Permit •
--- is, 'C. CITY OF T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00114
T I G n R D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/13/2008
PARCEL: 2 S 113AA -00500
SITE ADDRESS: 16100 SW 72ND AVE B18 ZONING: I -
SUBDIVISION: OREGON BUSINESS PARK I LOT: OOA JURISDICTION: TIG
PROJECT: PAYLESS
Project Description: Installing (1) low voltage data system.
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 APPLIED TECHNICAL SYSTEMS INC
15350 SW SEQUOIA PKWY #300 -WMI 6024 SW JEAN RD
PORTLAND, OR 97224 STE E -200
LAKE OSWEGO, OR 97035
Phone: Contact #: PRI 503- 684 -9611
FAX 503 -598 -0498
FEES Reg #: ELE 2 -71CLE
LIC 89511
Description Date Amount SUP 2997LEA
[ELPRMT] ELR Permit 5/13/2008 $75.00
[TAX] 12% State Surch 5/13/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 or 1.800.332.2344.
Issued By: ermittee Signature: .� 1 9
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:
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.
t' 'FROM (mom) MAY 12 2008 14: 58/ST.14: 59/No.7500000828 P 2
17ec rica's.Yernlit Application Hill 011 1( I.: 1.s1: 0\1.1
City of Tigard 1 FEERWrij at - , Permit No.: ,:Ai U - c% I 1
13125 SW Hall Blvd., Tigard, OR 97221- - 1/ , .
Phone: 503.639.4171 Fax: 503.598. 1960 i -. .. (. Other Permit!
I i c A n r> Inspection Line: 503,639.4175 time Ready /fly; Jura: Elf See Page 2 fur
Interact: www•tigard- or.gov Notified/Method: Supplemental information
ti,
1t1 .4� -! r ,, q 1 `; ^°• i } , iq •umnpe+oea� f n ���� +� 1 t t T• :'r ' , f n mr
q ,, t .. ( , i . , r 'p�q A < . OT,-, . (: 1 t i r l ':, f r, r,rr r,,,n,-r,,,.,�.,.
tl -b�is! •i�:�jl3; 1iSt�21117itp °� �iIMtII d.dulJilYf }1u�{I 1,11,.1' -... !,•6,n�111 �t`_.V�!_'f] - - �[i ';I r',1.(.. i..Vt1:r 1 •n IIthI @Ililr_- 1'v:§0
❑ Ncw construction (81 Addition /alteration/replacement Please check all thnt apply (submit 2 sets of plans w /items checked below):
0 Service or feeder 400 amps or mule ❑ Building aver three Murky..
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
fib 11r l:t1v -'1 3 -i '
r" ,`t�1t�lriTj rifir a ' •` 17;1 � : (M1� ",t•p . ma y i 17tr i� . i 1 + l is : r ,�{ , �iplli�R��'I'fr�'� 1 exceeds 10,000 amps at 150 volts or ❑ Floating builds
less t0
pound, or exceeds 14,000 ❑ Commercial-use agricultural
❑ I- and 2-family dwelling IN Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
O Multi- family ❑ Master builder ❑ Other: ❑ Firc pump. Q htslallarion of 75 KVA or
.' '1t• •�tli l''i;'ti
i' ?` 'Ii'iiil„ifl't " 5+'+'ntwtar'; no,rn;a a!r.VUS y71 e•n• •r
1�1``1�f��t� I t , I) 1 f nQ r +"t` ni;; yry7n:•y.�m ,s 5' - ; t s,;.,•,,(.1�� • t� �t{ 5ili ❑ Emergency fysre,n, larger separately derived system.
, 1„n."t,i1f1a9::.' t,•'.W.I' ' !" � �l�Oti41u: ”4:- .t•».G;Fr 11 i! avlF :� a
'' I� hl iY Wt, ❑ Addition of new motor load of
+ •.�t.t'!�.ti•.I+t•S+x.d:PAi °.1 edtlM.,�t!igi dS..y,.t
Job no,: Job site address 16100 SW 72nd 100111) or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / Statc/ZIP: Tigard/Oregon/97223 ❑ Health -ism lbcilities, ❑ Supply voltage for more than
0 Harardous locations. 600 volts nominal.
Suitc/bldgJapt. no.: I Project name: Payless Drugs ❑ Service or feeder600 amps or more. q 1r
111,:1 i�, 1 +1�+' ; A r;} t!u:ur . u;t a2M.ti` J n'J� 1 a I 11..7 Yl11EI isf'I :;iV:t',' ?r
Cross street/dire ctions to job site: - oacmition « sR, r°tit •
- New residential Burgle or multi - family dwelling milt.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. R. or portion 33,40 1
1 / : 7 '( p limited energy, residential
NI,V:112 l NO '''ff,J,,lbt �, i i 'l r ?" <qIW?,°" `+'Yli�flEr 7 5,. 114,•.,, t•
#1 (with above
+'t 1 �lp tt J I I .1'1y1 l "i r 'i ' . s f�li ! l u , ' m. n.) 2
K4- �MfMNIWtW MIfAR! O�: �liLl'._>r, l�111 .. '
Limited entry, multi - family
Data low voltage cabling residential (with shove sq. ti,) 75.00 2
Services or feeders Installation and/or relocation
200 amps or less 80.30 2
106.
