Permit Y '
C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
f I ,
II, DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00403
DATE ISSUED: 11/9/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 126BC -01506
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 480 ZONING: C - G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Data /Telecommunications. Job #C50491.
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:
WYSE INVESTMENTS CAPITOL DATA & COMMUNICATIONS
111 SW 5TH AVE SUITE 1100 11401 NE MARX ST.
PORTLAND, OR 97204 PORTLAND, OR 97220
Phone: 503- 294 -0400 Phone: 503- 255 -9488
Reg #: LIC 142457
ELE 26- 1054CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcha 11/8/2005 $6.00
[ELPRMT] ELR Permit 11/8/2005 $75.00
Total $81.00
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.
Issued By: Permittee Signature: c
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.
.0.--- ( FOR OFFICE USE ONLY
E1e .triea'1 Permit 4Eifitiiiii` �, 7 year a - Received . -, s' Pe rmit no : / r c �` Date /r _ 6 - ` J aU 7 1.17
C of Tigard Plan Review
4 I
a Other Permit:
13125 SW HALL BLVD., TIGARD, CRO 23f1 Q 2005 1 Date /By-
Phone: (503) 639 -4171 Fax (503) 598 -I 60 U CITY OF TIGARD Date Ready /By Juris: / ❑ See Page 2 for
Inspection Line 503- 639 - 41 v / V y Notified/Method• / fir Supplemental Information
Internet: www cl.tigard or us ‘-'I l ! ko 1 II. I f : f-((, j
Ili r A lri PLAN REVIEW
Li New construction D "- Addluon/a tera i e Et / 1en 0 Please check all that apply.
❑ Demolition ❑ Other: ❑ Service over 225 amps, comm'l ❑ Hazardous location
CATEGORY OF CONSTRUCTION ❑ Service over 320 amps - rating ❑ Building over 10,000 sq.ft.
❑ I - and 2- family dwelling H Commercial /industrial ❑ Accessory building of 1- and 2- family dwellings 4 or more new residential
❑ Multi - famil ❑ Master Builder ❑ Other ❑ System over 600 volts nominal units in one structure
JOB SITE INFORMATION AND LOCATION ❑ Building over three stories ❑ Feeders, 400 amps or more
Job no : C50491 Job site address 9020 SW Washington Square RD ❑ Occupant load over 99 persons ❑ Manufactured structures or
❑ Egress /lighting plan RV park
City /State /ZIP Portland, OR 97223 ❑ Health -care facility ❑ Other:
Submit 2 sets of plans with any of the above
Suite/bldg. /apt no. r'�i6 Project name United Health Group The above are not applicable to temporary construction service.
i FEE SCHEDULE
Cross Street/Directions to job site Description I Qty. I Fee. I Total I "
New residential - single or multi - family dwelling unit.
Subdivision Lot no • Includes attached garage.
1000 sq ft or less $ 145 15 4
Tax map /parcel no.• Ea. Add'I 500 sq. ft or portion $ 33.40 1
DESCRIPTION OF WORK Limited energy residential $ 75 00 2
Network cabling Limited energy, non - residential $ 75 00 2
Each manufactured home or modular
❑ PROPERTY OWNER I ❑ TENANT dwelling, Service and/or feeder _ $ 9090 2
Name: Service or feeders installation, alteration, and /or relocation
200 amps or less $ 80 30 2
Address 201 amps to 400 amps $ 106 85 2
401 amps to 600 amps $ 160 60 2
City /State /ZIP 601 amps to 1000 amps $ 24060 2
Over 1000 amps or volts $ 454.65 2
Phone Reconnect only $ 66.85 2
Temporary services or feeders installation, alteration, and/or
Owner installation: This installation is being made on property that I own which is not relocation
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 200 amps or less $ 66.85 1
201 amps to 400 amps S 100.30 2
Owner signature: 401 amps to 600 amps _ $ 133 75 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits - new, alteration, or extension, per panel
Business Name. A. Fee for branch circuits with
service or feeder fee, each
Contact name:
branch circuit S 6.65 2
B. Fee for branch circuits
Address. without service or feeder fee,
each branch circuit $ 46.85 2
City /State /ZIP. Each additional branch circuit: $ 6 65 . 2
Miscellaneous (service or feeder not included)
Phone. Fax Pump or irrigation circle $ 53 40 2
Sign or outline lighting $ 53.40 2
E -mail: Signal circuits(s) or limited -
CONTRACTOR energy panel, alteration, or
Business Name. CAPITOL DATA & COMMUNICATIONS extension. Describe: l Page 2 875 2
Contact name: RAY YOUNGER Each additional inspection over allowable in any of the above
Per inspection $ 62 50
Address 1 1401 NE MARX ST. Investigation per hour (1 hr min) $ 62 50
Industrial plant per hour $ 73 75
City /State /ZIP: PORTLAND, OR 97220 -1041 ELECTRICAL PERMIT FEES*
Subtotal 75.00
Phone. 503- 255 -9488 Fax• 503- 257 -7121 Plan review (25% of permit fee)
State surcharge ( 8% of permit fee) 6.00
CCB Lic • 48748 !Electrical Lie.. 26 -496C Supry L TOTAL PERMIT FEE 81.00
Suprv. Electrician signature, required: ���t /l J This permit application expires If a permit Is not obtained within 180
da}s after It has been accepted as complete
Print Name RICHARD MARTIN C 2 )� e : 7JOYJO� • Fee methodology set by Tn -County Building Industry Service Board
Authorized signature:
� J lj 'fi - .•Number of Inspections per permit allowed
Print Name RICHARD MARTIN
CITY OF TIGARD
MIMING DIVISION PERMIT #: ELR2005 -00403
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/9/2005
Phone: (503) 639 -4171 OAP
Inspection Requests (24 Hrs.): (503) 639 -4175 °: .
INSPECTION WORKSHEET FOR DATE: 11/21/2005 TIME: 7:13AM PAGE: 33
SITE ADDRESS: 09020 SW VVASHINGTO SQUARE RD 80 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: � TED HEALTH
DESCRIPTION: Data/Telecommunications. J . #C50491.
OWNER: VVYSE INVESTMENTS, PHONE #: 503- 294 -0400
CONTRACTOR: CAPITOL DATA & COMMUNICA' IONS PHONE #: 503 - 255 -9488
Inspection Request Scheduled For: Date 11/21/2005 Pour Time:
Code # • - • • Description Confir # Contact # Message
99 Electrical final 022034 -0 971- 506 -3396 N
or - . - una s nstr •- s:
•
S PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ • LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: it Phone #: (503) 718- 44
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