Permit a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00029
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: i/5/2009
PARCEL: 2S 112 DA -01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 190 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: 002 JURISDICTION: TIG
PROJECT: DIANA HARRISON CPA
Project Description: Low voltage for fire alarm.
A. RESIDENTIAL B. COMMERCIAL
AUDIO '& STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
•
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES MERLIN POINTE TECHNOLOGIES
15350 SW SEQUOIA PKWY #300 -WMI 12606 NE 95TH ST SUITE C -130
PORTLAND, OR 97224 VANCOUVER, WA 98682
Phone: Contact #: PR1 360- 892 -0065
FEES Reg #: ELE 37- 100CLE
L1C 155924
Description Date Amount
[ELPRMT] ELR Permit 1/5/2009 $75.00
[TAX] 12% State Surch 1/5/2009 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 • • - : • - -tions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued = y: ��� 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.
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Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Date /B / �I Permit No.: /
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4 /.
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 JAN 0 6 200g Date/B : Other Peirrtit:
TI G A R D Inspection Line: 503.639.4175 Date Ready /By: See Page 2 for
Internet: www.tigard- or.gov CITY OFTIGARD Notified/Method: n Supplemental Information
TYPE OF vglilLDINU DIVISION PLAN REVIEW
❑ New construction Addition /alteration/replacement 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 ❑ 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
❑ I - 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 ", "I- 2 ", "1 -3 ",
Job no.: H Job site address: Set I00HP or more. occupancy.
pl(i /A r1 (S 3�U .5i/ tJoi q 1A'hf #10 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: n ) qr ❑ Health -care facilities. ❑ Supply voltage for more than
1 "� TLA�J n 1 al - / 7 72 2y ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 79 Project name: p �q 11 1 /�� 0 Service or feeder 600 amps or more.
/A �i-� (1111 FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
/ VA./ 0.'44 % Di(r 0% ire al 'cvI SpAg alt l 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
-Tj/ I get,' /S�t4pK q,+D / S /lr1 rt�;Cil f residential (with above sq. ft)
nn Services or feeders installation and/or relocation
Mt ofii -f1 To Ad /; 5y r 200 amps or less 80.30 . 2
CR PROPERTY OWNER �! / ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
PA C111.057 601 amps to 1,000 amps 240.60 2
Address: i ci (-, 5c....1 <Ft/JD, A /94_ p/ ' 3 ed Over 1 ,000 amps or volts 454.65 2
City/ State/ZIP: non 972 Z �� % Temporary services or feeders installation, alteration, and/or
12 i149 a n
7 /n / relocation
Phone: 3 ) 6,2 to 3OG Fax: ( ) 200 amps or less 66.85 1
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, 6.65 2
_ f f each branch circuit
Business name: p , L',/ 10/ 'dTf /76h ,iQ /d Ft L /e,. B. Fee for branch circuits
` without service or feeder fee, 46.85 2
Contact name:
leV- / i oe S6.- first branch circuit
,1, -` Each add'I branch circuit 6.65 2
Address:
i2604 "AC. 9C Cr S(- e / o Miscellaneous (service or feeder not included)
City/State/ZIP: 01JC!Ot/LC'it ✓/) 9k, (.2 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ()3 ) 3 y , able Fax: : ( ) Reconnect only 66.85 2
E -mail: Ee/ 0 ,i 6/1i/pr 44.1 . C0/1 Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: M CA` j , r ilt- /,f4 energy panel, alteration, or
Address: , 2 L JJ 1c Si S1(- C - 136 extension. Describe: ( Page 2 7 5 GU 2
City/ State/ZIP: VAALev L✓4 le‘ r.. Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: (34 g '2 - 00 Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
I ‘6-26f �7 /CL' �LIC p �66� Ct!A ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: _____/ Subtotal: 75
Print name: �-' Date , O9 Plan review (25% of permit fee): _•e --
- e State surcharge (12% of permit fee): g- 0
Authorized signature: /. TOTAL PERMIT FEE: 'q . oc)
This permit application expires If a permit is not obtained within 180
Print name:
� / �(� � s ` � Date: /,.. Oy days after It has been accepted as complete.
"' • Number of inspections allowed per permit
1: \Building \Permits \ELC- PennitApp.doc 05/23/06 440- 4615T(I I /05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #:ELIP
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1 -21 - 0 I TIME: PAGE:
SITE ADDRESS: 1516 S W S&_a•v Bl1A 3L 1 c 1 1 6 CLASS OF WORK:
SUBDIVISION: -- TOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 OVA
Corrections /Comments/ Instructions:
PJ Hb. k &op a5vNL
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr", Nth L- T Date: 1 " 2 - 1 " '61 Phone #: (503) 718- Zyq6.,
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
1 RESIDENTIAL WORK ONLY: ,
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
El Audio and Stereo Systems* •
El Burglar Alarm
❑ Garage Door Opener* •
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other: •
[COMMERCIAL WORK ONLY: .
Fee for each commercial $75.00 •
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
C2 Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control* .
El Medical
❑ Nurse Calls •
❑ Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Pamits\ELC- PermitApp.doc, 03/23/06 ,