11E41111.'''' n;ra:., D'{quhM?0+ J`1 gin }�� xw»- ,•y'wS+:l:u: a'� !ri•n•,•prrl
MST � r ... ' 1 l ti n , t:4yl r t t vV Ville'• ;j . till t• 0 unIP 2
�I�YMq.wrY..t. .. �. Y '..�lll:l�'n111..t,.1!t'.Y7'l.� VU ,uGeC�i ' `'JY�alWi4�.�r4 201 amps to 40
Name: Patine Realty Associates 401 amps to 600 amps 160.60 2
Address: 15350 SW Sequoia Pkwy #300 - WMI Ov er 1, 1, amps 0000 mops to
Over amps 240.60 2
or volts 454.65 2
City / State/ZIP: Portland, OR 97224 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.115 I
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intcndcd for sale. lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date:
Branch circuits — new, alteration, or extension, per panel
} r; lr,��°I ;l. -.q, yin(tY•, ; •r;t.y Jl .', , mt; p a n ry n :•�1 1 •!r { eq� r {�nt( sy�;,yus: q ..tu spirt r r �y A. Fee for branch circuits with
1- 3 `,' Nlilfi lr t!1�i �, r 4 a: 1 /2 1 ' liU 7 ' ;I l t >< 3 i ' C�sti gr a .�;i, l i":? i t M 't :'•tee i l i; above service or fccdcr foe, 6,65 2
Business name: each branch circuit
B. Fee for branch circuits
without service or feeder fee,
Contact name: first branch circuit 4 6,85 2
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: /StatrJGIP: Miscellaneous (service or feeder not Included)
Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phonc: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
M , ,yl n ^ .,ligtt• f �� Y. r
�l;>'�If�]?r�+_>v!1:�i:: Breast n ::><:�_�i��tli ?iCQ�#�il c a:11' it {(�,'�',�,i }l�l Sign or txrtlinc lighting 53.40 2
Business name: Applied Technical Systems Signal circuit(s) or limited-
mew panel, alteration, or
Address: 6024 SW Jean Rd suite E -200. extension. l r I Pagc 2 2
City/State/ZIP: Lake Oswego, OR 97035 Each additional 'ovation over allowable in any of the ahnve
Per inspection 62.50
Phone: (503) 684.9611 Fax: (503) 598.0498
Investigation per hour (1 hr min) 62.50
CCB Lic.. 89511 1 Electrical Lie.: 2 -7ICLE J Suprv. Lie.: 1474LEA Industrial plantperhour 73.75
e .t .�;l?rtlk1'.lY lr`S"5 il• µ! N .:.:Snit .!'!•i'I- r:u::)ti�.Elib n', / ' iL t41}r U,
Suprv. Electrician signature, required: C�'t^� Subtotal: 75.00
Print name: Richard Olney Date: 5/12/08 Plan review (25% of p ermit fee):
' �J State surcharge (12% of permit fee): 9.00
Authorized signature: ( 4/0,4, a v C ags•-4 TOTAL PERMIT FEE: 84,00
Print name: � < *4,a 0 LM� I D 5 /12/08
This permit days enter b has beta las permit b not obtained accepted as complctc. within NO
pt.
• Number of inspections allowed per permit
I:\ Buildiaae rrnitsl6LC- PennitApp.doc 05/23N6 44046157(11 /05 /COM/WLB
CITY O.FTIGARD
BUILDING DIVISION PERMIT #: ELR2008.00114
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/13/2000
Phone: (503) 639-4171 1 g�I�i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/28/2008 TIME: 7:OOAM PAGE: 55
SITE ADDRESS: 16100 SW 72ND AVE 818 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: OOA TYPE OF USE:
PROJECT NAME: PAYLESS
DESCRIPTION: Installing (1) low voltage data system.
OWNER: PACIFIC REALTY ASSOCIATES. PHONE #:
CONTRACTOR: APPLIED TECHNICAL SYSTEMS INC PHONE #: 503-684-9611
Inspection Request Scheduled For: Date: 5/28/2008 Pour Time:
Code # Inspection Description rim # Contact # Message
135 Low voltage 070391 -01 503705 -6216 N
Corrections /Comments /Instructions:
(\
\.X1
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G ---, N Ve Date: 6 b Phone #: (503) 718 - L 17