Permit 4 """ v',� ∎ ..4 ELECTRICAL RESTRICTED ENERGY PERMIT
' - 44 " CITY OF TIGARD
4.! 6I: jii /' COMMUNITY DEVELOPMENT Permit #: ELR2010 -00063
""' '` 1312 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/20/2010
`TiG A'Ra Parcel: 2S113AB00101
, •r1 a AU °4:
Jurisdiction: TIGARD
Site address: 16101 SW 72ND AVE 140
Subdivision: PACTRUST BUSINESS CENTER Lot: 0 .
Project: Kemper Trinity
Project Description: Install telecom cables
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 04/20/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 04/20/2010 $8.14
PHONE: 503 - 624 -6300
Contractor:
PROGRESSIVE TELEPHONE SYSTEMS &
COMMUNICATIONS INC
8025 SE TELFORD RD
PHONE: 503 - 665 -4900
FAX: 503 - 665 -4830
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
•
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 Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
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 all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the 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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: `� ///(/ v 1I`eG'
Permittee Signature: iik. / -f w
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.
04/19/2010 MON 12:09 FAX 5036654830 PTSC ?001/002
RECEIVE
•
ectrica er iillt LApp� icatio n ., : • ..FOR OFFICE IJSEONLY .:
• • City of Tigard APR 1 9 2010 Received
1 11 1
Datellsy. Permit No fiL2 U I D D DOlo3
`t 1 '3125 SW W Hall Blvd., Tigard, OR 977, plan Review
' Phone: 503.139.4171 Fax 503.598.19(iICITY OF TIGAR • note /B : Other Permit:
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISI I I " It hair,: E Scr NTS for
• Internet: www.tigard- or.gnv milled Menrod: — Sapplementa, Information
AN` RI V:IK .
TYPE 'Ok' WORK YL'
❑ New construction [ �Additipn /altcratiou /repiacelnent pSc, ;c ce� fCCdeC4UU % o B ❑ Id fia1T& bc�kedbf`Ulv).'
❑ Demolition ❑ Other: where the available fault current ❑ Marinas ;nal hoalyards.
CA i L. GORY - OT : CONSTR1. C 1 ION exceed, 10.000 amps at 150 voltu u ❑ Floating buildings.
lens to ground, or exceeds 14.000 ❑ Commercial -use agricultnr:4
❑ 1 - and 2- tinnily dwelling .[l C'ornmc.7 /industrial ❑ Accessory building amps for all other installations. buildings,
L,] M ulti ftmnily ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
. " • . ❑ Ertcrgcu system. larger separately derived system.
• JOB SITE. 'INFORMATION AND LOCATION
ION 1 n UC ❑ Addition of n w molar toad or ❑ "A" "L•", "I -�" "l -3"
Job no.: l4 g,7 + Job site address: 1 1 „ i b 1 � 7 n d �,I „ ) tool,,, tar more. occupancy.
u � u /// C 1 ❑ Sic or more residential units. 0 Recreational vehicle psi k,.
City/ State /ZIP:. r. /1 . .- , , d ,11 4 . R 1 't I j n / ( ri, - } r ❑ Health -care facilities:. ❑ supply vnha rm more tlkin
Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: / ' Projeu1 name. Q f r> -k. Li s or mote.
• C CU C - ❑ Service or feeder 600 am p
Fp F :scill�n�li�E
Criss Street/directions 10 job site: f? - -
r, don
.._._ _ . i Qt fee. 1 Total
Ncw resideutittl single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,00(1 sq. ft. Or less 145_15 4
Tax tttap /paf( el ❑o -: -. Ea. add'I 500 sq. fl. or pottinn 33 _ 40 1
DESCRIPTION - -- Limited energy, residential 75.00 2
P'I•I OF WORK (with above eq. ft) •
^ ' B0 ��- f , Limited energy, multi- family
C 4' -C 4yYLJ 4 -b e 2_& residential (with above sq. ft. 75,00 2
Services or feeders installation. alteration, and /ar relocation
200 amps or less 8(1..30 2
1 ' • ti, PROPERTY OWNER I [ . TENANT 201 amps to 400 amps 106.85 2
' f / • >nnc: y1~ 401 amps t 600 amps 160.60 2 Ah. mp
i 1 4Z - -- `
- 601 amps to I ,000 amps 240.60 2
kddT(,5: IL • j �tv 'c 11
�. - . . Lr ll �/ Uvcr i amps or volts 45465 2
.
