Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s COMMUNITY DEVELOPMENT Permit #: ELR2010 00244
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/05/2010
Parcel: 2S 101 AD03500
Jurisdiction: Tigard
Site address: 6600 SW HAMPTON ST
Subdivision: Lot: 0
Project: Quest Diagnostics
Project Description: Data telecommunications system.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 11/05/2010 $75.00
PORTLAND, OR 97224 12% State Surcharge - Electrical 11/05/2010 $9.00
PHONE: 503 - 624 -6300
Contractor:
TECHNOCOM INC
7929 SW BURNS WAY STE. F
WILSONVILLE, OR 97070
PHONE: 503 - 682 -4195
FAX: 503 - 682 -2781
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 Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
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 0 R 952 - 001 -0100. You ma • • . • - . • •y of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 332.2344.
Issued B Permittee Signature:
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 Applical C E I V E D 1 . ( ) R 0 1 . 1 , 1 ( 1-. 1 I.. f ) N l, l
City of Tigard "` _
13125 SW Ha1I Blvd., Tigard. OR 9 5 2010 Pan Review �, Ott Pamir 1
Phone: 503.639,4171 Fax: 503.59. rhde/B
In.. on Line: 503.639,4175 Date Ready/By Id See Page z for
I . '• I ` ' Internet; www.tigard- or,gov CITY OF TIGARD Notified/method: wteimi Supplemental Information
j . � ?�.i. n . j a��� yy
,�.,{��� i r . ..•;nas�.\ _ , 1It�i�4,rE.rr ?L: :� '_ �:.
Please cheek all that apply (submit b seta of plans Wheals checked below):
❑ New construction ddttion/alterationheplacemcnt ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ .Demolition ❑ Other: where tl.e seaiIahle fault =tent ❑ Marinas and boatyarth.
. ,. . .. ;y ::.:::. use agricultural
�; '', r, : ;• . •'.�,, ;,; = exceeds 1000otanpsa2150w1faw Floating buildings.
F:A'I'IrGaRY ' "FRiJC1 _ l ase t ground, �t exceeds ta ❑ rammercial-
❑ 1 - and 2 family dwelling. Commorcial/industrial ❑ Accessory building sings for all other installations. buildings.
❑ Fire pump. 1D Installation of 73 KVA v.
El Multi ID Master builder Other: ❑ Emergency sY larger separately derived system.
...• :'•••'••••••• _ ,,, :...,.. <.: load o "F',"1
11YI1'Ol�li'I!L = tt1W: ;I:OC'A'�It)1�T ;' = ;:: ❑ Addition of rnw motor ❑ »A»,
• ., f I -_ — - �, % � 7 4 IOOF)p w MOM. ne't.
Job no.: Jo (t 0., 1 1/ ob site address: o / n S7 I . 0 Sit er more residential units. 0 Recreational vehicle par
City /StatC/7.1P.
❑ Health-care thcilitiea [ 1 Supply voltage for more than
/ J r / r -1 q ❑1•rarm,donalocations. 600 volts nominal. cy
Suit /apt no.: I Project norm 0 Service or feeder 600 amps or more.
— • ,i 1 . .'4"Er.SCHEI) LE -: • ::.
Cross street/directions to job site: r «1 Total •
— New • residential single• or muld-fam nJ ily dwelli uoit .
-- — _ Includes attached garage.
Subdivision: 1 Lot no.; 1,000sq. It. or less 168.54 4
Ea add'1500 so. R. or portion 33,92 1
Tax map /parcel no.: Limited energy. residential 7s -00 2 •
• DESa%n9 ION; dl.? wORK : , .: _ _ . , with above s . ft
L imited energy. mu ti - liunily 75.00 2
VA Ice S residential (with above sq. it) _
Services or fe installation, alteration, and/or relocation
1w amps or Is 100.70 L?
