Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00147
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/17/2007
PARCEL: 2 S 113AA -01000
SITE ADDRESS: 16570 SW 72ND AVE B9 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT: 00C JURISDICTION: TIG
PROJECT: SERVICE MASTERS
Project Description: Data /telecommunications.
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 TELEDIGIT INC
15350 SW SEQUOIA PKWY #300 -WMI PO BOX 22287
PORTLAND, OR 97224 PORTLAND, OR 97269
Phone: Contact #: PRI 503- 722 -8084
FAX 503- 722 -9914
Reg #: ELE 3- 414CLE
FEES LIC 116188
Description Date Amount
[ELPRMT] ELR Permit 5/17/2007 $75.00
[TAX] 8% State Surcha 5/17/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
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.
r
Issued By: 'CC
U , y Permittee Signature: �'��
I
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: , Kar14 l' eft), DATE: S/J /0
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.
, Electrical Permit Application • FOR OFFICE USE.ONLY
Received
City of Tigard Date/By: Permit No.:
i ;, a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
7- 1 i D Inspection Line: 503.639.4175 Date Ready /By: Juris. ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New 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 Commercial /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.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: 1Q S 7 ,e ' W i a hd ewe 100HP or more. occupancy.
• ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: p D R q 1 e)' y ❑ Health -care facilities. ❑ Supply voltage for more than
t ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: S Pi/ v L e ✓ agi,tr ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 5 1n) 1 era a ve tf 5 1W Description 1 Qty. I Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
D Ur k 4 rr R-b.. Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 145.15 4
Ea. add'l 500 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 75.00 2
• T�s 1 1 j 8 1) 6,1 a- c 'Lt (i - r "Q
ACS ' Lk residential (with above sq. ft.) _
e Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ii4 TENANT 201 amps to 400 amps 106.85 2
•
t 401 amps to 600 amps 1 60.60 2
Name: Se yl ✓haS�4C yy 601 amps to 1,000 amps 240.60 2
Address: NS s W c7 n U O► we .. Over 1,000 amps or volts 454.65 2
City/State /ZIP: po r iA a ,,�, 1 0 ,. q? aa4 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (S' 03 ) 6 .9 - (O !HS Fax: (x"03) S4 $ 48 (q 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
la APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Tc, 1 e1, .' j 3 vtL. B. Fee for branch circuits
(/ `' without service or feeder fee, 46.85 2
Contact name: DA n i e,1 V A (1 erS first branch circuit
Address: ' t l / 1 t Each add'I branch circuit 6.65 2
• Miscellaneous (service or feeder not included)
City/State /ZIP: P0 , Bo x a$ata1 Pori - 64 0 g .11 a (49 Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: ( 26 ) 1) (3oe 9 Fax:: (563 ) Sit 2 19605 Reconnect only 66.85 2
E -mail: ie -' 1 c t a .4 e 1 e 4.4* f t AL • (p w. Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
T i? t a l t i r C •
energy panel, alteration, or 7
extension. Describe: / Page 2 2
Address: P. o, IS 0 as a (61
City/State /ZIP: P 0 rk ‘„,4 0 A. 41a-4°1 Each additional inspection over allowable in any of the above
Per inspection 62.50
/ Phone: (5 ) 7 ? 3. `t7 0 $N Fax: (r ) Si $ 11 (p QS Investigation per hour (1 hr min) 62.50
7 �• CCB Lic.: 11( itq Electrical Lic.: 3' u l t{ (4. Suprv. Lic.: (19' ' (. E Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Olt Q rs v . ) V a l l P OS Subtotal: 7.5 0
Plan review (25% of permit fee):
Print name: rn An n UQ I I J b S Date: 5/11 /07 State surcharge (8% of permit fee):
Authorized signature: _T 04 a v i IA s TOTAL PERMIT FEE: ?/, o -z)
Y J — This permit application expires if a permit is not obtained within 180
Print name: /1 n J U411 C) o S Date: 5%7 1 • Number of inspections allowed per permit.
