Permit .,.,. CI ■ Y OF ■ IGA■ D
y ELECTRICAL RESTRICTED ENERGY PERMIT
p flii,-.4..)- T
i COMMUNITY DEVELOPMENT Permit #: ELR2010 -00060
iv = COMMU
,,,.;:,,;.,., Date Issued: 04/16/2010
AIGARD.` 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
d,,_ ?1. ;!., *,; .14 ,.; .:_, Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 460
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: AM Trust North America
Project Description: Data/Tele Communication
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 04/16/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 04/16/2010 $8.14
PHONE: 503- 624 -6300
Contractor:
XTREME COMMUNICATIONS, INC.
24023 NE SHEA LANE, #215
WOOD VILLAGE, OR 97060
PHONE: 503 - 618 -8816
FAX: 503 - 618 -9985
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
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 - 0 100. 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: - -A- " CA - - Permittee Signature: 0 -
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.
04/16/2010 06:58 5036189'385 PAGE 02/03
Electrical Permit Application RECEIVED FOR OFFICE USE ONLY
City of Tig 2rd Received PerTrILI? ../() Ca
III I ll 13)25 SW Hall Blvd., Tigard, ()R 97223 APR 1 6 2010 Date/By:,
Plan Review
: 3 . ne! : • Pho 503.639,4171 Fax: 503.598,1960 bat/1 Other Perml:
T1 G A R
inspection Line: 503 CITY OF TIGARD
,639,4175 Date Rcady/By; Ivri5. Eli See Page 2 for
1:1
Interact; www.tigard•Or.gov Notified/Method: Supplemental information
L. _ I k _ II i k
, . , . , .: , :: . ..• ,, . ,: , . ,. , .: ..t.t.r or *roijuc . : l' ,:., , l: ' ': :. • ,, l ;,..:.: ':•1 ::;l';.'l • l ;:...•:!':: ,l;... ,l' l. ',''7'll': • l
New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/itcms checked below):
ID
o
0 Servicc or feeder 400 amps or more 0 Building ov i..ree str.es.
er lt i
0 Demolition I 0 Other: where the available fault current 0 Merinos and boatyards.
CATEGORY OF CONSTRUcTION exceeds 10,000 amps at 150 volts or 0 Floating tniildings,
less to ground, or exceeds 14,000 0 Cotnmcrcial-uac agricultural
p I- and 2-family dwelling 1-t ommercial/industrial 0 Accessory building amps for all other installations, buildings.
El Multi-fatnily ] Master builder E Other: CI rim pump. 0 Installation of 15 KVA or
. . . . D Emergency system, larger separately derived system.
.. . , " : • ' ' .1011 §rrt TNtoRsuvoN. 4 0), LOCATION ' . .:,. , .. .. 1:1 Addition of new motor lond of
100HP or morc. °money,
Job no.: 7301 Job site riddress: /2.-i705P $ •,/ 6 $ Pks 4 1 1 90 u si, ur innre residential units. 0 Recreational vehicle parks.
----,, -
City/Sinte/ZIP: rttitif oje. ,772-_, 0 Health-carc facilities, 0 Slipply voltage for more than
0 firizattloue locations. (i00 volt!: nominal.
Suite/bldg./apt. no.: Project name: AIN r r44 ,C rtele g D scnicv or feeder 600 lays or MOM.
Cross street/directions to jot) site: .77re el '71.(a14ee , Description _ j I P. 1 Toth! 1 " .*
New residential single- or multi-family dwelling unit.
Includes attached garage.
-- .
1,000 sq. ft. or less 145.15 4
Subdivision: . Lot no.:
- E.3, addll 500 sq. II or portion 33.40 1
Tax map/parcel no.: Limitcd energy. residential
- 75.00 2
(wilit shova at)
._:......-
Limited energy, multi-Family
75 2
kdocc € Istattel *fru cf tired Cektipia
--- residential (with above sq. h.)
S erv i ces or feeders installation alteration, and/or relocation
Ltei-1:79,w‘ T
TLE E CO H1 4 cuvi C 0 "/. ..g 200 amps or less 80 30 2
- 7 - 7 - ,-.4 ,
. ' . 1J: PROPERTY . R. : : . . ! ' : ' : . 0 TENANT::. ?, ' , ;' . 201 amps to 400 am - nip 106.85 2
■
Namc: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address; Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
- ._.
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sate, lease, rent, or exchange, according 10 ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, er panel
Owner signature; Date: . A. Yee for branch circuits with
. . . , .
.. , .. ,: 0 APPLICANT ::. . . : ' . .. ' . . 0 CONTACT .PERBON :' , , ; above service or feeder fee, 6.65 2
each branch circuit
Business name: 13. Fee for branch circuits
without service or feeder fee. 46.85 2
Contact name: 9"/Z7' igi . I , ys b, / d_. first branch circuit
Address: Each add'I branch circuit 6.65 2
. Miscellaneous (service or feeder not included)
City/State/ZIP: CE " - ) 5 -2/0 -2S5X Each manufactured or modular
90.90 2
/
Phone: (.5. dwelling. service and/or feeder
0.3) 4.) P_ 4'7/4, Fax: : ( ) Reconnect only 66.85 2
E Pump or irrigation circle 53.40 2
• .: _ . ." :. - , , , . ' : CONTRACTOR , - 2 , :. ' ., .: . " ' : !: ,' , Sign or outline lighting 53.40 2
„Signal eircult(s) or limited- -
Business name: th-eai e 6,, , ,..tc.. energy panel, alteration, or ,,.,,
Address; 0.1#, 7.1 NE .4e3:7 Adih„ It& Z/6- extension. Describe: / Page 2 f-, - 2
City/State/ZIP: kj thei i Op_ q ?o Each addltionnl Inspection over allowable in any of the above _
- - - Pcr inspection 62.50
P lone: ( 1b7 ) 616- sl Fa: ( 52,4) 418 f il,s --
, ccr3 Investigation per hour (1 lir min) 6250 ,,., 2 3 , Electrical Lic.: .-S'i s Suprv. Lic.:
tAcr
industrial plant per hour 62.50
Lk,..
73.75 i
_ . _
: PERMIT : FEES '',: . • : _,,..-, ' 0)
Suprv. Electrician signet , rlquired: ,..- - I 0 ' ( i Subtotal: 7-,.7, 0 0 0 '
,
, ELECTRICAL
,
Plan review (25% of pcnnit fcc):
Print name: e inticeit pat(-
State surcharge (8% of pcnnit fee): .
Authorized signature: xti_ete TOTAL PERMIT FEE: , 8- ,
. This permit application expires if a permit is not obtai . within 1110...5 . 1V
Print name: g , 4,11411c.,11- Date: if li /0 , days after it hne been accepted as complete.
* Number o I impectionq allowed per permit.
1:113itildingTerm19 \EI.C.PermitApp.clne Of/21M 440-4615-rn1105/COMAVET3