Permit v_
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
13 COMMUNITY DEVELOPMENT Permit #: ELR2009 -00300
T I G ARL) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10IO2I2009
. Parcel: 25101 DA00101
Jurisdiction: Tigard
Site address: 13190 SW 68TH PKWY 110
Subdivision: TRIANGLE CORPORATE PARK Lot: 3
Project: Business Objects
Project Description: Install restricted energy for voice /data.
Owner: FEES
PACIFIC NW PROPERTIES LIMITED PA Description Date Amount
STERN FAMILY LIMITED PARTNERSHIP &, Restricted Energy Permit 10/02/2009 $75.00
STERN, HELEN R REV TRUST, 6600 SW 105TH 12% State Surcharge - Electrical 10/02/2009 $9.00
PHONE:
Contractor:
PROCOM COMMUNICATIONS INC
2316 SE CLATSOP
PORTLAND, OR 97202
PHONE: 503 - 233 -8037
FAX: 503 - 233 -8052
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 throu h OAR 952-001-0100.
�-
0. You may obtain a copy A of / the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: w�� 1 Q � X 01 I.l v u 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. P lk pc) 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 protect.
Approved plans are required on the Job site at the time of each Inspection.
Gep 30 09 10:58a Procom Communications 5032338052 p.2
Electrical Permit ApplicatioC FOR OFFICE USE ONLY
City of Tigard SEP 3 0 2009 , A Permit No.: I Q 20OQ 4 ,0304
I - • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review • Phone: 503.639.4171 Fax: 503.598.1 OF TIGARD Date/13 ' Other Permn.0 (4y di • 4 . COO
Inspection Line: 503.639.4175 `I ^ Date Ready/By: liaM H Sec Page 2 for
TIGARD Internet: wivw.tigard or.gov BUILDIN�� G DIVISIOI_t notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /itemx checked below):
❑ New construction ® Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition El 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 14,1100 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® CornmerciaVindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Foe pump ❑ Installation of 75 KV.4 or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 1 [ 6 Job site address: 13190 SW 68 Parkway 1001 -0r or mote. occupancy.
O Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard/Oregon/97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Projixt natne: 5S'" 0 or feeder 6110 amps or mare.
nn SS 6 rhip� FEE SCHF,DULF,
Cross street/directions to job site: De-10O. 1 Qa• 1 he 1 'total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. 11. or less 145.15 I 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. 0.)
Data Cabling Limitcd energy. multi - family 75.00 2
residential (with above sq. (t.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ® TENANT 201 amps to 400 amps 106.85 2
Name: SAP 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 13190 SW 68th Over 1,000 amps or volts 454.65 2
City /State/ZIP: Tigard/OR/97223 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 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
Iln
Owner signature: utch circuits - new, alteration, or extension, per panel
Date: A. Fee for branch circuits with
® APPLICANT 1 ❑ CONTACT' PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: ProCom R. Fee for branch circuits
without service or feeder fee,
Contact name: Shawn Giles 46.85 2 branch circuit
Address: 2316 SE Clatsop Each addi branch circuit 6.65 2
Miscellaneous (service or feeder _ not included)
City /State/ZIP: Portland /OR/97202 Each manufactured or modular
90.90 2
' dwelling, service and/or feeder
Phone: (503) 233 -8037 Fax: : (503) 233 -8052 Reconnect only 66.85 2
E-mail: shawng @procomcommunications.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 1 53.40 2
Businu name: Same Signal cin ttit(s) or limited-
energy panel, alteration, or 75
Address: extension. Describe: Page 2 2
/State/ZIP: Each additional) inspection City/State/ZIP: ty peclion over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: 109929 Electrical Lic.: 3 397CLE 1 Suprv. Lic.: 1172LEA Industrial plant per hour 73.75
� ELECTRICAL PERMIT
Super. Electrician signature, required: Subtotal: 75
Print name: Shawn Giles Date: 9/30/09 Plan review (25% of permit fee):
State surcha (12% of permit fee): 9
Authorized signature: c9/ iCl C i TOTAL PERMIT FEE; 84.00
Print nam Shawn Giles TT7/// ��/` LL Date: 9/30109 This p ermit application expires if a permit is not obtained within 180
days aver It bac been accepted as complete.
• Number of inspections allowed per permit.
I^. Buildatb +Raouts\ELC-PcnaitApp.doc 05/23/06 440.4615T(tti0 /C0M/WEB