1: U3uildingd'ermitstELC- PermitApp.doc 05/23 /06 440- 4615T(11 /05/COANWEB ,/
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*
0 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
O Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
O Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
O Medical
❑ Nurse Calls
0 Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: /
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
•
CITY OF TIGARD - -
BUILDING DIVISION - = • PERMIT #: ELR2007 -00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/17/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/7 /2007 TIME: 7:03AM PAGE: 59
SITE ADDRESS: 16 570 SW 72ND AVE B9 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK 1 LOT #: OOC TYPE OF USE:
PROJECT NAME: SERVICE MASTERS
DESCRIPTION: Data/telecommunications.
OWNER: PACIFIC REALTY ASSOCIATES. PHONE #:
CONTRACTOR: TELEDIGIT INC PHONE #: 503- 722 -8084
Inspection Request Scheduled For: • Date: 8/7 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 053494 -01 503 - 830-8745 Y
Corrections /Comments /Instructions:
lo PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: UV (S8 Date: 0' 1 .O Phone #: (503) 718- /VA
CITY OFTIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/17/2007
Phone: (503) 639 -4171 47/
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/24/2007 TIME: 7:OOAM PAGE: 40
SITE ADDRESS: 16570 SW 72ND AVE B9 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: OOC TYPE OF USE:
PROJECT NAME: SERVICE MASTERS
DESCRIPTION: Data/telecommunications.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: TELEDIGIT INC PHONE #: 503
Inspection Request Scheduled For: Date: 7/24/2007 Pour Time:
Code # Inspection Description �C # Contact # Message
135 Low voltage 52591 -01 503- 830 -8745 N
Corrections /Comments/ Instructions:
Abt;11 itJ 6 eaTZ_,TIGN.)
v■► t r `V' • S l`1
�opi + ts ( b QZ,
I. 6- to
62 �
❑ PASS XPARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: W 0 6 Date: ) ` Zi( 6) Phone #: (503) 718 - b
CITY OF TIGARD `
BUILDING DIVISION PERMIT #: ELR2007 -00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/17 /2007
Phone: (503) 639-4171 III
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/20/2007 TIME: 7:03AM PAGE: 70
SITE ADDRESS: 16570 SW 72ND AVE B9 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: OOC TYPE OF USE:
PROJECT NAME: SERVICE MASTERS
DESCRIPTION: Data/telecommunications.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: TELEDIGIT INC PHONE #: 503 -722 -8084
Inspection Request Scheduled For: Date: 7/20/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 052386 -01 503 - 722 -8084 N
Corrections /Comments /Instructions:
i 0 e (I- ( (5./-
i. i 9 p e cAl--)k-
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector, I Date: Phone #: (503) 718 -
( ,
( " f ' ,
CITY OF TIGARD P4/ _
BUILDING DIVISION Lis PERMIT #: ELR2007- 00147
13125 SW Hall Blvd., Tigard, OR 97223 n , 5 " DATE ISSUED: X5/17/2007
Phone: (503) 639 -4171 l!/` u 1+ '�"",
Inspection Requests (24 Hrs.): (503) 639 -4175 '!�i
INSPECTION WORKSHEET FOR DATE: 6/14/2007 TIME: • 7 :OOAM PAGE: 43
SITE ADDRESS: 16570 SW 72ND AV; B9 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS 'ARK I LOT #: 00C TYPE OF USE:
PROJECT NAME: SERVICE MASTERS
DESCRIPTION: Data/telecommunications.
OWNER: PACIFIC REALTY ASSOCIATES. PHONE #:
CONTRACTOR: TELEDIGIT INC PHONE #: 503 - 7228084
Inspection Request Scheduled For: Date: 6/14/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 050166 -01 503 - 784 -3859 Y
Corrections /Comments/ Instructions:
r,O v►/ 1/,11 T/ W gl V )41 v4 /52 (e v ) 000
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: "H2-4)--7/ Date: 1 7 Phone #: (503) 718-