Permit .'` n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
•
COMMUNITY DEVELOPMENT Permit #: ELR2009- 00327. •
- [�,ARD 13125 SW Hall Blvd. Tigard OR 97223 503.639.4171
Date Issued: 10/13/2009
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 150
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Schuller Financial
Project Description: Install restricted energy for voice /data.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 10/13/2009 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 10/13/2009 $8.14
PHONE: 503 - 624 -6300
Contractor:
CONNECTIONS NW INC A WASHINGTON CO
2501 NE 170TH CT
VANCOUVER, WA 98684
PHONE: 360- 772 -0494
FAX: 360 -326 -1586
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 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 obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800,332 2344
n .
Issued By: M 0 � �/�.f �l� n Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property "I own which isnot intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
/� �J CONTRACTOR INSTALLATION ONLY
®
SIGNATURE OF SUPR. ELEC' .,fJ�'t�vk Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection,that 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.
!Pk
Electrical Permit Application F \ ''•, ° FOBOFFICE USE oNL\
' .�,
City of Tl and Received p No.:
° 1 3125 SW Hall Blvd:; Tigard, OR 97223 OCT 1 3 2009 DateB : _ to ,` . ■ 7
DtherPermit:
g Plan Review
' Phone: 503.639.4171 Fax 503.598.1960 DateB
T I G A R D Inspect Line: 503.639 CITY OF TIIG ARryryD Date ReadyBy: ®• See Page 2 for
Internet: www.tigarthor.gov S�UI NG DIVISIDTotiftied/Method: Supplemental Information
- .' . TYPE OF WORK` • • • .: „ • r 'PLAN REVIEW'• .- •
❑ New construction IgkAddition/alteration/replacement Please check alltl at 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 'CONS_ TRUCTION • ''.. 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
- - , — Emergency system. larger separately derived system. •
�J,O 0 d, J,013 SITE ;INFORMATION; AND. LOCATION �• ':, , " , ., � , ; Addition of new motor load of ❑ "A " "E " "1 -2 " "1 -3 "
Job no.: Job site address: /.2-YO? $W 6 gty fief # J S Si x o or more. occupancy:
` I ❑ Six or more residential un ❑ Recreational vehicle park
City /State /ZIP: 7,/.611 RD ' de_= ❑ ❑ Health -care facilities. ❑ Supply voltage for more than
Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: -- / 50 Project name: c� � � l \RV I nat �( ❑ Service or feeder 600;amps or more.
R.. ,FEE _SCHEDULE. ,. . ,
Cross street/directions to job site: Description 1 QtN. I Fee. 1 Total I
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
Tax map /parcel no.:
.. .. energy,
Limited ener ,
' ' ' m• DESCRIPTION' OF 'WORK with . above s ft. 67.84 2
� w VOL- Fl6 E' / X Cl L V�e c�P/ rfi Limited energy, multi- family 67.84 2
„� T 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
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own'which is not 201amps to 400 amps 125.08 2
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
y APPLICANT _ ;0 CONTACT N A PERSO ';r above service or feeder fee,
"" each branch circuit 7.42 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first branch circuit .
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /Z1P: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: • Pump or irrigation circle 67.84 2
, v'.. , f CONTRACTOR . •" 4 ,, Sign or outline lighting 67.84 2
Business name: c f�l,C c-rz S NL►t�71- L e- ' � ,NC Signal circuit(s) or limited-
energy panel, alteration, or
Address:
6 0 q N W 133 RID G X(LGLE" extension. Describe: 1 Page 2 2
City/State /ZIP: MIUGDu VEK. �- W l ` [ g6 g S Each additional inspection over allowable in any of the above
( 360) Si O o ^ � ( n Per inspection 66.25
Phone: Fax: 360.) S 7 "l r, —004 7
Investigation per hour (1 hr min) 66.25
CCB Lic.: P 79 / g Electrical Lic. 3 5 9 1 - 3 Suprv. Lic.: Industrial plant per hour 78.18
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' • . ;' . ELECTRICAL.PERMIT,_EEES " .
Suprv. Electrician signature, required: all L J 2 J l Subtotal: (4 . RI-1
Print name: 6.f-p Q Zt -1T :Date: /C).--1 3-- 07 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 8 . , y .
Authorized signature: TOTAL PERMIT FEE: S Q o
• This permit application expires if a permifis not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
t.\ Building 1 Permits \ELC- PermitApp.doc 10/01/09 440- 4615T(1 I /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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
1
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
( COMMERGIAL°WORKDNLY "
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ 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