy
❑ S ix or more residential units ecreational vehicle parks
City/State /ZIP: ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: 45"Q Project name: Tr/Z E L LE-- ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site:
� 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 l
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft ) 75 00 2
�
1 / i Limited energy, multi- family
VO 1 CE.— tric A. (,31 2.5.4 ►•1 G residential (with above sq ft) 75 00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106 85 2
Name: 401 amps to 600 amps 160 60 2
601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts 454 65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 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 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B Fee for branch circuits
Contact name: without service or feeder fee, 46 85 2
first branch circuit
Address: Each add'I branch circuit 6 65 2
Miscellaneous (service or feeder not included) _
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90 90 2
Phone: ( ) Fax: : ( )
Reconnect only 66 85 2
E -mail: Pump or irrigation circle 53 40 2
CONTRACTOR Sign or outline lighting 53 40 2
Signal circuit(s) or limited -
Business name: a G. rr-so me/um / C 04 energy panel, alteration, or
Address: /2- c(A) GA-4.4161,1 2 Si-ft 1" - E — Pi extension Describe ! Page2 2
City/State /ZIP: Po 31`4 p OR Ci 720 4 Each additional inspection over allowable in any of the above
Per inspection 62 50
Phone: ( 3) 2q5. 29 2 Z Fax: (503) 2g5- D8'. Investigation per hour (I hr min) 62 50
CCB Lic.: 5(1( 9,2 Electrical Lic.: - ygert,e Suprv. Lic.: /204) `54 Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal - — s, O7 )
Print name: � d Dd � G� Date: f — 3 , Plan review (25% of permit fee)
a� State surcharge (8% of permit fee) % i 67)
Authorized signature: TOTAL PERMIT FEE S Li, 0 0
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
1 \ Building \Permits\ELC- PermitApp doc 05/23/06 440- 4615T(I I /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 $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Budding\Permus\ELC- PermitApp doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2008 -000 4
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1!3/2008
Phone: (503) 639 -4171 `i
Inspection Requests (24 Hrs.): (503) 639 -4175 ''IL.
INSPECTION WORKSHEET FOR DATE: 1/4/2008 TIME: 7 :01AM PAGE: 55
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 450 CLASS OF WORK:
SUBDIVISION: ONE EMBASSY CENTER LOT #: TYPE OF USE:
PROJECT NAME: ARIIELLE
DESCRIPTION: Data/Telecommunications
OWNER: PORTLAND OFFICE ASSOCIATES, PHONE #:
CONTRACTOR: 0 0 TELECOMMUNICATION CO PHONE #: 503-295.2922
Inspection Request Scheduled For: Date: 1/412009 Pour Time:
Code # Inspection Descriptionirm -# Contact # Message
135 Low voltage 06255' -0l 5503 -939 -6623 N
Oct fz1 MAC- -
Corrections /Comments/ Instructions:
vll
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G N Of3 Date: 1' I ' o$ Phone #: (503) 718 - 'ILub