Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
i` t ;• 1� ^ 4 " COMMUNITY DEVELOPMENT Permit #: ELR2010 -00102
T i G`ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/08/2010
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 450
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: ACE American Insurance
Project Description: Low voltage for security system.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 06/04/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 06/04/2010 $8.14
PHONE: 503 - 624 -6300
Contractor:
SIEMENS INDUSTRY INC
15201 NW GREENBRIER PKWY, SUITE A4
BEAVERTON, OR 97006
PHONE: 503 - 234 -9995
FAX: 503 - 234 -8030
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: N
Security Alarm: Y
Garage Door Opener: N
HVAC: N Total $75.98
Vacuum System: N
Other N Required Items and Reports (Conditions)
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- 001 -0100. You may ohtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
2 -
41 111111M .
Issued By. _..........e......
Permittee Signature: _--- ii
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.
x k. . . ra 1 ` m
Electrical Permit Application . $ f � ' ,ri I R O1 i I €hj,I Sh. O 1 1A , It " :
C ity of 'Tigard Received
: . r Permit No.: — • L '11 _ 00 (
' 13125 SW Hall Blvd., Tigard, OR 97223 � Plan Review
Phone: 503.639.4171 Fax: 503.598.1' :� 1 ��1 DateB : Other Permit: / I `
I I C 'r1 IZ IC! Inspection Line: 503.639.4175 D J Date Ready/By: ® See Page 2 for
,t Internet: www.tigard- or.gov ` ' `ee O . <11Q Notified/Method: Supplemental Information
TYPE OF WORK .\ - L Sl
��
❑ New construction Ni Addition/alteration/ r ne �� PLAN REVIEW
I,C3 Please check all that apply (submit 2 sets of plans w /items checked below):
GO I n
(1 v ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: _ j1 - 1° V where the available fault current ❑ Marinas and boatyards.
l CATEGORY OF CONST CT1ON 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 N 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 ", "1 -3 ",
100HP or more. occupancy.
Job no.: Job site address: 12_1 1 p
p 1 S►,J 6 f & y it `7 `� 50 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: p / 2 ❑ Health -care facilities. ❑ Supply voltage for more than
/ � ,( 7 7 2 2 / ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: /15,0 '
Project name: /9Ce Arocciad & 5U CE 7 1 0 Service or feeder 600 amps or more.
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 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
L V w //LI AI G f C DA- CA A-a -ESf _
ic6) a7 f 5-16:41 residential (with above sq. ft.)
/ Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER 2 TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Ace J 1,)'u/1A .) C C' co /vi 1 94 N �/ 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
v APPLICANT . .. 1 'CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name:
11E0/1 _11 B. Fee for branch circuits without
S / f✓U U 5 T 'II In/ C , service or feeder fee, first 56.18 2
Contact name: S" r4-1 6 MCC 1( branch circuit
Each add'I branch circuit 7.42 2
Address: /552 1 kitki G 13A-1 6" pz..wy fi - A y Miscellaneous (service or feeder not included)
Ci /State /ZIP: // Each manufactured or modular 67.84 2
rj &Rs/EA- 1. 0/N- 1 17o 0 C, dwelling, service and/or feeder
t
Phone: (56 ) 2. ,e totj Fax:: ( ) Z0'7 /yo Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: SA . (6.44.- 1( 7 f/gM ENS . C OM Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) orlimited- energy
// panel, alteration, or extension. .( Page 2 _ 2
Business name:
2 16/4 E N1 (u Oki ) y Each additional inspection over allowable in any of the above
Address: /fir" 1 » ��- g M e^ pit, y S - - f J L/ Additional inspection (1 hr min) 66.25/ hr
tr f 1 Investigation (1 hr min) 66.25/ hr
City/State /ZIP: T 4tV ICTI A. f 7 co 6 Industrial plant (1 hr min) 78.18/ hr
Phone: ( p ) Fax: ( p ) Z � Inspections for which no fee is
S �� 1 S 3 1 ! D / / specifically listed (%A hr min) 90.00 / hr
CCB Lic.: 1 3'30 . Electrical Lic.: 3?- q �prv. Lic.: H 1 1 1 13 j ELECTRICAL PERMIT -FEES
1 r 7/ , hi 7 1 /I/ Subtotal: �p� - -
C Suprv. Electricid 1 n uc4 required:
Plan review (25% of permit fee):
Print name: tiI S full F Date: 41" 1 0 State surcharge (12% of permit fee): $ b ) 9
TOTAL PERMIT FEE: �75'. GI r
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. ,- �y -far
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB ``•'� /'
( G. ✓Ptal
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*
H Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
H 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
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
Other( (.,,,,A
tal number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \Building\Permits\ELC- PermitApp.doc 10/01/09
Jun - 04.2010 04:04 PM Intel Corporation 503- 264 -3486 2/2
06/04/2010 13:06 5035981968 CITY OF TIGARD PAGE 02/02
Electrical Permit Applkatto -_ "t 11 f r , t g
I I Lf I / r� : ` •r gar k •,
City of Tigard r A� i�' a .
