Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELR2010 00168
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/27/2010
Parcel: 2S101DA00100
Jurisdiction: Tigard
Site address: 13010 SW 68TH PKWY 100
Subdivision: TRIANGLE CORPORATE PARK Lot: 7
Project: US Bank Equipment Finance
Project Description: Data & telecommunications.
FEES
Owner:
PACIFIC NW PROPERTIES LIMITED PA Description Date Amount
STERN FAMILY LIMITED PARTNERSHIP &, Restricted Energy Permit 08/27/2010 $75.00
STERN, HELEN R REV TRUST, 6600 SW 105TH 12% State Surcharge - Electrical 08/27/2010 $9.00
PHONE:
Contractor:
CHRISTENSON ELECTRIC INC
111 SW COLUMBIA ST, STE 480
PORTLAND, OR 97201
PHONE: 503 -419 -3300
FAX: 503- 419 -3695
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 $84.00
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 O: ' 952 - 001 -0100. You may obtain a copy of the _ • direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued — _ •ermittee 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' Date:
LICENSE NO.
Call 503.639.4176 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.
AUG -27 -2010 FRI 09:28 AM CHRISTENSON ELECTRIC INC FAX N0, 95034193695 P. 01/03
Electrical Permit Agplicatio '1, ECEIVED FoRR ovvi Ii usE ONI.i'
City of Tigard Received -' /27 li in '
• 13125 SW Hall Blvd., Tigard, OR 97223 A, '� i� ' t Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Dawn
t . t G 1,, t Inspection Line; 501639.4175 CITY. F�, t� f�l) Date Ready /ay: 1;3 See Page 2 far
Internet: www.tigard- or,gov �� v i ; QN N aified/Methxt: . Supplemental Informutiou
. r•. .11LD� Ir •
,, ,: �., �`i'Yl!)��Q1f?,:.,_, Ric. "'> :■.. ....::::;:�'V
❑ New construction ►adition/alteration/replocement Please cheek all that apply (submit 2 sets of plans w/ tans chocked below):
t--1 ❑ Service or feeder 400 amps or snore ❑ Building over throe stories.
El 'Demolition 'Demolition titer: where the available fault current ❑ Marinas and boatyards,
`' •
: >:.. , `.: £A C x Y .0)H ;: 1SC1G10 exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
- less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2 dwelling ommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder 0 Other: 0 pire pump. ❑ Installation of 75 KVA er
0 Emergency system, larger separately derived system.
:. ` .JOB;$1TE.' INFORMATIQIV,;:,AND: LOCATJOiQ. .. El Addition of new motor lo.ui of ❑ »A ", "F", "1.2" ` 1 - ",
l Quip w more. occupancy. nolfil3and lob site address:' 1.� Sw ( h Q� W `' ['Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: 0 /y _./] s"` G 7 2.2. 3 G] Health -care facilities. ❑ Supply voltage for more than
Yes rtK� A \ �='/ 1 ❑Hnmrdaus locations. 600 volts nominal.
Suite/bldg./apt. no.: ! 0 - 3 I Project name; US 1 Q (J1 ,1\ ID Service or feeder 600 amps or mote.
r FEE SCHEDULE
Cross street/directions to job site: naertpden . Om 1 Fn. bold 1 •
' New residential single- nr multi- family dwelling unit
fA r r7Q _ 53 Includca attached garage.
Subdivision: Lot no.: 1,000 s4. R. or less 168.54 _ 4
liu. add'I 500 sq. ft. or portion 33.92 1
fax map /parcel no.: - Limited energy. residential
75.00 2
` (with above sq. Rl
- 'DESCR {PT[Qhl'.OF'� WORK" —
Limited energy, multi- family 75.00
LaJD V6\ Att., CAA s eat-144,y%-3
residential (with above sq. R.)
Serviced or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
' ..
' :: 201 amps 400 133.56 2
.. PROtERTY: :OWNER. ` ' ::: ' TE .; 201 m amps
Q A.
401 amps to 600 amps 200.34 2
Name; -
601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volta 552.26 2
Temporary services or feeders installation, alteration, and/or
City / State/ZIP: relocation
Phone; ( ) I Fax: ( ) 200 maps or less 59.36
[12_, 01 amps to 400 amps 125,08
2
Owner installation: 'This installation is being made on property that 1 own which is not 401 amps 10 to 599 amps 168,54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits –new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
shove service or feeder foe, 7 4' 2
[ ] . APPLICALV ` • ::: ACF PlaRtiON — each bnutch circuit
• Business name: 06/0/A9,434-y‘ I.P PAS B. Fee for branch circuits wirhour
i service or f fee. first
^ 56.18
Contact name: _ branch circuit
. - Each add'l branch circuit 7.42 2
Address; Miscellaneous (service or feeder not included)
Each manufactured or modular 67,84 2
City/ State/ZIP: dwelling, service and/or feeder
Phone: ( ) I Fax: Reconnect only 67.84 2
( ) Pump or irrigution circle 67,84 2
E - mail: Sign or outline lighting _ 67.84 2
•'•••• CON:I : ':` .: Signal circuit(s) of liillitod-enerey
Business name: ,n panel, alteration, or extension. ' Pace
c *4 ) ' `^� .0 n' � Each additional Inspection over allowable in any of the above
.
r
Address: ,. ,42 Addilianal inspection (1 hr min) 6625/ hr
l r s. - Investigation (1 hr min) 6625/ hr
City / State/ZIP; 0 f k 9 1 t o ) A Industrial plant (I hr min) 78.18/ hr _
Phone: ( , _ '2 , i Fax; �� 3UJtC — inspections specifically for which no is 90.00/ hr
'" s listed s n min)
CCB Lic.; Electrical Lic r • L ___ 11 ,,,,, Suprv. Lic.: 50.15 5 •• :.. • ELECTRICAL PERMIT - .FEES.. '.
A
-
Subtotal: ,
Suprv. Electrician signature, required: Mae , Plan review (25% of permit fee):
Print name: I I 1 J� ' I Date: e ` a� State surcharge (12 % of permit fee); 1 IS • S. TOTAL PERMIT FEE;
Aulhori7:ed signature: 7•hia permit opplication expires if a permit is not obtained in 1
dnys after it has been accepted as complete.
Print name; bate; • Number of inspections allowed per permit.
I dliuildinplpermitrti 'i.C'- Permi:App.doc 07/01 /10 440•4t0 Sf(u /OSICOMPWr•a
AUG -27 -2010 FRI 09:29 AM CHRISTENSON ELECTRIC, INC FAX NO. 95034193695 P, 02/03
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