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Permit (81) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT • t3 COMMUNITY DEVELOPMENT Permit#: ELR2012 -00194 T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/16/2012 Parcel: 1 S 136DD05300 Jurisdiction: Tigard Site address: 11850 SW 67TH AVE, STE# 100 Project: Guardian Life Subdivision: WEST PORTLAND HEIGHTS Lot: 9 Project Description: Low voltage for Data/Telecommunications Contractor: PROGRESSIVE TELEPHONE SYSTEMS & COMMUNI Owner: PNWP LLC #2 PO BOX 190 PNWP LLC GRESHAM, OR 97030 6600 SW 105TH AVE #175 BEAVERTON, OR 97008 PHONE: 503 - 665 -4900 PHONE: FAX: 503 - 665 -4830 FEES Description Date Amount Specifics: Restricted Energy Permit 08/16/2012 $75.00 12% State Surcharge - Electrical 08/16/2012 $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 '< - b'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done accordance wi ••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. TENTION: Oregon la. r =•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -0 -0010 thro gh OAR 952 -I - 00• • ou may obtain a copy of the rules or direct questions to OUNC by callin. 54 . .2.1987 or 1.800.332.2344. �� / / I i Iss d By: Permlttee Signature. ._` .� � /lam_. 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. From: 08/15/2012 11:28 #380 P.002/003 Electrical Permit A RECEIVED Application A + 1 2012 T012 Ol I II USU. 0 \I.1 City of Tigard R � ; ,� : I / • 13125 S W Hall Blvd., Tigard, OR 9 Plan R 1 - 5c Permit No.: �L�. �� col ���111 Phone: 503.639.4171 Peer : `503 5 £ ' L Plan lteviea, n r i> Inspection Line: 503.639. 1 1 �; 175 tf �11.1 Date/13 � �P°n»c Internet: aw,v.tigerd or.gov IIVGDNISIO �RdJMeth P.� =Inf TYPE . OF .Vi!O1tK, Nce Supplemental Information • ❑ New construction • dditiodalteration/r . _.. : ` ;t '':_ ffir :.t� l" ` ° ''> i•:��•r eplacement Please cheeY all that fp i ek • below): ❑ Demolition apply (submit J sets of plans w /items checked below): Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories. iCATEGOlEY OF . where the available fault current ❑ Marinas and boatyada Ns attlI l' . ' exceeds 10,000 amps at 150 volts or ❑ Fl ❑ 1 - and 2 family dwelling IT Commercial/industrial glam mentceeds oo ia,o oetinglmildiaga. ❑ Accessory b uilding s m ❑ C ommacialcse agricultural ❑ Multi- family ■Master builder [] O 3 - ❑ amps for Other 10 one• buildings. JOB SICE,.aiil MATtON Aria SON ❑ em ❑ Installation of 75 KVA or ❑ Addition of new mote load of A " , > ",der system. Job no.: Q Job site address: b l $ so � /l v� wow a more. ❑" 1'2 " °l-s " . ❑ S i x or more residential units. • ❑ Recreational whack parts. i ❑ Health -care facilities. ❑ Supply voltage for more than ( ( dglapt no.: 10C) Project name: I / 0 ' 600 volts nominal. -E ' -- sett ,4L 1, (. .a?� ❑ Service or feeder 600 amps or more. Cross street/directions to job site: New residential d �, �0 Subdivision: Includes attached garage multi-family dwelling unit. p/ P Lot no.: 1,000 sq. ft or less 168.54 -O Tax ma areal no.: Ea add 500 s9 or portion - 33.92 _11 DF.S(1U 'rION OF WORK Limited it h above • ft energy, residential "CAP ' V �i" with III 6714 _ © t� Limited energy, with above residential with above R III 67 � © Services or feeders installation alteration and/or relocation q PROPERTY OW or ' • to 100.70 — Name: : (,�_! ` l�.t. -Pv to 400 133.56 MI 401 amps to 600 11111 200.34 = Address: I i SC) S() `14-"I n . � 601 amps to Over 1,000 a mpso s or v l ts 1111 3 - II /�-�jJ mpvol - .. ity /StateJZIP: a `- ( Pre e-,\ U -70 Temporary services or feeders i v relocation Phone: ( ) Fax: ( ) installation, alteration, and/or • 200 amps or less =�_� Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps intended for sal; lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 125.08 _ amps to 599 168.54 _ Owner signature: Branch circuits - new altered° . or extension . and Date: A. Fee for branch with �;_ A pucion - ►': t O P aboveservice rire , �.. 1�R SbN. . . - � fee Business name: Tr ($St vr�T _ { ,�� • ,p cad, brtmch ci reu;t 7.42© tSi ' r W I tx ....±):2-1/k0 L!A'1(b • B. Fee for branch circuits without car name: ttle: • L�l (/ ( service or feeder fee, first 91 � -� l S Gl branch circuit 56.18 Co e Address: () / ti z.:)...1\ Each a branch c or [eerier not 'Waded —© Miseellac City/State/ZIP: .es ' 'a Bervia DC-Q.. r "Y(. C? �3 o Each meauf d or rf fe wide r 11111 67.84 © Phone: (503) . /, , "_I. � :. service and/or .6_ `we Fax:: (50,j) '&6-, 4.693 Reconnect only 67.84 - E -mail; a CH h p pU t Pump or irrigation circle 67.84 _ Signor outline lighting in 67.84 - Business name: rC t!, C. SS l V2 t eia Av signal �cuit(s) or 1®ited eavgp � �_© l L y 1 e eherat or e>mr� n Address: (\� t .•� S /?I.0 `Each additional ins , tl io o ver allowable In an of the above 0 Li-, a Additional inspection (I hr mm) - 6625/ hr Investigation (111r min) 11111 6625/ hr _: i l,1 7r�-/� '/ O I _ Fax: ( [.f'l!-'•5 , .. 3� (/ l � s fo r t wi h no fee is 11111 78.1 B/ hr _■ e r ctrical Lic.: ale l I (7 Suprv. Lic. listed hr tam III 90.00/ hr - , Sup :t • l iifit2i I' t q:. t . X =' ! r" !fili)i °� Subtotal: /�d�` ant name: Q� r" t' ' i e e � Plan review (25% of permit fee : ! L . / a :: • B ®� / 1-- State surcharge (12% of permit fee): Authorized signature. • J �, TOTAL PERMIT • i FEE: MINIM This permit application expire if a . permit is not obtain - • thin 180 f Date: �;���� days alter tl hay been acceptad as complete. • Number o i n+pee t io m allowed per permi 1:�auildiag�PamitalII,Gmi Pe � • ..doe 10/01/09 ' 4 404615TO 1 / 05 /COM/ W6B From: 08/15/2012 11:31 #380 P.003/003 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined..... 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 system (SEE OAR 918- 309 -0000) • Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Cloc ystems 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: t "No licenses are required. Licenses are required for all other installations P Bnildin P nits ELC -P nniiApp.Jnc 0? 2-'06