Permit # CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
l a COMMUNITY DEVELOPMENT Permit #: ELR2009-00332
„ , Date Issued: 10/22/2009
, ARD^ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15495 SW SEQUOIA PKWY 190
Subdivision: Lot: 0
Project: ColumbiaSoft
Project Description: Restricted energy for access control.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 10/22/2009 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 10/22/2009 $8.14
PHONE: 503 - 624 -6300
Contractor:
STANLEY SECURITY
15495 SW SEQUOIA PKWY #100
PORTLAND, OR 97224
PHONE: 503 - 968 -3353
FAX: 503 - 968 -3398
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: N 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 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 throu h 0 952 - 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.
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Issued By: � VU � f( . 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.
Electrical Permit Applicat , r 7-11/
r „ Received ..,
City of Tigard j : p ;t ' . Date/By: Permit No.: `r
1- Cf•U �
13 12 5 SW Hall Blvd., Tigard, OR 97223 Pl R
Phon 503.639.4171 Fax: 503.598.1060, �; i, , Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: 9 0 See Page 2 for
Internet: www.tigard- or.gov CIS' Y OF -E ; G 11 R Notified/Method: IC� Supplemental Information
TYPE e_ '1 4 I fe OF
DIVISION PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction Addition /alteration/ /replacement
❑ 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 ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no. :30 11 ' Job site address: " i} IOOHP or more. occupancy.
❑
ISy95sw Se Ki fi
e. iIi W y t I o ❑ Six or more residential units. Recreational vehicle parks.
City /State /ZIP: j Ir ' {} (2 0 R C' Z�y / ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
19 Project CO HM13 4 S OF
Suite/bldg./apt. n0. Pro ec name: t ❑Service or feeder 600 amps or more.
_ FEE SCHEDULE
Cross street/directions to job site: CA e./V1lAJ D R 1 UL Description I Qty. I Fee. I Total i *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
DUST/3 1A- A-€c e S S C t) P TR(JL . residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 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 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
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 circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
+ �` Signal circuit(s) or limited -
Business name: sTivu P 1 S'ecki k 7Ij energy panel, alteration, or
Address: ' 5 S si) S-e y N 0 t 4 petty *No
extension. Describe: I Page 2,3750 2
City /State /ZIP: '7-( [ , 4 2 0 Y 9' 7 22_,Ii Each additional inspection over allowable in any of the above
( 5,3) c b 3 3 5 3 ( 56 ° f 6, 3 3 y' Per inspection P ( ) 62.50
Phone: Fax: Investigation per hour 1 hr min 62.50
CCB Lie.: 16154,7 Electrical Lic.:3 - 105 1 1 CLE Suprv. Lic.: — ' Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: /�� Q Subtotal: $ '7 5?
Print name: St "Q.0 e Al h04SE Date: IV, --0 —0, Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: cs.... , L y TOTAL PERMIT FEE: [ q R
,,('}'"e,, , N This permit application expires if a permit is not obtained within 180
Print name: ...... <V,( MU Date: to el days after it has been accepted as complete.
* Number of inspections allowed per permit.
I: \Building \Permits \EI- C- PermitApp duc 05/23/05 440- 4615T( 1 1/05/CO,51 /WEB 1 -a li
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