Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
` ° 1 COMMUNITY DEVELOPMENT Permit #: ELR2010 -00221
TI G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10!20/2010
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 215
Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project: Umpqua Bank
Project Description: (1) data telecommunications
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 10/20/2010 $75.00
PORTLAND, OR 97224 12% State Surcharge - Electrical 10/20/2010 $9.00
PHONE: 503 - 624 -6300
Contractor:
STONER ELECTRIC
1904 SE OCHOCO
MILWAUKIE, OR 97222
PHONE: 503 - 462 -6500
FAX: 503 - 659 -4968
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 OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or (67-9-770 1..800.332.2344. L /
Issued By: 41�; Wes_ Permittee Signature: ail /0 (67-9-770
I v` / 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 603.639.4176 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.
Oct. 19. 2010 8:22AM S t REC , t ED No. 5076 P. 1
Electrical Permit Application OCT 19 2010 FOR OFFICE I ONLY
City of Tigard Received P en td/•
,..1- " 13I25 SW Hall Blvd.. Tigard, OR 97
N OF TIGARD �� a /O 20 /i ` i // Q� + �
' A Phone: 503.639.4171 Fax 503.5 DIVISION Dete/Ry OtherPerm'li�� /O doc2 /
1 1 t . It l 1 Inspection Line: 503.639.4175 Date Ready/fly: 7ati= ki See Page 2 for
Internet: www.tigard Notified/Method: ft, Supplemental information
2 ' g. = ,�: =. - PLAN %RE. )L' " 4:�
❑ New construction Addition/alteration /replacement Please check all That opply (submit 2 seta ofelons w /hems checked below):
❑ Service or feeder 400 amps or more In gelding over three stories.
❑ Demolition 0 Z9t her: where the available fault current LI Merin= end boatyards.
•. Tak `. link SxltUdCION ' ; > :� gdh,, o� , exceeds 10,000 amps at 150 volts or ❑>:loeding buildings.
'• lees to anmd. or exceeds 14000
gr ,❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Pyre pump. ❑ Inslallelioa of 75 kVA or
,�..' z, ;:, , t ❑ 1 e- arse stole/ dplVeds s m.
�;: B P Y Y te
- %.'Y_ - icY TE:INFORMATION ` AND L _'� ❑Addillon ❑ A ", 1?', 1 -2" 1.3"
Job no.: /u-,b ✓ 1 Job site address: 66 .$.) mpi_Atf 10011P or more. occupancy.
❑
❑Sixormomresidrntialtmila. Recrcwional vehicle parks.
City /State/Z1P / ; . 4 .,e � 97�/ CI Health-care Ilelirios. ❑ Supply voltage for more than
[ I Hazardous locations. 600 volts nominal.
� 5 - roject name: u„,rOR�,,F 1:1Serviceorfee e600ampsormore.
:: .,:.I - '"' =:'tEE SCHEDULE `a%- =:: � = :. .
Cross street/directions to job site: : u rierion 1 ::a x -- ,i J
J Derc mi. 1 pee I - , Tole/ J •
New residential single- or multi - family dwelling unit,
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. 0. or less 168.54 4
Ea. add'I 500 sq, ft. or portion 33.92 1
Tax map /parcel no.:
�;..,:::_.� ;.:_ _ �.•. .' Limited energy,rosidentisl 75.00 2
h_
ra = _Vi AESCRIPTION:1OP N.0.I �: _- (with above sq. R.)
' Limited energy, multi- family 75.00 2
v ee7T c C/.a - residentiel (with above sq. R.)
Services or feeders lnstallatlon altera lion, and/or relocation
200 amps or teas 100.70 _ 2
xr i C)i t V:OWNER ; ® c� 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200,34 2
601 amps to 1,000 amps 301.04 2
Address; Over 1.000 amps or volts 552.26 2
Temporary servlcea or feeders installation, Aherallon, and/or
City /State/ZIP: relocation
200 amps or less 59.36 1
Phone: ( ) Tax: ( ) .
201 [imps to 400 amps 125.08 f 2
Owner installation: This installation is being made on property that 1 own which is not
401 amps 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, per panel
Owner signature: Date: A. Fee for branch circuits old,
nM� above service or feeder fee,
APPL[CYj�ll : r I `CQNT(PERQN -'c'.- ',
each branch -circuit 7.42 2
Business name: 13. Pee for branch circuits ,t•itho ur
servico or trader fee, first 56.18 2
Contact name: branch circuit
- Each edd'I branch circuit 7.42 2
AddreS9: Miscellaneous (service or feeder not included)
Cll /State/zTF: Each manufactured or modular 67.84 2
dwelling. ng. service and/or feeder
~
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67,84 2
E - mail:
Sign or outline lighting 67.84 2
;.d.:,.; -_: 54 :::_, CONTRACTOR c ; i`:i; ; . :.. . signet circuit(s)orlimited-energy
Business name: STONER ELECTRIC, INC. panel, alteration, or extension. l Paget 75.00 o 2
Each additional inspection over allowable in any of the a above
Address: 1904 SE OCHOCO Additional inspection (1ltrmin) 66.25/hr
City/StatcIZIP: MILWAUKIE OR 97222 i 66.25/ hr
• Industrial plant (1 h r min) _ 78.18 / hr
Phone: ( 503 Pave: ( 503) 6 4968 Inspections for wh ich no fee is 90,00i hr
� � „ s�yceifically listed (% hr min)
44/CCB Lic.: 44823 Electrical Lie.: 26 -122C rsuprv. Lic.: 34965 _ :�. ,.. .: • ELECTRICAL P> Ri±m` zfra: =- : ='
rn ] Subtotal: [�
Suprv_)?lectrician signature, required: � 6,.e+a --.., Plan review (25% of permit fee): .
Printnorne: MICHAEL FALCONER 1 Date:ip /,9 /, State surcharge (12%of perntitfee): 9,o
Authorized signature: TOTAL PERMIT FEE: 94, 00
Title permit application expires If a permit 1s not obtained within 190
Print name: Dote days after It has been accepted as complete.
Number of inspections elf owed per permit.
tmuaainePennital.C- Pem1iupp.doc 07/01/10 44aa615T(t1ro5ICOMIW2e
Oct. 19. 2010 6:22AM Stoner Electric Croup No. 5076 P. 2
Electrical Permit .Application . City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
rRESIDENT7ALAOKyIS -- --
Pee for a 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.
COMMERG. 0NO. i*.i*:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑
Boiler Controls
[] Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ IIVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: l
*No licenses are required, Licenses ate required
for all other installations
ilivaineerodta LC- PemuN,pp.rtoe 07 /01/10