Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II It ' COMMUNITY DEVELOPMENT Permit #: ELR2010 -00282
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/29/2010
Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16290 SW UPPER BOONES FERRY RD
Project: Dow Agrosciences Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Low voltage for fire alarm system for computer room.
Contractor: SUPPRESSION SYSTEMS INC Owner: PACIFIC REALTY ASSOCIATES
4417 PACIFIC HWY EAST 15350 SW SEQUOIA PKWY #300
TACOMA, WA 98424 PORTLAND, OR 97224
PHONE: 253 - 926 -3300 PHONE: 503 - 624 -6300
FAX: 253 - 926 -3306
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/17/2010 $75.00
12% State Surcharge - Electrical 12/17/2010 $9.00
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: N Fire Alarm: Y
HVAC: N Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is iss 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 ccordance wi 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. ENTION: Oregon aw uir- you to follow the rules adopted by the Oregon Utility Nolilica'• - . - nter. Those rules are set forth in OAR
952 -00 -0010 through OAR 95 01- 0 r u may obtain a copy of the rules or direct questions to OUNC by - : or 1.800.332.2344.
lss ed By: Permittee Sig / ?�
r
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 the next available inspection date.
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
City of Tigard �� Received G.�i
e 13125 SW Hall Blvd., Tigard, OR 97223 C� Plan Revie • r 12111111 a.
® Phone: 503.718.2439 Fax: 503.598. �J Other Permit:
f I G n R U Inspection Line: Line: 503.639.4175 1 I. Date Ready/13y: la See Page 2 for
Internet: www.tigard-or.gov .c.., ' t�� otified/Method: • Supplemental Information
() V 1 �'� ` r
TYPE OF WORK
Fi �, ♦ PLAN REVIEW
❑ New construction ddition/alteration/4 �1 Please check all that apply (submit 2 sets of plans w /items checked below):
V', ❑ 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 ,CommerciaVindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency
JOB SITE INFORMATION AND LOCATION Addition o f new system. larger separately derives system m
❑ Addition of motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: J ob site address: Pt)C. a-' ^� toot>P or more. occupancy.
1 taZ�l (.1Z,R,y Roa.t,l ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ') (L e 0(L.- T � ❑ Health -care facilities.
0 Supply voltage for more than
( „� C% ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project namem! f • — � , ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: nesa 1ptban I Qn. I Fee. I Total
t•
,� l • New residential single- or multi-ftm By dwelling unit.
CDOA et..1 1(J�0r, �� �• Includes attached garage
Subdivision: Lot no.: 1,000 sq. R or less 168.54 4
Ea. add'l 500 sq. R or portion 33.92 1
Tax map /parcel no.: Limited
energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. R)
f Limited energy, multi-family
Lc.. . V b\xC4 �� D CTEe 1 1 d1 Co ('
lc CS �l.
R.. residential (with above sq. R) 75.00 2
Services or feeders installation, alteration, and/or relocation
. ' T- l j'J' Q. LCA l/■ 1( ,7 " 200 amps or less 100.70 ' 2
❑ PROPERTY OWNER aI'ENANT 201 amps to 400 amps 133.56 2
Name: '
1 r r1,1--kV 401 amps to 600 amps 20034 2
601 amps to 1,000 amps 301.04 2
Address: Address:1442A D LA. pp ct Zobv`s F-saxti ZZ. cpiri Over 1,000 amps or volts 552.26 2
City/State/ZIP: Po�T Lie f 0 0....
Temporary services or feeders Installation, alteration, and/or
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps 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, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT I 'EONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business nameco ` > ,& itsTmM g C B. Fee for branch circuits without
1 ' f ' W service or feeder fee, first 56.18 2
Contact name: 'L.k.:IJ1ps. 2 0L tb branch circuit
(` Each add'l branch circuit 7.42 2
Address: 4(4 l p L1 1 T ; Q. t ` y r s . Miscellaneous (service or feeder not included)
City/State/ZIP:'CAC � W e2 („{Z 11 a ping, manufactured or feeder
67.84 2
) d r S3 � � I ( r]� 3306 Reconnect only 67.84 2
Phone: 1 G . V G7 � J F ax:: —
nSSlil'p1'
Pump motion circle 67.84 2
E-
•n4 mil Z 0, /'1
1 - G� �' Sign or outline lighting 67.84 2
T CONTRACTO Signal circuit(s) or limited-energy
Business name: C panel, alteration, or extension. Page 2 �% 2
v Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr mm) 66.25/lr
City/ State/ZIP: Investigation (1 hr min) 66.25/hr
Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) Fax: ( ) V Inspections for which no fee is 001
specifically listed (% hr min)
CCB Lic.: VI:a-2:i 0 ( Electrical Lie f' 10 Suprv. Lic • : 'S351 LEA ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: A 1 I/1 Subtotal: '7" c)
Qv Plan review (25% of permit fee):
Print name: ✓► eV F" . Cle __ Date : 12 l ' /) ) C State surcharge (12% of permit fee): q, CRS
TOTAL PERMIT FEE: • '3V
Authorized signature: 11\ `�
v \/e This permit application expires if o permit is not obtained within 180
N.V. Date: r days after it has been accepted as complete.
Print name:
i l►S� 92—` ��•� a I i to ) 10
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
ragti: ENT•780RS OK , ii £ 7 ,'
Fee for a 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:
rt,OMMERCIAL WORS ONLY P7__ # -= v
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
❑ Data Telecommunication Installation
g Fire Alarm Installation r O 2 C Lt.o., C31 C M'� �- ■ 21a. el f)CLCA• it s`b 1 ^�
❑ HVAC Ct7 CNN 12." t �� 0du
❑ 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