13125 SW Roll lvd -Tigard, OR 47223
1 1. " '. Phone: 503.634 4171 Fax; 503.590 ' .. _„ Qtb Pnmtt:
- , „_ inspectionLhlc: 503.639.4175 / P eto - i c y •
Memo www tlgar eev f t+it 141 - a"
ID Ncw construe '
den t=' Addltlou /altofYrGtxV .- , �(j o a a thmt ppty (.wmltxaua olpinua/Uamao,. �a MOW).
r Demolition L10ther: \ " � „1 ��i % 0 Owlet orfceder400ampsermete Building owro:reesiode.
1 where the available ZwIt tweet p aredneo =01 boRtYlIn ,
• 1 ; ' 1 1 g a b i t i " x r re. f 1 t * Y : • J a d 8 4 mops et 150 wee + e t o .4 14.)00 nr M C mVIVIN W Ogr14412Mil
❑ t- and Z- fitmliy dwelling CS CommereiaUinduetr itt - Aceesoory building amp far an oterhntalietiono battdlnte.
MultiArnil ❑ Mortar builder Other: el Frepump. Ellaaaallitiendr79KVAet
, —7,- p Addi lk++ E Imprtmptanlefydtr;vtia . yalc,,,.
Job no.: Job site Rddroee M ' 4 e : emey r.x; "1.7 -.
!2.,905 I to . ba $ c/50 Motor o �oo><„
C[ fSfata/bIP: � C 9la or rnoro lcildentiltl Wu- ® itosrestlond vohioloperlte.
f,Y t] Built
� ® hesn!laiMkr DSoppy wlaaefbrmom IAA
-X14. 7 ' 4 I ] Bt mrdaax loemtlpn and volts nominal.
Suite/bldg. /apt,no.: it5 J Projectnemo: el � "r.I 018eertoeorftcda'600
Cross tlt:tiwt/diracticne to Job eft*: %
1177- twrr ml■1t'•rmiale
New resldenfaf einem- or Intl .amity dwelling unit.
Includes attached , •:re:.
Subdivision: _ I Lot no.: 1,000 • ft. or teas MEMO 11•111113
Tau map/pertol no.; — 00 e
Li snotty, .. i 6714
or pardon 33.92 �Q
- - .. ,'" ' th :u I 11. 6714
- m 1 energy, mu ,. IIy
i rt..l • ti +M., / :� set . •.., 1 . abov .. i. 07.04 ��
Co keg Or iL . , 1 • ...1,.• 1 •• r I ∎, ,'_., relocation
200 •.
salsas NE 100.70 131
� -0_ . ,;1;. ,. • • '- 'j' --- 201 on to400 amps IIIEMEMIIIII11111111
Name: iu 401 am. it 600 sal •. MN Zo0,34 �d
,r�.•r .l,u ., 1,1 301,04 sumln
Addros; Cvor 1,000 amps or volts = 352,20 EIMp
Cttyy /Stam/Z11 Temporary sern ee arfccdere lnebtlladon, alteration, an Nor
Phenol ( ) Pax: ( ) =Imps alms MI 3970 1=111E1
()west Instnlladoae This install on is bolo made en property 201 snips to 400 Imp 125.08
ll le a p perty thatt own which is not qol amps to s99 am MIME'
6 ass, ren or axohan according to ORS 447, 444, 670, and 701. x
Intends. for
melt circuits-oar a i,, •„ emotion , , net
Ow= signature: Date: A. ebOw atervlea at i4ue Po 7A3
Business name: d 5- C as . r birch elm he via -
Coltlactnnme: aerviceoribedorlbgRrse 16,16 �II
�,Orvl ro EIL_ branch 4
Address: /S2 Soh add'! Wench elm!: 7.42 �
v I IAA) Can. AAA
City/Steno/ZIP; ,, ' a1 •.„,a� « - , ef - r. . � EI
Phone: (95 3) 2i1 /lay Fax:: ( ) Z11 /fob Aucmin=on_Y =1112Z1 El
B mail: , - , -.y _ - El
! D
r dr ,• ■.. r a r �r .;:F - .r . �.�`., °^; ,rJ,1y {" t . t • 7.
Business name: - T5,w dc of )iu i,?v S'rit - • E r T r ' ��
_ _. Nina' I o • on over al •. t.IAe I, an 'lithe shove
Addrose; f i e t e 1 _ u y ' n JAW Additional1 .... •on 1 *Ism 11111113333 _III
City/State/LIP: ' - ltlradaedon 1 fir min) � �
i t 'i 4 ( Ov Industriet• 73.11/ he —.
F 01 ) z.-7 /goo Fex: ( 113) Zr7 A
CCU Ma : b Electrical Lie.: 0 /hr
- Suprv, 7.io • IMO -r l - omilitrziaw
Supty. $ldotri4ien signature, required: Piam cw ofpO n:slt
Net name: v i Fic Date: , Mats surcharge (12% of ' htbo); PL'
t r
' Andforteed slenature:
TOTAL PERM? P8& �
�� IPermrtappll . r , i , 1i(RpormielenotanoPovdwithin110
Print Nino; Date: .. days afres h bee lama accepted ae amw,yhlG
" xamberoriaepooNons allowed papenrll
LlikdidFl Pa iteRLC.Pennitepp:dee 10/010 MOi61ar(t11071cOb1/w131
Jun -04 -2010 04:04 PM Intel Corporation 503- 264 -3486 1/2
88/84/2010 19:06 6038981960 CITY OF TIGARD PAGE 81/02
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