Permit „ CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00007
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/11/2011
Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 170
Project: Versalogic Subdivision: Lot: 0
Project Description: Data telecommunications system.
Contractor: CABLE RUNNERS Owner: PACIFIC REALTY ASSOCIATES
10500 SW BOONES FERRY RD 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97219 PORTLAND, OR 97224
PHONE: 503 - 245 -3669 PHONE: 503 - 624 -6300
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/11/2011 $75.00
12% State Surcharge - Electrical 01/11/2011 $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: y Fire Alarm: N
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 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 d by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0090. You may obtai a rul direct direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 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 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
l Rece ived t y l DateB : ❑Cr au �
3' Permit No.: �`` _ _
III
° 13125 SW Hall Blvd., Tigard, OR 9722 `y r s Plan Review -\
17 i Other Permit: ❑000 • Phone: 503.718.2439 Fax: 503.598.1960 , ' 1 0 1 1 Date /By: 0 000❑
TIGA.RD Inspection Line: 503.639.4175 t � A ` L Date ReadyBy: 0000 luris: ® See Page 2for
Internet: www.tigard - or.gov �I�\ ht \Notified/Method: 00000 ity Supplemental Information
.. -s n., is a ••
TYPE OF WORK P,`-ol Of I,,..„I`IOV4 Print name: ❑ ❑ ❑ ❑ ❑
U New construction U Addition /alteration /replacemetita�' v
❑ O ther: ❑ ❑ 0 ❑ ❑ t.. PLAN ,REVIEW
❑ Demolition Please check all that apply (submit 2 sets of plans w /items checked below):
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' CATEGORY OF CONSTRUCTION ❑Service or feeder 400 amps or more ❑ Building over three
U l- and 2 family dwelling U CommerciaUindustrial U Accessory building where the available fault current stories.
❑ Multi- family ❑ Master builder ❑ Other: ❑ ❑ ❑ ❑ ❑ exceeds 10 amps at 150 volts or ❑ Marinas and boatyards.
less to ground, or exceeds 14,000 ❑ Floating buildings.
' JOB SITE INFORMATION AND LOCATION . amps for all other installations.
❑ Commercial - use
Job no.: 0 0 ❑ 0 ❑ Job site address: 15055 SW Sequoia Pkwy ❑Fire pump. agricultural
❑Emergency system. buildings.
City /State /ZIP: Portland, OR 97224 ❑ Addition of new motor load of ❑ Installation of 75 KVA
1001-IP or more. or
Suite/bldg. /apt. no.: #170 Project name: Versalogic larger separately derived system.
El Six or more residential units.
Cross street/directions to job site: ❑ ❑ ❑ ❑ ❑ ❑ Health - care facilities. ❑
occupancy.
El Hazardous locations. ❑ Recreational vehicle
❑ ❑ ❑ ❑ ❑ ❑ Service or feeder 600
parks.
Subdivision: 0 0 0 0 ❑ Lot no.: 00000 amps or more.
Supply voltage for
Tax map /parcel no.: 0 0 0 0 ❑ more than
600 volts nominal.
DESCRIPTION OF WORK '
Data / Telecom FEE SCHEDULE
Description I Qty. I Fee. ' I Total Is
0 0 0 0 0 New residential single- or multi - family dwelling unit.
Includes attached garage.
❑ PROPERTY OWNER. I ❑ TENANT ' , 1,000 sq. ft. or less 00 168.54 00000 4
Name: 00000 Ea. add'l 500 sq. ft. or portion 00 33.92 00000 I
Limited energy, residential ❑ ❑ 75.00 00000 2
Address: ❑ ❑ ❑ ❑ ❑ (with above sq. ft.)
Limited energy, multi- family 00 75.013 00000 2
City /State /ZIP: ❑ ❑ ❑ 0 0 residential (with above sq. ft.)
Services or feeders installation, alteration, aril /or relocation
Phone: (0000 0)000 0 0 Fax: (00000)00000 200 amps or less 00 100.70 00000 2
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps ❑ 0 133.56 00000 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps ❑ ❑ 200.34 ODD 00 2
Owner signature: Date: 601 amps to 1,000 amps ❑ 0 301.04 00000 2
Over 1,000 amps or volts OD 552.26 00000 2
❑ APPLICANT I ❑ CONTACT PERSON ' Temporary services or feeders installation, alteration, and /or
Business name: Cable Runners relocation
200 amps or less ❑ 0 59.36 00000 I
Contact name: Phil White 201 amps to 400 amps ❑ ❑ 125.08 00000 2
Address: 10500 SW Boones Ferry Rd 401 amps to 599 amps _ 0 ❑ 168.54 00000 2
Branch circuits — new, alteration, or extension, per panel _
City/State /ZIP: Portland, OR 97219 A. Fee for branch circuits with
above service or feeder fee, 0 0 7 42 0 0 0 0❑ 2
Phone: (503) 245 - 3669 Fax: : (503) 245 - 5705 each branch circuit
B. Fee for branch circuits without
E- mail:.cablerunners @comcast.net service or feeder fee, first 0 56.18 00000 2
CONTRACTOR branch circuit
Each add'l branch circuit 00 7.43 00000 2
Business name: Cable Runners Miscellaneous (service or feeder not included)
Address: 10500 SW Boones Ferry Rd Each manufactured or modular 0 0 67.84 00000 2
dwelling, service and/or feeder
City/State /ZIP: Portland, OR 97219 Reconnect only 00 67.84 00000 2
Pump or irrigation circle ❑ 0 67.84 00000 2
Phone: (503) 245 - 3669 Fax: (503) 245 - 5705 Sign or outline lighting ❑ ❑ 67.84 00000 2
CCB Lie.: 122854 Electrical Lie.: 26 - 951 CLE Suprv. Lie.: 2827LEA Signal circuit(s) or limited energy 1 01 g7T
panel, alteration, or extension. Page 2 2
Suprv. Electrician signature, required: Each additional inspection over allowable in any of t h
unve
Additional inspection (1 hr min) ❑ ❑ 66.25/ hr
Print name: Phil White Date: 11 Jan 11
Investigation (1 hr min) 00 66.25/ hr 0000 0
Authorized signature: " ' l\ 0 0 0 0
VVV Industrial plant (1 hr min) 0 ❑ 78.18/ hr 0
l:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440-4615T(1 1/05 /COM/WEB
Inspections for which no fee is 0000
specifically listed (Y2 hr min) ❑ ❑ 00/ hr ❑
ELECTRICAL PERMIT FEE
Subtotal: , ,o�--
Plan review (25% of permit fee): f 00000
State surcharge (12% of permit fee): i Z
TOTAL PERMIT FEE: , as a
This permit application expires if a permit is not ob fined within 180 days after it has been accepted as
complete.
* Number of inspections allowed per permit.
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1:\ Building \Permits\ELC- PermitApp.doc 07/01/10 ,