Permit `V CITY OF TI ARD
. :: ELECTRICAL RESTRICTED ENERGY PERMIT
° . COMMUNITY DEVELOPMENT PERMIT #: ELR2006 - 00309
DATE ISSUED: 12/19/2006
4TIG4RD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 113AB -00101
SITE ADDRESS: 16101 SW 72ND AVE BLDG A -120 ZONING: IP
SUBDIVISION: PACTRUST BUSINESS CENTER LOT: JURISDICTION: TIG
Project Description: QUALCOMM. Voice /Data.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES GG TELECOMMUNICATION CO
15350 SW SEQUOIA PKWY #300 -WMI 121SW SALMON ST STE P1
PORTLAND, OR 97224 PORTLAND, OR 97204
Phone: Contact #: PRI 503- 295 -2922
FEES Reg #: ELE 3907LEA
LIC 59692
Description Date Amount
[ELPRMT] ELR Permit 12/19/200( $75.00
[TAX] 8% State Surcha 12/19/200( $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
dd-a 73
Issued By: � �� /� � Permittee 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'N: 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.
Y m ` `, +�V1 IIFi Ill e_ : ,i , -
Electrical Permit Applies , -- r - Y k t � r a w" -, ; I ()Ilsc)F1,IC 1 U ()1 \'I l 4.. � . '
311r r. i- 1 li)afeFlr � � -p � � ,S '..,, :!i of 'o.; .ti.P. e a s.. .�'`" J. ' ,
' , City of Tigard f* . EV ' r D ByfJ /9 Permit No.: ,1) 6600'►
t a 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
4 ei Phone: 503.639.4171 Fax: 503.598.19 Date/By Other Permit:
- r106',, 'A Rrl7� Inspection Line: 503.639.4175 DE 1 9 2006 Dale Ready/By: 3 uris El See Page 2 for
�T� G
RGfr?\ri1S! Internet: www.tigard - or.gov 1 ' Notified/Method: ` Supplemental Information •
TYPE O LE& Ur' 11.J - " _ PLAN REVIEW , •
❑ New construction tiltAdditi tW�r I t q g (Tr 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 b 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 Gil Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ 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 - ", "1 - ",
Job no.: Job site address: + � 1 Six or or more. occupancy.
�0 01 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ---, � 9/224 ❑ Health -care facilities. ❑ Supply voltage for more than
1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: G) `i �" ❑ Service or feeder 600 amps or more.
t � FEE .SCHEDULE .
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or Tess 145.15 4
Ea. add'! 500 sq. ft. or portion 33.40 I
• Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
• Limited energy, multi - family 75.00 2
Lak vO�A6 � 4-DA-TA vC` ''rA residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or Tess 80.30 2
❑ PROPERTY `OWNER I ❑ 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 1 own wh 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 1 ❑ CONTACT PERSON . . above service or feeder fee, 6.65 2
each branch circuit
Business name: /� lAo Co 4. a y
l9� �G(,EC��� PJ iC�k"l!"i QN �, (�'4N B. Fee for branch circuits
without service or feeder fee,
Contact name: 46.85 2
�(gf,' 1 1 r , b I lr first branch circuit
Address: ( 9 c- Skt... ,Of.1 sr c,'-'L, p) Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City / State/ZIP: `7 .02.31,O OR 9' 4 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (53) 9.15 '592 Fax: : ( c3) • .95 non, Reconnect only 66.85 2
E -mail: n c3� ,c 6 ea I ( + ( Pump or irrigation circle 53.40 2
CO ACTOR • . . -.. • - Sign or outline lighting 53.40 2
Business name Signal circuit(s) or limited-
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City /State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: 4 ,7 9._ Electrical Lic.: 6907 Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Oa Subtotal:
Print name: ( ( Cy ' , i Date: r+11 q /Dia Plan review (25% of permit fee):
/ State surcharge (8% of permit fee):
Authorized signature: lug `e ? TOTAL PERMIT FEE: / , d 0
This permit application expires if a permit is not obtained within 180
Print name; t-y ,0 Date: 1 2_,i f ed Qcc, days after it has been accepted as complete.
( • Number of inspections allowed per permit.
I: \Building\ Permits\ ELC- PermitApp.doc 05/23/06 440-4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard . ,
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: • •
g'RESIDENTIALWORKONLY: 1
Fee for all residential systems combined ... $75.00 '
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 $75.00
system
• (SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑
•
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Et.P2006- .00i0C
13125 SW Hall Blvd., Tigard, OR 97223 -- DATE ISSUED: 12/19/2006
Phone: (503) 639 - 4171 °
Inspection Requests (24 Hrs.): (503) 639-4175 _
INSPECT ION WORKSHEET FOR DATE: 1200/2006 TIME: 7_00AM PAGE:
SITE ADDRESS: 16101 SW 72ND AVE BLDG A - 120 CLASS OF WORK:
SUBDIVISION: PACTRUST BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: QUALCOMM
DESCRIPTION: OUALCOMM- Voice /Data-
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: GG TELECOMMUNICATION CO PHONE #: 503 -- 295.2921
Inspection Request Scheduled For: Date: 1:2}:0/20(18 Pour Time:
Code # Inspection Description Confirm # Contact # Message
131 Low voltage 041326-01 • 503-490-7811 N
Corrections/Comments/Instructions:
4/
PASS 1 PARTIAL APPROVAL ❑ CANCEL 1 I NO ACCESS
FAIL CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: G.' Yv 68 Lei Date: I 2 - 6 (04) Phone #: (503) 718- 2- .