Permit a CITY OF TIGARD
Ili
ELECTRICAL RESTRICTED ENERGY PERMIT
°. ` COMMUNITY DEVELOPMENT PERMIT #: ELR2009 -00003
T I G A R D DATE ISSUED: 1 /5/2009
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S113AA -00400
SITE ADDRESS: 16260 SW 72ND AVE B2 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT: 018 JURISDICTION: TIG
PROJECT: AMSOIL
Project Description: Install low voltage for data.
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 STEELHEAD TECHNOLOGIES INC
15350 SW SEQUOIA PKWY #300 -WMI 11600 SE HAWTHORNE ST
PORTLAND, OR 97224 PORTLAND, OR 97216
Phone: Contact #: PRI 503- 255 -0364
FAX 503- 255 -3947
FEES Reg #: ELE CLE142
LIC 181413
Description Date Amount
[ELPRMT] ELR Permit 1/5/2009 $75.00
[TAX] 12% State Surcha; 1/5/2009 $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 Or- • on Utility Notification Center.
Those - are s- • h in O • : 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these ru - s o` -tired questions to OUNC at
503.2• •.6699 or 1.800. 2344.
Issu - • By: i, _ 1_,,,. , i Permittee Signature: "AL. , / A U j
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.
r'E1t etrical Permit APplicatirECE,INTD roll OFFICE. USU (:► N L
Received
City of Tigard Z 009 Da B : 0 ( p - Permit No.: 1 , y i n 40•40 AI
° 13125 SW Hall Blvd., Tigard, OR 97223 i),\ O 6 Plan Review
C . Phone: 503.639.4171 Fax: 503.598.1960 � Date/B : Other Permit:
1, 1 G `ii 1) Inspection Line: 503.639.4175 O �i TIG n" " Date Ready /By: B1 See Page 2 for
Internet: www.tigard-or.gov t` C � l' j [' , � � � G 1 , / ON / Notified/Method: Supplemental Information
TYPE OF AV PLAN REVIEW
N ew 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ o n Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: l6 26 0 Q J n -' 1001{P or more. occupancy.
1 / V �) L ! ❑ Six or more residential units. ❑ Recreational vehicle parks.
77:144 City/State/ZIP: �Z ❑ Healt -ca re facilities. ❑ Supply voltage for more than
/q f 9 ryL �/
/ V'_ G / ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: /j)s Q i L ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 6 W peep.'-y Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'15,00 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
) Limited energy, multi - family
� ^
.l „bk. ) p frio-roe n e 5 residential (with above sq. ft.) 75.00 2
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: ( ) I Fax: ( ) 200 amps or less 66.85 I
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
Branch circuits — new, alteration, or extension, per 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'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) 1 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: S le e.` Ef e6. feel.) n 0 1 0 c, es Signal panel, or alteration, limited-
energy p alteration, or
Address: /7( 0 Sc 5/ r extensions, cab Page2 5' 2
City/ State/ZIP: G !` 7 j f aa)7Iflo,f4Je
V [ 2 Each additional inspection over allowable in any of the above
C Per inspection 62.50
Phone: ( 0'2.J i O 3 6 (. f Fax: 5 ) s -34(47-- Investigation per hour (1 hr min) 62.50
CCB Lic.: I L/ I Electrical Lic.: [E 1y� z. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: a_ . _ Subtotal:
Print name: )( Date: f ` S d Plan review (25% of permit fee): 7 '
n State surcharge (12% of permit fee): / •"'
Authorized signature: TOTAL PERMIT FEE: 8. C/, oU
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.
C\ Building \ Permits\ELC- PermitApp.doc 05/23/06 440-4615T(Il /05 /COMM1VEB
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELR 2009- 00003
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1p.:42009
Phone: (503) 639-4171 i-ff31111
Inspection Requests (24 Hrs.): (503) 639-4175 ;44,41-•
INSPECTION WORKSHEET FOR DATE: 1/7/2009 TIME: 7 PAGE: 36
SITE ADDRESS: 16260 SW 72ND AVE 32 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 010 TYPE OF USE:
PROJECT NAME: AMSOIL
DESCRIPTION: Install low voltage for data.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: STEFLHEAD TECHNOLOGIES INC - YNA _ PHONE #: 503-255-0364
Inspection Request Scheduled For: Date: 1/7/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 079431-01 503-761-2510 Y
\Mi gA
Corrections/Commen s/Instructions:
PASS PARTIAL APPROVAL El CANCEL El NO ACCESS
7 FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: N6Q)t_ Date: Phone #: (503) 718-
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee forall residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
p Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
p 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
❑
Cbck 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
1:\ Building \Permits \ELC- PermitApp.doc 03/23/06