Permit , ;- CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I r
r COMMUNITY DEVELOPMENT Permit #: ELR2010 -00087
'1.,!-.
T F GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/18/2010
rt Parcel: 2S112DB00300
Jurisdiction: Tigard
Site address: 7233 SW KABLE LN 500
Subdivision: Lot: 0
Project: Nuance Systems
Project Description: Low voltage for voice & data.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 05/18/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 05/18/2010 $8.14
PHONE: 503 - 624 -6300
Contractor:
ORE COM TELECOMMUNICATIONS LLC
9828 E BURNSIDE ST STE 100
PORTLAND, OR 97216
PHONE: 503 - 597 -3700
FAX: 503- 953 -8501
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 p- - is issued • •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes a i :II other applicable law. All work will
be •one in accordance wi • approved plans. This permit will expire if work is not started within 180 days of is anc o ork is suspended for more the 180
•ays. ATTENTION: Oregon . requires you to follow the rules adopted by the Oregon Utility Notificatio. Cente,. Those rules are set forth in OAR
952- 001 -0010 through OA' -00 -0 • . You may obtain a c spy of the rules or direct questions to OUNC by calling 503. • 6.669• 800.332.2344.
Issued Byk s / �/ �, / P erm i ttee Signature: `
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.
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1 Received
III City of Tigard Date/B : / S I1 Permit No.:& t2ao,o - OW .
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date /B : Other Permit: QupAp/o COIp3
I I i',\ I. I�( Inspection Line: 503.639.4175 Date Ready /By: Juris: fd See Page 2 for
'.r ._. - 1 • Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction yj Addition/alteration /replacement 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 ,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 A
❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "I - ",
�
,�]� P n
❑ Six or more residential units. 10014P or more. occupancy.
Job no.: Job site address: 72,3 3 5v, ry LE
0 vehicle parks.
C`
City /State /ZIP: l ' (T �� 0 ( 7 Z 7 3 ❑ Health -care facilities. ❑ Supply voltage for more than
, ❑ Hazardous locations. 600 volts nominal.
❑ S or feeder 600 amps or more.
S�ite/bldg. /apt. no.: ',00 Project name: � S - y t,1 S FEE SCHEDULE
Cross street/directions to job site: ) # r: f ,,-..— - 7 r&_ Description 1 Qty. 1 Fee. 1 Total 1
/ 7 New residential single- or multi - family dwelling unit.
,9/2_,_7_,_,.) g ('S/r•. S S f�LK- 22r _ 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
Limited energy, multi - family 67.84 2
Vol CE ¢ Qa„Pq G �j 4/ J' - /11/5779i.G residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT - • I • ❑ 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)
City/State/ZIP: /State /ZIP: Each manufactured or modular 67.84 2
Y 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
Business name: n panel, alteration, or extension. 1 Page 2 E 7,01 2
®1GC 'C D!k �eJiv/ C' 7_707 Each additional inspection over allowable in any of the above
Address: C y c3 z' �Sf/bi //J 5-7-. • 7 /0.0 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Dn Investigation (1 hr min) 66.25/ hr
l, .� �O- / Q Z/ Industrial plant (1 hr min) 78.18/ hr
Phone: ( ' o ) - 17 - 37 tc) Fax: (5 (. ) 5 '65-6 Inspections for which no fee is
specifically listed ('/A hr min) 90.00 / hr
CCB Lic.: , 5 ze 3 if Electrical Lic.: -f
: 31 CL- Suprv. Lic.: 3?g 7 (fig ELECTRICAL PERMIT FEES .
Suprv. Electrician signature, required: ` Subtotal: 7 gf
Plan review (25% of permit fee):
Print name: -k,��� ,l,t-� 0t- 9- �- 1 Date: ‘/ State surcharge (12% of permit fee): i./(1
TOTAL PERMIT FEE: 75,18'
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
1 : \ Building \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:
•
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n 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 Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
•
n Protective Signaling
❑ Other •
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \Building\Permits\ELC- PermitApp.doc 10/01/09