Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a
>s COMMUNITY DEVELOPMENT Permit #: ELR201000051
T t GAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/30/2010
R
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 210
Subdivision: Pacific Corporate Center Lot: 0
Project: NuScale
Project Description: Low voltage for data
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 03/30/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 03/30/2010 $8.14
PHONE: 503-624-6300,
Contractor:
VIKING SECURITY
PO BOX 3503
SALEM, OR 97302
PHONE: 503 - 910 -9803
FAX:
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 Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and - other applicable law. At work will
be done i - - • • - ith approved plans. This permit will expire if work is not started within 180 days of issuance, if •rk suspended f• more the 180
days. TENTION: Orego law - quires you to follow the rules adopted by the Oregon Utility Notification Ce• er. ho- rule ar - forth in OAR
952 101 -0010 thr• gh OAR 952 ' • 1 -• 00. u may obtain a copy of the rules or direct questions to OUNC by calling 503.24...699 0 .88 • 32. 144 4
// � / __ �Li % 1/
Issued By: _ i_ u.� j ` _ Permittee Signature: ..a
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 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 Application ? } .l� r h; ! 41 !' `:s .' i fir ( 1 it 1 til
'4 14J1t `" " ,' 49 F� I OR OI M 514t)N'I 1` 1 h � ` � a : , Qy' a i��;�� 1 1
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k c4 . City of Tigard t g ' . - . 9 � }' Received
Date/By: oC/ /0 Permit No.: EL, i 2. p�OIO 'dQ��f
$ ° 13125 SW Hall Blvd., Tigard, OR 97 B_i �/ Pl Review
'1 *. Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
�i
,,I I < i>; I ' , I) Inspection Line: 503.639.4175 � 1r11 AR 0 , r D R /B l uri f • See Page 2 for
.+ 7r I' Internet: www.tigard- or.gov G [ } Noti fi ed/Method: �/ J�r Supplemental Information
TYPE OF WORI��IT�t' PLAN •REVIEW
❑ New construction 40 Addition /alteratipe p t riD4Vi S [Ojrf 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 [i 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 0 Emergency system. larger separately derived system.
❑ Addition of new motor Toad of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: legrii n / 100HP or more. occupancy.
U v'A /& t 2� 0 Six or more residential units. ❑ Recreational vehicle parks.
/ n,. I l- Imo, J ❑ Health -care facilities. ❑ Supply voltage for more than
City /State /ZIP: ��� ^� 0 � p�, 22 y �(p J r O UW Qaµ�t Om 600 volts nominal.
!/ f � / 0 locations.
Suite /bldg. /apt. no.: 2 /o Project name: 4 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 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) 67.84 2
AViarte. �� � ^ f Q /1 Limited energy, multi - family
67.84 2
fU / �',/J � /hn� 1.14/1 J ii s residential (with above sq. ft.)
,/ ` !1t/ Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
•
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( )
Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
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
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting / 67.84 2
, CONTRACTOR . • . Signal circuit(s) or limited - energy r
/ � panel, alteration, or extension. Page 2 2
Business name:
//r le� L( /f/ Each additional inspection over allowable in any of the above
/
%) Address: (�, v gn! 3ra.5 Additional inspection (1 hr min) 66.25/ hr
'` Investigation (1 hr min) 66.25/ hr
City/State /ZIP: kr# 0k 97.70' Industrial plant (1 hr min) 78.18/ hr
r Phone: (5'23 ) 9/o _ ? 9o3 Fax: ( ) A'4 - Inspections for which no fee is 90.00 / hr
specifically listed ('A hr min)
\ CCB Lic.: / 986' �7 Electrical Lic.: `y_ v7 Suprv. Lic.:2ig(LE� ELECTRICAL PERMIT FEES
' Suprv. Elecfrici sig nature, required: Subtotal: Ze
P lan review (25% of permit fee): ��
Print name: D,9h.40 , q zL 4 D ate: t .S 3Q /Q State surcharge (12% of permit fee): . 9 7
7 / / TOTAL PERMIT FEE: — g . 9t'
Authorized signature: / This permit application expires if a permit is not obtained d within 180
Print name: , / At 9 q k ...e, D Jp0 n * Number of At allowed
days has d been accepted as complete.
(/ Y d per permit.
I\Buiiding\Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
i RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK-ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n B • oiler Controls
n Clock Systems
n D • ata Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ 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: \Building\Permits\ELC- PermitApp.doc 10/01/09