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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2013 -00124 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/10/2013 Parcel: 1 S 135DA03500 Jurisdiction: Tigard Site address: 11481 SW HALL BLVD 200 Project: Serenity Subdivision: METZGER ACRE TRACTS Lot: 19 Project Description: Low voltage for phones and data Contractor: A -REBS COMMUNICATIONS INC Owner: BECKAL LLC 5855 SW TARALYNN AVE 7100 SW GABLE PKWY BEAVERTON, OR 97005 PORTLAND, OR 97225 PHONE: 503 - 520 -0625 PHONE: FAX: 503 - 641 -5216 FEES Description Date Amount Specifics: Restricted Energy Permit 06/10/2013 $75.00 12% State Surcharge - Electrical 06/10/2013 $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 ac .• :. •_ •. : •proved 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. ATT •TION: Oregon law quire • to follow the rules adopted by the Oregon Utility Notification Center. Those rule are set forth in OAR 952 - 001 -••010 through OAR 952-001-01' t. You ay • •: in a cop of the rules or direct q uestions to OUNC b callin 503 987 0 1.80 332.2/4. - i , .� Issu • • By: L, Permittee Signature: 1 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 Appli v�; z:° E LVED FR OFFiE USE ONLY �' City of Tigard I Received 1 0 2 013 Date/By: 4 /,'a 3 Permi No.: f L Q2oi3 y - ao/a 13125 SW Hall Blvd., Tigard, OR 4PPIN 3 Plan Review /�, P hone: 503.718.2439 Fax: 503.598.1960 D ate/By: Other Permit: !p/U /�0�0/,3 - 0a /i{� T 1 G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: Buis: ® See Page 2 for Internet: www.tigard-or.gov Il DING DI\SI ' Notified/Method: Supplemental Information TYPE OF WORK Print name: I U New construction U Addition /alteration /replacement PLAN REVIEW ❑ Demolition 0 Other: Please check all that apply (submit 2 sets of plans w /items checked below): CATEGORY OF CONSTRUCTION ❑Service or feeder 400 amps or more ❑ Building over three U I- and 2- family dwelling U Commercial /industrial U Accessory building where the available fault current stories. exceeds 10,000 amps at 150 volts or 1=1 Marinas and boatyards. ❑ Multi- family ❑ Master builder ❑ Other: less to ground, or exceeds 14,000 ❑ Floating buildings. JOB SITE INFORMATION AND LOCATION amps for all other installations. ❑ Commercial -use Job no.: Job site address: 11481 SW Hall Blvd ❑Fire pump. agricultural ❑Emer system. buildings. City /State /ZIP: Tigard,OR 97223 ❑Addition of new motor load of ❑ Installation of 150 IOOHP or more. KVA or Suite/bldg./apt. no.: g., Project name: i! I ❑Six or more residential units. larger separately derived system. Cross street/directions to job site: ❑ Health -care facilities. ❑ occupancy. ❑ Hazardous locations. ❑ Recreational vehicle ❑ Service or feeder 600 parks. Subdivision: Lot no.: amps or more. ❑ Supply voltage for Tax map /parcel no.: more than 600 volts nominal. DESCRIPTION OF WORK Add low voltage wiring for phone and data FEE SCHEDULE Description I Qty. I Fee. I Total l• New residential single- or multi - family dwelling unit. Includes attached garage. ❑ PROPERTY OWNER I ❑ TENANT 1,000 sq. ft. or less 168.54 4 Name: Ea. add'l 500 sq. ft. or portion 33.92 I Limited energy, residential 75.00 2 Address: (with above sq. ft.) Limited energy, multi - family City/State /ZIP: residential (with above sq. ft.) j 75.00 2 Renewable Energy U See Page 2 Phone: ( ) Fax: ( ) Services or feeders installation, alteration, and /or relocation Owner installation: This installation is being made on property that I own which is not 200 amps or less 100.70 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 201 amps to 400 amps 133.56 2 Owner signature: Date: 401 amps to 600 amps 200.34 2 © APPLICANT I ❑ CONTACT PERSON 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 Business name: A -REBS Communications, Inc Temporary services or feeders installation, alteration, and /or relocation Contact name: Bob or Scott Strong 200 amps or less 59.36 I Address: 5855 SW Taralynn Avenue 201 amps to 400 amps 125.08 2 401 amps to 599 amps 168.54 2 City/State /ZIP: Beaverton, OR 97005 Branch circuits — new, alteration, or extension, per panel 520-0625 Fax: (503) 641-5216 A. above for branch or feeder with Phone: (503) ( ) 520 ( ) 641 5216 above service or fee fee, E -mail: arebscomm @aol.com each branch circuit 7.42 2 B. Fee for branch circuits without CONTRACTOR service or feeder fee, first Business name: A -REBS Communications, Inc branch circuit 56.18 2 Each add'I branch circuit 7.42 2 Address: 5855 SW Taralynn Avenue • Miscellaneous (service or feeder not included) _ Each manufactured or modular 67.84 2 City /State /ZIP: Beaverton, OR 97005 dwelling, service and/or feeder Phone: (503) 520 -0625 94 S,// Fax: (503) 641 -5216 Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 CCB Lic.: 86096 Electrical Lic.: 34- 554CLE Suprv. Lic.: LEB2430 Sign or outline lighting 67.84 2 74 // y , / , y Signal circuit(s) or limited- energy i See SQd Suprv. Electrician signature, required:Bob Strong panel, alteration, or extension. Page 2 _ 2 Each additional inspection over allowable in any of the above Print name: Bob Strong Date: 06-07 -2013 Additional inspection (1 hr min) 66.25/ hr Authorized signature: Investigation hr mm) 66.25/ hr Industrial plant t (1 hr min) 78.18 / hr I:\Buildingermits ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440 -46t5T(It /05 /COWEB T �' \ P \ M/ 4 t g .00 • *No licenses are required. Licenses are requir Electrical Permit Application — City of Tigard for all other installations 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: 1 Fee for each commercial system • $75.00 • (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: _ • • 1:\ Building\ Permits \ELC_PermitApp_ELR_ERE.doc Rev 0521/2013