Permit CITY OF TIGARD , ELECTRICAL ENERGY
-
RESTRICTED ENERGY
I DEVELOPMENT SERVICES PERMIT #: ELR2004 -00032
„ 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 2/12/04
SITE ADDRESS: 12909 SW 68TH PKWY 250 PARCEL: 2S101AD -03200
SUBDIVISION: TIGARD OFFICE BUILDING ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
Project Description: 3rd. floor. Job #71090 Low voltage install voice /data cabling.
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: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES E C COMPANY
15350 SW SEQUOIA PKWY #300 -WMI PO BOX 10286
PORTLAND, OR 97224 PORTLAND, OR 97296
Phone: Phone: 503 - 552 - 5503
Reg #: ELE 26 -45C
LIC 49737
SUP 4040S
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/12/04 $75.00 Elea! Final
[TAX] 8% State 2/12/04 $6.00
Total $81.00
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)
246 -6699. ,
Issued by � `
''// Permittee Signature ?1 . Cf ._L{ ?
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:
CaII 639 -4175 by 7:00 P.M. for an inspection needed the next business day
• 42/E 22:04 5032205347 PAGE 02 • F lt OFFICE CiSE (ONLY
I ical Permit '
/p- -/a t No.. LA0r210 000,3 -2.
City of Tigard Pt®ming Approval Sign
Date(Bv Permit No.;
13125 SW Hall Blvd. FEB 10 20 Plan Review Other
Tigard, Oregon 97223 Rp Datc/Bv: Permit No.:
Phone: 503 - 639 -4171 Fax: 503- 1T1 T Post - Review Land Use
Pbo ; Datc/By: Case No.:
Internet: www.ci.tigard.or.us BUIL G i •;
g �� r,' Contact Jens.: ® See Pa 2 for
24-hour Inspection Request: 503-639-4175 - Name/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW lease check all that a
New construction Demolition service over 225 amps- Health-care facility
commercial 0 Hazardous location
Addition/alteration/replacement Other: Q Service over 320 amps- rating of 0 Building over 10,000 square feet,
• • CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
1 & 2- Family dwelling _ ommerciaVIndustxial ❑ System over 600 voles nomin
�d one structure
0 Building over three stories ❑ Feeders, 400 amps or more
Access° Buildin Multi-Family ❑ Occupant load over 99 persons Cl Manufactured structures or RV park
Master Builder Other: ❑ Egress/lighting plan 0 Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 13 ( No a% S 1 C . - • - FEE* SCHEDULE
Suite #: \ - Bld_. /A•t. #: Number of inspections per permit allowed
N $1 nr C Description Qty Fee (ea.) Total
Project Name: Ar,e r issY 4'^ • �� C New resideutlal- single or multi - family per
Cross street/Directions to job site: dwelling unit Includes *flatbed garage.
Service included:
1000 sq. ft. or less — 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy. residential 75.00
Subdivision: I Lot #: Limited energy, non residential 75.00
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90
Services or feeders - Installation,
"t N -S k CA\v4T , u ,A oil \ c. / 14 t alterattoa or relocation:
` 200 amps or less 80.30
C b c 201 amps to 400 amps 106.85
401 amps to 600 amps 160.60 .
ROPERTY-- OWNER L[JTENANT - 601 amps to 1000 sm�s _ 240.60 •
Over 1000 amps or volts 454.65
N — Reconnect only 66
Address: Temporary services or feeders - installation,
alteration. or relocation:
City /State/Zip: 200 amps or less 66.85
201 amps [0 400 amps 100.30 Phone: Fax:
- 401 to 600 amps 133.75 •
n APPLICANT _ 0 CONTACT PERSON — Branch circuits - new, alteration, or
Name: emotion per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee. each branch circuit 6,65 •
City /State/Zip: B. Fee for branch circuits without purchase of
service or feeder fee. Oust branch circuit 46.85 -
Phone: 1 Fax: _ Each additional branch circuit 6.65
rfisc.(Service or feeder not included):
E -mail: - E 53.
ach or irri L ion circle
CONTRACTOR Each sign or outline lighting 53.40 ,
Job No: °1 1 G C1 0 _ Signal circuits) or a limited energy panel,
alteration, or extension 1 Page 2
Business Naive: C C C a ■n+ iff _ Description:
Address: po Q0 \t,.414 O Rro '"eAefov*-.w.-■., cr3k-i•-PJ _
Each additional inspection over the allowable In any of the above:
Ci /State /Zi e : 9 \ , 0 R ex, ' at Per inspectionj,er hour (min. 1 hour) 62.50 ,
Phone: as 0 - S ` Fax: Q 0 1 S - S 01 Z tnvea iga
ttion fee: -_
CCB Lic. #: yg111! Lic - : - G.• y 5 C.
-
El ectrical Permit Fees*
Supervising electricia'� subtotal $ 9 S .. O
signature required: A Y,: a ., V ` r 1 Plan Review (25% of Permit Fee) $ —
Print Name: 6:s16,. • 4, r Lic. #: \V, 9'0,T State Surcharge (8% of Permit Fee) $ C - C"
TOTAL PERMIT FEE $ oO
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: - Date: 180 days after it has been accepted as complete.
•Fee methodology set by Trl- County Building Industry Service Board.
(Please print name) ,
i:\Dsts\Petrnit Form s\ElePermitApp.doc 01/03