Permit IN CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR2010 00185
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/15/2010
Parcel: 2S113AC00102
Jurisdiction: TIGARD
Site address: 7250 SW DURHAM RD, BLDG# J
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Stash Tea
Project Description: Data telecommunications system.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 09/15/2010 $75.00
PORTLAND, OR 97224 12% State Surcharge - Electrical 09/15/2010 $9.00
PHONE: 503 -624 -6300
Contractor:
XTREME COMMUNICATIONS, INC.
24023 NE SHEA LANE, #215
WOOD VILLAGE, OR 97060
PHONE: 503 - 618 -8816
FAX: 503 - 618 -9985
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 thr - 952- 001 -0100. You ma obtain a c or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
`
Issued By ! . 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' 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.
09/14/2010 08:32 5036189985 PAGE 01/02
Electrical Permit ADDlication16,CE DE — 1 011.1(4: lisE ONI.'
City of Tigard
c, c P 1 4 71‘ d
°' Receive
Drite/B ; ill Ifa
13125 SW Hall Blvd., Tigard, OR 97223 0 L . Plan Reviosv
• Phone: 503.639.4171 Fax; 503.598.1960 ; , I .) ..- cx,
, NV ,1:1xtetB Other Permit • , i
;
nspecton Line: .. la See Pag
i i(;Aiz.t) I i Li 5036394175 e 2 for
Intern Cir i ° s r GDINISI ° ' 8.
e; svviwtigard-or,p,nv Supplemental Infonnation
..:.,' :...;:-...:....:: , ... :.:.'.....i.,....:::....1.::',..„.., ;'
0 New construction pAddition/alterati Mean check all that apply (submit/ tea of plans Whams e below):
O Set:vice or Reda 400 amps or more i:113iiilding 'over three Stories.
[3 Demolition E1 Other: where the stvailnbla frtalt current 0 Marinas ami bOatyards,
:..'.: ,: : ; ;',:,.:: 1 :;: : .::...iS:,. ,7.:?"..: ...:::;.!:.....: exceeds 100(10 Atnot Rt 150 *dig or 0 Floating buildings,
loss to 'mound, or exceeds 14,000 o Commercial-use agricultural
El 1- and 2-family dwelling Rt Commercial/industrial 12 Accessory building amps for all other installatione. buildings, .
.0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
0 tmergeney mystem larger separately derived system.
. :'''''''' -:'. • s'''''.. '...Ai'ditYttritkittikstkliast:AtiliAttiettON... .•.:, ....s ....,'':::::,. . ' 0 "A", "r, "1.2". "1-1",
100HP or moro. occupancy.
Job no.: .1.i 2.1# Job site address: . 7 - 12..iiv Dtir Rd .
a Six,or mar* residential wits. Cl Recreational vehicle parks.
City/State/ZIP: -7-1.,;,,,,_ 0 Wealth-care fhcilitics. 0 Supply volmgo for mom than
O 14c..arclrms location& 600 volts nominal.
.■---•
Suitc/bIdg./apt no.: Project name: offigik fel 0 Service or feeder 600 amps or more.
.:.,.,......, ,":...•...,.i .:...;......• . .;;FEEACIIIIIIMEZ...:.!:.:
Cross street/directions to job site: otit;e ,
rtien 1 QM 1 Fes. .'- I. Totd L: ....
.
New residential Single- nr multi-family dwelling unit.
Includes attached gunge.
Subdivision: I Lot no.; 1.000 sq. ft. or less 168.54 4
Ea, addi 500 sq. ft. or portion 33.92 1
Tax map/parccl no.: Limited energy, reaidential 75.00 2
.....::,.....!-:.., . f...:..h..:::,.....:...:::, : (with above sq. ft.)
. „ . • Limited energy, multi-flimily
75.00
VOIc4 Leriale? celobl 1847 residentiM (with above sq. it.) - 2
— Services or feeders installation and/or relocation
200 amps or ices 100.70 2
• • . • -
01.PitOkER:11'..014Elli • .: : •'•!•........ ..... . :. . , ..0 ItNANT ..... , ., ... 201 mp s to 400am 133,56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to l,000 amps 301,04 2
Address: Over 1,000 amps or volts _ 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 201 amps to 400 amps 125.08 2
1 own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rcnt, or exchange, according to ORS 447. 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fco for branch circuits with
. ,...: : , :l.,:' ...... !.-;;',.... ::.:. MI ... tirifkiiitAtirt . ,.:.i.• . ...is : :: .,''.:. 4 ::...*! • : • .121" . 00istitAtt ItitSdisr.....-:::::; a (* fee 742 2
ranen circuit
Business name: 13, Fcc for branch circuits without
service or (ceder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit - 7.42 2 • Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 67,84 2
dwelling, service and/or feeder
—
Phone: ( ) 1 Fax: : ( ) Recormcct only 67.84 2
Pump Or irrigsltiOn &de 67.84 2
E-mail:
. . Sign or outline lighting 67.84 2
• :.:, 1 , ..:.....'..?,: ....'. ..1 ii.'.... .. :;•:.',: '.:.': ; • - . . • : • : .' • :.... • . . 7 ;.' • '. ; .•:: • • ' . :...+;: '.- Signal eiteuit(s) or limited
Business name: a
panel, alteration, or exten I sion. Page 2 7 5.7154- 2
____Z e za
(4 c te_9,...aC. Each additional inspection over allowable in any of the above
Address: Ztft, 7...f fl e Ihm Lane of z.v.s- Additional inspection (I hr min) 6625/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: id v ai L ve.. 6 ia ,_ q
,.. industrial plant (1 hr min) 78.18/hr
Phone: (4b3 ) 4Ift Fax: ( 5o3) i_fLil s' Inspretiona for which no fee is 90.00/ hr
- specifically listed CA hr min)
C . CB T,ic.: i I 240 y Elcctrical Lic.. _ . 5- , Suprv. Li • -..":- ? . ....*, :
.411C. r H
I Subtotal: 76 °-
Suprv. Electrician signature, recluircd: OSIF - , ._.1
4 Wan review (25% of permit fee);
Print name: &) ( frair
Date: ,- /4. 2.40/0 State surcharge (12% of pennit fee):
TOTAL PERMIT FEE:
Authorized signature:
This Permit tiPPEemine expirm if s permit is not obtained within 180
days after it hwi been seeeptett ss vompietr
- .
Print name: Datc; • Number of hdpectirmm allowed per permit.
.. —
1.1131ilding\ Permiunia-C-aismitArip,doc 07/01/10 440.4615TO IMSMOM/WED