Permit l n CITY OF TIGARD '► ELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00035
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/14/2009
PARCEL: 2S112DA -01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 198 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: 002 JURISDICTION: TIG
PROJECT: COMPUTERATION
Project Description: Data/Telecommunications.
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:
Owner: Contractor:
PACIFIC REALTY ASSOCIATES CONNECT TELECOM LLC
15350 SW SEQUOIA PKWY #300 -WMI 1209 SE LARCH WAY
PORTLAND, OR 97224 GRESHAM, OR 97080
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Phone: Contact #: PRI 503-491-1144
FAX 503- 674 -0736
FEES Reg #: ELE CLE16
LIC 144533
Description Date Amount
[ELPRMT] ELR Permit 1/14/2009 $75.00
[TAX] 12% State Surch 1/14/2009 $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 direct questions to OUNC at 503 .2246..66n�
99 or 1.800.332.2344.
Issued By: 1 .�� �J Permittee Signature: Ozz i ty444 . .u xt .
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.
Electrical hermit ApplicationRECElVED FOR OFFICE USE ONLY
City of Tigard JA 1 2009
Date/B • • opt Permit No.: — I 9.260 9 , OO 41
° 13125 SW Hall Blvd., Tigard OR 97 223 Plan Review
' C Phone: 503.639.4171 Fax: 503.598.1 Date/B : Other Permit: ' • . WA • • illy
TIGARD Inspection Line: 503.639.4175 dry OF TIGARD Date Ready/By: glii= H See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 51 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 0 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 a 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.: Job site address: looter or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 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.)
^^_, /� y� ^ r r c Limited energy, multi - fa 75.00 2
VO I � A- st b C $ ) Tx} �)S' i-Di O1-, residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I X TENANT 201 amps to 400 amps 106.85 2
Name: l' (Nap UTE gt 'r p iy ��. C:. , 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: t 5 3 50 SW . sE c (J A `pKtsL( - I R 8 Over 1,000 amps or volts 454.65 2
City/State /ZIP: -poz-ri 4..(30 l 0 R - a -1 Z2� Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( q ( --zq 4 4 Fax: ( ) 200 amps or less 66.85 l
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 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: first branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2 _
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
_ dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: C/31. - 1.9E,Gr ^ ( LUG energy panel, alteration, or
Address: t 2 o 5E. (p Q, w444 extension. Describe: Paget 2
City/State /ZIP: & LES N `1'M I OR.. 9-7 080 Each additional inspection over allowable in any of the above
Phone: 5 03) t4 1- 1 14 4 Fax: Per inspection 62.50
�v3) ( p� ` T— � � 3 (p Investigation per hour (1 hr min) 62.50
CCB Lic.: L 4 5 .33 I Electrical Lic.: G(, £ I b Suprv. Lic.:2 l 4 (Hi Industrial plant per hour 73.75
StTprv Erect an signature, required: 1 .% • % k I o • 1 • .% ELECTRICAL PERMIT FEES
Subtotal: 7 S - OO
Print name: Date:
Plan review (25% of permit fee):
n J State surcharge (12% of permit fee): 9. o o
Authorized signaturC:►' ze TOTAL PERMIT FEE: 8l� - G 6
(� This permit application expires if a permit is not obtained within 180
Print name: (0_5) 4`b SEe,./ Dato (--lc4 � 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(11/05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2009-00035
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/14/2009
Phone: (503) 639 -4171 AA, ; 1
Inspection Requests (24 Hrs.):.(503) 639 -4175 ! "'I
INSPECTION WORKSHEET FOR DATE: 1/2712009 TIME: 7:00AIm PAGE: 10
SITE ADDRESS: 16360 SW SEQUOIA PIM 198 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: 002 TYPE OF USE:
PROJECT NAME: COMPUTERATION
DESCRIPTION: Dataf(elecommunications.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: CONNECT TELECOM LLC PHONE #: J03- 49 -1144
Inspection Request Scheduled For: Date: 1/2:12009 Pour Time:
Code # Inspection Description C ?nfirm # Contact # Message
135 Low voltage \. 079921 - 0 . 1 503 - 491 - 1144 N
Corrections /Comments /Instructions: \
`\. C i:2S A C _
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:',. , \ \
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V SS ❑ PARTIAL APPROVAL ❑ CANCEL CC ESS
' L Ilk'' ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: '. (N) tie) Date: 1 • 2.2 - Qci Phone #: (503) 718- 1-14
ElectriciiTermit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: j
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- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
IA 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
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06