PRoPll+lt'I'1t' OWNER:
..a T�Ai� . 2
� : ? -: 201 amps to 400 amps 133 56 401 amps to 600 amps 200.34 2 •
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders Installation, alteration, and/or
City /State/ZIP: relocation
1 Fax; ) 200 amps or Ica , 59.36 1
Phone: ( ) I — 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 ramps 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 elttensio per panel
Owner signature: • Date: - A. For for hrandi circuit- with
above service or feeder fee,
''KAP It.A 07 ' :: • • 1COri1 I'A PEPSON -. ' _ each branch circuit 7.42 2
—'' B. Fee for branch circuits without
BUSiOtZgt Haiti . 0 • •' . 0 Ai m service or feeder tee, hrsi
• 56.18 2
Contact name: i branch circuit _
411 / - J Each add' I branch c 7.42 2
Address: • , apri, `• / J e Each a ant branch h circuit ire ssv.'rr eder out t„a>,aea) -- - - --
Each manufactured or modular
City /Statc/ZIP: EMM P i' ." 4 1 _ dwelling. service and/or feeder 67.84 2
• Phone: (5 643 2, �[ 0 6 Fax: :. 1 a. 9 j Reconnect only
Y 67.84 , 2
Pump or irrigation circle 67.84 2
E - tnail 4
' I-J 4 �,h p„r .� Sign or outline lighting 67.84 ....... �C Of/ 2
: . . +• , +: Vfiggeoddjlari2JXL,___Q2C
>s•� .. _ • W - - sigma circuit(a) in I' 'tell-energy 2 ! J . r�
: / panel. alteration orextension. f Page 2
Business name
/ / r ! L/ a> Each additional inspection over allowable in any of the above
Address: A E / `' Additional inspection (1 hr min) �— 6625/ hr
investigation (1 hf min) 66.25/ hr
City/State/ZIP: [ , j j y . O 0 Industrial plant (1 hr min) 78, l 8/ hr
Phone: (. iO U 2 /� ( �i "f 5 Fax: ( 08 • g
f. 7 c ] dons 1w Wluth no fL•e is 90.00 / hr
apocifically listed (h hr min
CCB Lic.:738 7 2_ I Electrical Lic ,..(o1' & Z uprv. Lic. l /-04 ...L �ii___ . : ,,.� ; :, ... '
subtotal: 7:1; CO
Suprv. Electrician signature, required: ,, , 1 ` i /.r 0 Plan review (25 %of permit fee): !
Print name: , J /1 / J Bata• ' Ir Q _, State surcharge (12% of permit fee) :_
T OTAL, PERMIT FEE: O 0
Authorized si' : •- •F:. , � / �, , this permit applica6oa aspires if a permit i9 not obbtieed within 180 •
days after it has been aaxpted es complete.
Print cam _ 4T / A - i Date., / f . 0 p • Number of impeaions allowed per pewit.
r:law'tilinsTerni ' -. •,,dec 07/01/10 440.d61SS(1 ' ICO1tioWF.a
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
uer, r r ,? � a:.ru F .t r :r� .,. � .n�rr a r•
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T �!��! „e t tt m! •'�Ur; ;i'.'rC .'.Y�t.rJEnP�,�{,�III(iyr:,,�•f 1l! t'.E�:>`!�d.:�:'
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 .. _
•.• . "3 trj7 + rl ' P'I r'{f � ' i S9'Ii4 � ' r �! 1hM'IIl'
�d � it! i � M l l tI :•� � h f''� 5 G ^»/' { .,., t. r Ir i F'sS1 •. r t
�..�.�,.: �.,,.... � 1nt,:•1 �.�.r.-- , r�,A��l�)� t '�'/m: r..rin+lh�l1,�:�!ffr�:.f.R:��� 4.7u ' r rtlt.�?f:l, °.'�:�.Lt.ii ��ti�i�{:' {
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Cheek Type ()Mork Involved:
ID Audio and Stereo Systems
Boiler Controls
❑ Clock Systems
D ata Telecommunication Installation
❑ Fire Alum Installation
[] HVAC
❑ Tnatrumentntion
❑ 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
: D dhtsP•nnitav1rr_PermdADD.doc 07/01 /10