Permit u CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2013 -00003
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/08/2013
Parcel: 1S 126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 410
Project: MacDonald Env Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Low voltage for data telecommunications
Contractor: CASCADE UTILITIES /RELIANCE CONNECTS Owner: WYSE INVESTMENT SERVICES
301 SW BROADWAY 1501 SW TAYLOR ST STE 100
ESTACADA, OR 97023 PORTLAND, OR 97205
PHONE: 503 - 630 -8312 PHONE: 503 - 294 -0400
FAX: 503 - 630 -6638
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/08/2013 $75.00
12% State Surcharge - Electrical 01/08/2013 $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 a . • . - -- • • h approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. • NTION: Oregon - req • - you to follow the rules adopted by the Oregon Utility Notification Ce Those rules are set forth in OAR
952 -0 r -0010 through OAR 952 -001 *.90. You • btain a copy of the rules or direct questions to OUNC by calling 503. t i d 1.800.332 44.
410 g / lib., 1 0
Iss d By: Permittee Signature ?r
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 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 Applicat CEIVED FOR OFFICE USE,ONEY
City of Tigard
Date/B: minti
•JI Permit No.: aeJ /5 -4
13125 SW Hall Blvd., Tigard, OR 972MN 0 8 2013
Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/B
Ti GA R D Inspection Line: 503.639.4175 C TV OF TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov �/ 1 , Notified/Method: Supplemental Information
Id. G DI V'S� fV
TYPE O K PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 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 ", "l - ", "l - ",
qo 2. 0 SW WQ5il Y tAei &tt.cQ"Q ,d 100HP or more. occupancy.
Job no.: Job site address: sv. le. o
ID Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: / I J �Q ❑ Health -care facilities.
❑ Hazardous locations.
CI voltage for more than
600 volts nominal.
Suite/bldg. /apt. no.: ( 0 Project name: ❑ Service or feeder 600 amps or more.
LL Q J FEE SCHEDULE
Cross street/directions to job site: S�o r ( !'e rr y /\ oR tJ a. 7 y, • d Description I Qty. I Fee. I Total I •
/ ,, ' I i /� r New residential single- or multi - family dwelling unit.
Vt/as4 ' S!/ G(Q/l� /V C i V�— Includes attached garage.
Subdivision: J (/ 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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi-famil 75.00 2
residential above
dential (with sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER K TENANT 201 amps to 400 amps 133.56 2
1 401 amps to 600 amps 200.34 2
Name: Mac 444 / d 4 V/ I ' / Q K 1 /QQ 601 amps to 1,000 amps 301.04 2
Address: 9 72 0_ S (A v Way') / / (/' 1 S �(( er;V to Over 1,000 amps or volts 552.26 2
r^ � Temporary services or feeders installation, alteration, and /or
City/State /ZIP: / e r• d �0/1 7 223 relocation
/
Phone: (50,1) 2Z - (ZZS �
Fax: ( 3 Zqc 6q 200 amps or less 59.36 1 O to
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 extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
r each branch circuit
Business name: CI c R d� Q--, •'/ � /� ( 442 c l i B. Fee for branch circuits without
CI ( service or feeder fee, first
Contact name: L e� V
, branch circuit 56.18 2
T Each add'I branch circuit 7.42 2
Address: 3 I SW coca a Miscellaneous (service or feeder not included)
City/State /ZIP: CM G c O 1 C O ' 1 q? p Z3 Each manufactured or modular 67.84 2
J / / / dwelling, service and/or feeder
Phone: (CO3) 6, 3 tQ S31 2 Fax: : (5 j O (�j 3 $ Reconnect only 67.84 2
r eYY� Pump or irrigation circle 67.84 2
E , ,$e/'Ut L ® C(&4CCe�t 11-el— Sign or outline lighting 67.84 2
tJ CONTRACTOR r Signal circuit(s) or limited- energy - 7
Business name: �S'C4 V h, r �Y 11S// I1g1ce 6, panel, alteration, or extension. Page 2 / �j90 2
I , I , Each additional inspection over allowable in any of the above
Address: 367 ( 5(4) /(2 ( Additional inspection (1 hr min) 66.25/ hr
I
City/State/ZIP: Investigation (1 hr min) 66.25/ hr
ty c — � -- �� �G � „9,, � � �� Industrial plant (l hr min) 78.18/ hr
� Phone: ( j3) 6 �3 Z Fa (�3) Gi3 3 3 Inspections for which no fee is 90.00/ hr
jj specifically listed (%Z hr min)
\0 CCB Lic.: Electrical Lic.: (�e 3 t/ 3s I Suprv. Lic.: 5 t ELECTRICAL PERMIT FEES
` Suprv. Electrician signature, required: ��� /� / /D /� �� Subtotal: '76: Oo
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): 1 0 0
.
1110 TOTAL PERMIT FEE: O 0 0
Authorized signature: V ,I� y This permit application expires if a permit is not obtained within 180
1 days after it has been accepted as complete.
Print name: Rp � e r L. vsL, Date: 1 Isle • Number of inspections allowed per permit.
L\ Building \ Permits\ELC- PermitApp.doc 07/01/10 440 -46 15T(1 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
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: l
*No licenses are required. Licenses are required
for all other installations
1: \Building'Permits\ELC- PermitApp.doc 07/01/10