Permit . ?h , ! CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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` . 2 , COMMUNITY DEVELOPMENT Permit #: ELR2010 -00064
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/20/2010
:4 GARD,' 9 Parcel: 2S112DA00700
Jurisdiction: Tigard
Site address: 15333 SW SEQUOIA PKWY
Subdivision: PACIFIC CORP CENTER Lot: 0
Project: Coca -Cola Sales Office
Project Description: Low voltage voice and data cabling
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:
LAN TEL SERVICES INC
1900 IRVING RD BLDG C
EUGENE, OR 97402
PHONE: 541 - 688 -1427
FAX: 541 - 688 -4642
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 O * R 952- 001 -0100. You may obtain n a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800..332.233 44 � / /� //�
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Issued By: 1,1-.4.......i......, 1,1-.4.......i......, L � 1 Permittee Signature: TKO Q/J/9 C��) -`II /
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.
CaII 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.
APR -16 -2010 00 12 LAN TEL SUCS EUGENE 15416884642 P.01
Electrical P Application .
RECEIVED , . 1 ' .,F1�IZI�;t :Fly �� t �1:dt I , �.
" v City of Tigard Da Pla t eBY w Pe eu 0 0
� 0 13125 SW Hall Blvd., Tigard, OR 97223 n Revie
' r R Phone: 503,639.4171 Fax: 503 598.196s� P R 1 O O Danr/BY: Other Permit:
rn "'1" ' ' Inspection Line: 503.639,4175 Date Ready /By; funs: ® ,e See Pa 2 for
IT;,I GA 12, U p Notified/Method;
Supplemental Information ,, :ti Internet: www.tigard- or -gov CITY OF TIGARD
TYPE OF WA/DING DIVISION PLAN REVIEW
❑ New construction ®Atdition/ alteration /replacement Please check all ghat apply (submit 1 sets of plats w /i[ems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
0 Demolition 0 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 agricultwal
❑ I - and 2-family dwelling ®Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
0 Multi- family 0 Master builder 0 Other: ❑ Fi pump. 0 Installation of 75 KVA or
❑ Emergency system. larger separately derived system
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of [] "A "E , "1.2 "1 -3 "
Job no.: Job site address: 15333 SW Sequoia Parkway 10011P or more. occupancy
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /StateJZiP: Portland, OR 97224 0 Health -care facilities. ❑ Supply voltage for more than
- ❑ Hazardous locations. 600 vole nominal.
Suite /bldg. /apt. no.: #5 Project name: Coca -Cola Sales Office ❑ Service or feeder 600 amps or more.
- FEE SCHEDULE
Cross street /directions to job site: SW Redwood Lane orscrigalon 1 Qty. 1 Fie. ETTO11 •
New residential single- or multl- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft- or less 168.54 Tr
Tax map/parcel no.: Ea. add'1500 sq. R. or portion 33.92 I
Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
- Limited energy, multi- family 67.84 2
Low voltage voice and data cabling. residential (with above sq. R.)
Services or feeders installation. alteration. and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER ® TENANT 201 amps to 400 amps 133.56 2
Name: Coca - Cola Bottling Co. 401 amps to 600 amps 200,34 2
601 amps to 1,000 amps 301.04 2
Address: 15333 SW Sequoia Parkway Over 1,000 amps or volts 552.26 2
City /State/2IP: Portland, OR 97224 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)682 -5133 Fax: ( ) 200 amps or less 59.36 l
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intcndcd for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amp 168.54 2
Branch circuits — new, alteration, or extension, per panel ,
Owner signature: Date: A. Foc for branch circuits with
El APPLICANT 0 CONTACT PERSON above service or feeder fee,
7.42 2
_ each branch circuit
Business name: Lan Tel Services, uric. B. Fee for branch circuits without
service or feeder t first 56,18 2
Contact name: Dawn Dover branch circuit
-_. - Each add'I branch circuit 7.42 2
Address: 1900 Irving Rd., Bldg. C Miscellaneous (service or feeder not included) _
City /State /ZIP: Eugene, OR 97402 Each manufactured or modular 67.84 2
dwelling. service and/or feeder
Phone: (541) 688 - 1427 Fax: : (541) 688 - 4642 Reconnect only 67:84 2
E -mail: ddover @lantelservices.com ' -'� Pump or imgation circle 67.84 2
Signor outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Lan Tel Services, inc. panel, alteration, or extension. I Page 2 67 2
Each additional inspection over allowable in any of the above
Address: 1900 Irving Rd., Bldg. C Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Eugene, OR 97402 Investigation (1 hr min) 66.25/ hr
— - - - - -- industrial plant (I hr min) 78.18/ hr
Phone: (541) 688 -1427 Fax: (541) 688 -4642 Inspections for which no Pee is 90.00/ hr
specifically listed (h hr min)
CCB Lic.: 90461 Electrical Lic.: 20353CLE Suprv. Lic.: 4250LEB ELECTRICAL PERMIT FEES
5uprv. Electrician signature, required: i ("))4--ca Subtotal: 67.84 /� Plan review (25% of permit fee):
Print name: Johnny Velez 1 -- Date: 4 1! -/O State surcharge (12%ofpermit fee): 8 -14
Authorized signature: /J�j % % %�� // TOTAL PERMIT FEE: 75.98
/.,Vf,(�I ��( /t.�- This permit applleation expires if a permit is net obtained within 180
Print name: Dawn Dover, Service Manager Date: 4--6 days after ft has been accepted as complete.
•/0 • Number of inspections allowed per permit -
t: taui,ping,raminnELC- paRahAppAoc 14/01/09 440-4615T(1I/OS/COM/WE8
APR -16 -2010 00 :12 LAN TEL SUCS EUGENE 15416884642 P.02
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL W4,RKONL'Ys
Fee for all residential systems combined .. $67.84
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 $67.84
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
E Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
No licenses are required. Licenses are required
for all other installations
1,\ Building \Pcrmia\ELC- PcrmitApp.dvc [0/01109