Permit a h• CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
at,r�
' DEVELOPMENT SERVICES
PERMIT #: ELR2006 -00165
�I �! DATE ISSUED: 7/11/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 101 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 410 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE CENTER LOT: JURISDICTION: TIG
Project Description: Voice /data
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPEIIRRIGAT:
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 STEELHEAD TECHNOLOGIES INC
15350 SW SEQUOIA PKWY #300 -WMI 1520 NW 6TH CT
PORTLAND, OR 97224 GRESHAM, OR 97030
Phone: 503- 624 -6300 Contact #: PRI 503- 492 -2119
FAX 503- 492 -6265
FEES Reg #: ELE 26- 1205CLE
LIC 159346
Description Date Amount
[ELPRMT] ELR Permit 7/11/2006 $75.00
[TAX] 8% State Surcha 7/11/2006 - $6.00 REQUIRED ITEMS AND REPORTS
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 r s adopted by the 6 regon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. Yo ay o-•' ain copies -f these
rules or direct questions to OUNC at 503- 46 -6699. f
Issued By: Permittee Signatur �� � '
OWNER INSTALLATION ONL
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 Permit Applicille. CEIVED r()lt o1:F1Cl.: (iSL:ON1..Y
City of Tigard Received Date/By. i /, /06,, AP, PennitNo � 096 _ /b 13125 SW Hall Blvd, Tigard, OR 9 I ''t 1 1 2006 Plan Review�
C Phone: 503.639.4171 Fax: 503.5' 8.1'60 Dffie/By. Other Permit:
T i G n I.1 Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By. Suns M See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method V I Supplemental Information
E OF WORK PLAN R EW
❑ 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.
CATEGO,Y OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
� less to ground, or exceeds 14,000 ❑ Commerdal -use agricultural
12 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire lump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", E ", "1 - ", "l - ",
Job no.: Job site address: t Z q o a $w l h - ft t �/ 100HP or more. occupancy.
❑
D ❑ Six or more residential units. Recreational vehide parks.
City/State/ZIP: -3 a (e l Q 2 3 ❑ Health-care aa dulocations. ❑ Supply voltage for more than
❑Hzros locations. 600 volts nominal.
0 .ldg. /apt. no.: 11/ n Project nameyliai , el a 1 -1---, a , ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 (NY. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax / arcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
P P Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Vo C
t � Da-i-.&_ ' Limited energy, multi - family 75.00 2
/� q , .i Cl residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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, Rer panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
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
Business name: 1 Signal circuit(s) or limited -
C p l k c a fin de h No\0Q � e 5 energy panel, alteration, or
Address: ' S N ( Q C \ f f I / C extension. De Page 2 2
City/State/ZIP: 6 r c5 o f "7030 Each additional inspection over allowable in any of the above
Per inspection • 62.50
Phone: 3) lo - 7 5.-ii D TFax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.. Lic.:, Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 1 I 4 - Subtotal: -7!,
Plan review (25% of permit fee):
Print na �/a rk i / D Da t e : � � - a State surcharge (8% of permit fee): G
V TOTA Authorized signature:
L PERMIT FEE: ,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Pamits\ELC- PamitApp.doc 05/23 /06 4404615T(I I /05 /COM/WtB
1
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
( RESIDENTIAL WORK ONLY — __-------------- - - - - -_ 1
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- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ 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 \Pamits\ELC- PemitApp.doc 0323106
CITY OF TIGARD - -•
BUILDING DIVISION PERMIT #: ELR2006 -00165
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7!1112006
Phone: (503) 639 -4171 , a , ° n ` 1
Inspection Requests (24 Hrs.): (503) 639 -4175 -'. __ I
INSPECTION WORKSHEET FOR DATE: 7/1812006 TIME: 7:03AM PAGE: 61
SITE ADDRESS: 12909 SW 68TH PKWY 410 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: NATIONAL TITLE
DESCRIPTION: Voice/data
OWNER: PACIFIC REALTY ASSOCIATES PHONE #: 50362.46300
CONTRACTOR: STEELHEAD TECHNOLOGIES INC PHONE #: 503 -492 "2119
Inspection Request Scheduled For: Date: 7/18/2006 Pour Time:
- # Inspection Description emir Contact # Message
Low voltage 033219.01 503. 260 -6897 N
all
Co - o
- mmentS/ Instructions:
cl___ ____ .
cm k
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A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V /J Date:1 I S ii (A Phone #: (503) 718-2A46 •