Permit i
.• --
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
. 0 q COMMUNITY DEVELOPMENT
'- Permit #: ELR2009-00256
.TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/03/2009
. Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16505 SW 72ND AVE
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Liberty Mutual
Project Description: Data telecommunications (on 1st floor).
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 08/03/2009 $75.00
#300 12% State Surcharge - Electrical 08/03/2009 $9.00
PHONE:
Contractor:
AZIMUTH COMMUNICATIONS INC
P.O. BOX 508
WILSONVILLE, OR 97070
PHONE: 503 - 639 -0110
FAX: 503- 639 -0115
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 R 952- 001 -010 . You may obtain a copy of the rules or direct questions to OUNC by calling 50.6 99 or 1.8 332.2344.
il,
Issued By Permittee Signature: I ( L ? J La
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 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 Application RECEIVED FOR OFFICE USE oNLI'
/ City of Tigard Received
Date/By: 9 Permit No.SW00 9 - Do 6
13125 S W Hall Blvd., Tigard, OR 97223 q U G 0 3.2100' Plan Revie
IS Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
r i C. n It D Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov BLIP nINGJltvtstON Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction I■/ Addition/alteration/replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 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 XCommercial /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. A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: ( 65.05 S 1 z. L � 1001 or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: p ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I F(,L,1- Project name: /�a�C' /tl� 4� ❑ Service or feeder 600 amps or more.
J FEE SCHEDULE
Cross street/directions to job site: Description I Qh'• 1 Fee. I 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
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. ft.)
«I
Limited energy, multi - family 75.00 2
VO DAB 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: 1 Bear/ y o u -- h (__ 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 Tess 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
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: AZ1 (y1 TE.4 Cpmivtu 0 t CAll O1'0 B. Fee for branch circuits
without service or feeder fee,
Contact name: 46.85 2
�j (A L81 G first branch circuit
Address: f o , &)x s-(r Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Li) \ L_S U N J(Lt,` Q _ 4 17 07b Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (50 3) X3 9 Fax: : ( S/) 3) 6 3 q . / S _ Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: A 2A/MW.. (a ,( tit 44 L & 1. C44TLCMJS Signal p a ne l, a er or t limited- o or
h 1'� �� energy panel, alteration, or
Address: Y U , czo Sa S extension. Describe: i Page 2 2
City/State /ZIP: Y L LSQ dl. L L& d Q q.707 6 Each additional inspection over allowable in any of the above
Per
Phone: ( 3 -coo (/ o Fax: S D ?) 637 O tic Investigation inspection
��3 ) rp on 62.50
per hour (1 hr min) 62.50
CCB Lic.: 1 15ez F3 Electrical Lic.: 6 -cl 4 C(e Suprv. Lic.: ;7.31 g (..--p Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / Subtotal: 75 0 Z)
Print name: ) c
4/ L G Date: gl 3 I pc? Plan review (25% of permit fee):
�� State surcharge (12% of permit fee): 9 , 0
Authorized signature: TOTAL PERMIT FEE: i � /
Print name: Date: This permit application expires if a permit is not obta within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building 'Permits\ELC- PermitApp.doc 05/23/06 440- 46!5T(1l/05 /COM/WEB
Electrical Permit Application - City of Tigard -
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
g Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC
❑ Instrumentation
_ ❑ Intercom and Paging Systems
❑. Landscape Irrigation Control*
❑ Medical
El Nurse Calls •
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: —1
*No. licenses are required. Licenses are required
for all other installations
I:\ Building \Permils\ELC- PermitApp.doc 03/23/06