Permit ELECTRICAL RESTRICTED ENERGY PERMIT
)_ ; ,4i CITY OF TIGARD
` COMMUNITY DEVELOPMENT Permit #: ELR2010 -00097
T 1 GARja 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/27/2010
Parcel: 2S112DA00700
Jurisdiction: Tigard
Site address: 15333 SW SEQUOIA PKWY, STE# 100
Subdivision: PACIFIC CORP CENTER Lot: 0
Project: Coca Cola
Project Description: Low voltage for audio /stereo wiring.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 05/27/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 05/27/2010 $8.14
PHONE: 503 - 624 -6300
Contractor:
HANSEN TECHNOLOGY GROUP
PO BOX 83783
PORTLAND, OR 97283
PHONE: 503 -351 -1290
FAX:
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Y 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 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 - • • - - = 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. A - ENTION: Orego law r= quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -01 -0010 through OAR 95 • % -0 i0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1.800.332.2344.
r
Iss -d By: / � 6 LL..• •
Permittee Signature: A .A 1il.1L L. PA._
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.
Cali 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 Applicatio t t e 4° ". u,fx i ()R ()Irl I( +I rt S1 0)NI "; r '' r r i-'‘1: tt ' '4' � ' "'
rpiL ECEIVED <T _
v 9e, er ;,,,V" 7 '. ( , ..:. T. , a. "d ,� .4. Ca. k: P ?�, x�,��+t . r fi� ^. +
'`'� City of Tigard Received � a� / l p Permit No.: Q"
yA M k
13125 SW Hall Blvd., Tigard, OR 97224 Plan Review
t3 Phone: 503.639.4171 Fax: 503.598.1960 ' 7 2 O 1 Date/By: Other Pemut:
^ ? Inspection Line: 503.639.4175 Date Ready/By: luri El See Page 2 for "op Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: i co Supplemental Information
TYPE O BUILDINC DIVISION Print name: 1 L
11 New construction U Addition/alteration /replacement
❑ Demolition ❑ Other: PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
CATEGORY OF CONSTRUCTION ❑Service or feeder 400 amps or more ❑ Building over three
U 1 and 2 family dwelling •Commercial /industrial U Accessory building where the available fault current stories.
exceeds 10,000 amps at 150 volts or ❑ Marinas and boatyards.
❑ Multi family ❑ Master builder ❑ Other:
less to ground, or exceeds 14,000 ❑ Floating buildings.
JOB SITE INFORMATION AND LOCATION amps for all other installations.
n ❑ Fire pump El Commercial -use
Job no.: Job site address: ` ) agricultural
l�C �, I, 3- 3 3 Seq void ❑ Emergency system. buildings.
City/State /ZIP: rL( `I 2 4 Ti _(-.. 0 I; " I I ZZ ( ❑Addition of new motor load of ❑ Installation of 75 KVA
Suite/bldg. /apt. no.: I Project name: 100HP or more. or
❑Six or more residential units. larger separately derived system.
Cross street/directions to job site:
❑ Health -care facilities. ❑
occupancy.
El Hazardous locations. ❑ Recreational vehicle
❑ Service or feeder 600 parks.
Subdivision: Lot no.: amps or more. ❑ Supply voltage for
Tax map /parcel no.: more than
600 volts nominal.
DESCRIPTION OF WORK
r I �,I `/ � «1�( e-a FEE SCHEDULE
- V�t'V' v C r / i) r® J ,J, 7P F'�t �✓1 � /t Description 1 Qty. 1 Fee. 1 Total 1
100 1 Z we■\ 4 Ei vii V G n- New residential single- or multi- family dwelling unit.
Includes attached garage.
LI PROPERTY OWNER I ❑ TENANT 1,000 sq. ft. or less 168.54 4
Name: Pe(, — r r u ` S -}' Co c Cr) It- Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
Address: (with above sq. ft.) .
Limited energy, multi - family 67.84 2
City/State /ZIP: residential (with above sq. ft.)
Services or feeders installation and/or relocation
Phone: ( ) I Fax: ( ) 200 amps or less 100.70 2
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 133.56 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 200.34 2
Owner signature: Date: 601 amps to 1,000 amps 301.04 2
❑ APPLICANT ❑ CONTACT PERSON Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
Business name: • relocation
200 amps or less 59.36 I
Contact name: 201 amps to 400 amps 125.08 2
Address: 401 amps to 599 amps 168.54 _ 2
Branch circuits — new, alteration, or extension, per panel
City /State /ZIP: A. Fee for branch circuits with
above service or feeder fee, 7.42 2
Phone: ( ) Fax: : ( ) each branch circuit
B. Fee for branch circuits without
E -mail: service or feeder fee, first 56.18 2
CONTRACTOR branch circuit
F-1 Each add'l branch circuit 7.42 2
Business name: H 1�1
. $ E n � (I (') I E (D li }� Miscellaneous (service or feeder not included)
Address: 1 0 ' .! 0 8 3103 t Each manufactured or modular 67.84 2
dwelling, service and/or feeder
City /State /ZIP: f o r\ d O2 C1 Th3 Reconnect only 67.84 2
1 Pump or irrigation circle 67.84 2
Phone: (03) 35 1 1 2.. 9 (7 Fax: ( ) Sign or outline lighting 67.84 2
CCB Lic.: 1 1 --4 1 Electrical Lic.: 36C1 OLE P- Suprv. Lic.: Signal circuit(s) or limited- energy
�� panel, alteration, or extension. `• Page 2 2
Suprv. Elect sig required: /9///0 Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr
•
Print name: Date: 5/21-1 I V Investigation (1 hr min) 66.25/ hr
' q /�/� , /� Industrial plant (1 hr min) 78.18/ hr
Authorized Signature' (A e y t/ i l t �1 ! I �� / Inspections for which no fee is
ll// specifically listed (%h hr min) 90.00 / hr
lABuildina Temtits\ELC-PermitApp.doc 10/01/09 440-4615T( 11 /05/COM/WEB ,$'76:—(
Electrical Permit Application - City of Tigard
0 Data Telecommunication Installation
Page 2 - Supplemental Information
❑ Fire Alarm Installation
LIMITED ENERGY PERMIT FEES: ❑ HVAC
RESIDENTLAL. WORK ONLY:
❑ Instrumentation
Fee for all residential systems combined ... $67.84
0 Intercom and Paging Systems
Check Type of Work Involved: ❑ Landscape Irrigation Control*
Audio and Stereo Systems* ❑ Medical
❑ Burglar Alarm ❑ Nurse Calls
❑ Garage Door Opener* ❑ Outdoor Landscape Lighting*
❑ Heating, Ventilation and Air Conditioning System*
0 Protective Signaling
❑ Vacuum Systems* ❑ Other
❑ Other: Total number of commercial systems: A
COMMERCIAL WORK ONLY:. 9 required
licenses are required. Licenses are r aired
Fee for each commercial system $67.84 for all other installations
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
•
I:\ Building \Permits\ELC- PamitApp.doc 10/01/09