City /State /ZIP: / Temporary services or feeders installation, alien tiuu, and /or
— �y J e relocation
Phone: L 1,a) g'5 / , � 02 / Fax: ( ) / �./ L %�/ l GX�l? 200 amps or less - _ 66.85 1
/ 201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that i own which is not
intended for sale lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133,75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: ,_,Date:
— - -' A. Fee for branch cimurts with
• 1!: APPLICANT" ; CONTACT PERSON ,. • above service or fearer fcc, 6.65 2
each branch circuit
1
Baseness name; .-
/ / e , /. _ i ,,s, _s 7:O Q' /� R. Fee lbr branch entuits
1=161F / t without service or feeder fee,
a first branch circuit 46.85 2
Address: 8 - 5 �& 7 - 4- »d /� � Q Each aild'l branch circuit I _ 6.65 2
o Miscellaneous (service or footle nut Included)
CiIVISVr1c17.1P: /� / rI ... ) - — -�
!jf + .,.c t in tSL . (-- '✓)Led (� each manufactured or modular 4 090 2
Phone: � ) / �� e eiuld/urfceder .
(!/ J /� dw servt
,:ax- : '74 3 Reconnect only GG.I;S p
E -mail e L h /• (L4)_ 107:3 [; , • b / Pump or irrigation circle 53.40 2
-
. CONTRA OR Sign or outline lighting 53.40 2
I3usiness name: di ) 4 L, 6 V energy (:in uil(s) or limited -
J� rncrlry panel, alteration, or '
Address: extension. Describe: Pau 2 7 2
(,sty /State /ZIP: e 'J / / /// F.adr additional inapccliun over aliowahlc in any of the above
- P' ea inspection I 62.50'
Phone; ( ) /1 02 42— 1 Fax' ( i a6 _/j/7 e Investig ;tlion per hour (t hr win) 62.50
CC:t3 Lic.; Flccttical Lic)Ie� Su c, � m � ustril Inda p
( [� prv. L.ic.: ..... plant tabour 73.75
— --- .. . E. ECTRICAL PERMIT FELS
— G
Supl'v. Electrician signature, required: d 4 1 /t7 / / /// tiubtotpl: '� ( 1 �
Print ntim i' 1112_,. • _ ( J f , 1 , Th T n O L' t , -_, Plan i vie ' (25% Ot; l7('ll1 fee): — -mi
[
_ __ State surcharge (12 ^/n of pcntpit fcc):
Author ized si . � r / �i •. / r / i
/ _ TOTAL FLIth7 I'
911:1:: � [ (71) �
Print name: _, � ` C / 1 - I . 1 - 'This perrnii application expires I a permit is not obtained „iihi,i 1ri0 t �* ��
/U4Ce: S O L- f) :itc: •
_' --. _... rd� da after tt has been accepted nX Complete,
" Number of inspections allowed per pound.
1: euitcing'Ccnnils LLC -Pere rApp « l 05 2) 06 4-/ -ar,
�l r /.Jit /i ai {f
04/19/2010 ION 12:09 FAX 5036654830 PTSC 2002/002
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"
(1 Heating, Ventilation and Air Conditioning System*
Vacuum Systems"
❑ Other:
COMMERCIAL WORK, ON LY:
•
Fee for each commercial $75.00 e,
system 1
(SEE OAR 918- 309 -0000) i
Check Type of Work Involved:
6
❑ Audio and Stereo SystenLs
❑ Boiler Controls
_
\")
- Clock Systems
❑ Data Telecommunicauon installation
11 e,
n Fire Alami Installation. .. A
_ - HVAC
❑ Instrumentation
Inten:om and Paging, Systems
n Landscape Irrigation Control*
Medical
•
❑ Nurse Calls
Outdoor Landscape Lighting"
r i Protective Signaling /`
Other _ , c h 6 6 _ L � L � , & e 7.i � . �C t vz ZI�Z G--/7 e 3
Total number of commercial systems: 1
*No licenses are required. Licenses an required
for all other installations
1 Jduillim PLC Pennirnpp d. „ 0:20 06