Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 ._ COMMUNITY DEVELOPMENT Permit #: ELR2011 -00075
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/25/2011
Parcel: 2S112DD00700
Jurisdiction:
Site address: 15770 SW UPPER BOONES FERRY RD
Project: FOD Subdivision: OREGON BUSINESS PARK II Lot:
Project Description: Data cabling
Contractor: TELESPHERE Owner: PACIFIC REALTY ASSOCIATES
449 SW ALDERWOOD 15350 SW SEQUOIA PKWY #300
WEST LINN, OR 97068 PORTLAND, OR 97224
PHONE: 503 - 880 -9412 PHONE: 503 - 624 -6300
FAX: NA
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/25/2011 $75.00
12% State Surcharge - Electrical 03/25/2011 $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 actor e 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. A TION: Oregof.law - -'res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- -0010 through OAR 952 -s: -0095 • May obtain a copy of the rules or direct questions to OUNC by calling 503.23 •87 or 1.800.332.2344. „_
Issued By: • �/l ,I� /LL1�L Permittee Sign /
ra % /
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.
Mar 25 11 03 :13p Mike Ciccotelli 503 -855 -4228 p.1 • Electrical Permit Applic� i Chi , 1 : ) . FOR ONCE t `;I ONl V
City of Tigard ' ,:. an P I Ai I Permit No.: ' . 0 // - V7
13125 SW hall Blvd. Tigard, OR MO) �,/ 5 2011 plan Re•v,eA•
Phone: 503.718.2439 Fax: 503.598.1960 Date• iv: Other Pe loll.
Inspection line: 503 wr yr r n a ' 7 Date Ready; By': lam: See Page 2 rnr
., < \1'.t ti t I t t_ , S• Noit :edtleihx S lementsklrtrormatioo
Internet: www'.tigard -o .goy �" app
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BL" p WORK 1
`-.. PLAN REVIEW . .
❑ New construction ® Addition/alteration /replacement 3'len;i: cheek Al ha app:y *twit 2 seers of plant rvriiems checked below):
❑ Service or. - der 410 amps of more ❑ k3uildirg over three stories.
❑ Demolition 0 atrc:: I where the I ' able fault current ❑ Adlatinas and baaty::rds.
E'ATEC�ORY OF CON 5TRt (I IO\ I exceeds I I 3 amps at 150 volts or 0 Floaing buiblings.
less to grey.. or estceeds 1 S i tIY) ❑ Co m /nerds! -use agrtcuhtaal
D 1- and 2 -f gaily dv.elling B Commerciah'induslrial ❑ Accessory building amps for all , her installations buildings.
❑ Multi- family ❑ Master builder ❑ Othtx: ❑Fire pun(+ ❑ installation of 75 KV A x
JO$ SIT INFO It 141ATI O of AND LOC':ATIChN ❑ Emergency' -stem. larger tepar aety derived system
. i i ❑ Rddi:inn of arc mow ktod of ❑ °: \„ E" ''. `l -3 '.
Job no.: Job site address: 15770 SW Upper Booties Ferry Rd l t wll> cr • cupa es
❑ six nm• more identiai snits. ❑ ltecrw:, and vehicle parks.
Cit!,1State'GiP: Tigard. OR 97035 ❑ Health - :cilities 0 Supple voltage, for more than
❑ Haearri us 1. atiotts. 6o0 s..i.its nominal
Suite/bldg. /apt. no.: Bldg B I Project name: FOD ❑ Service or ti • • et 600 amps or more.
FEE SCHEDULE .
Cross street/directions to job site 72 and Upper Boones Fy Rd j oratipttan I Qa•. i Fee. I fetal i '
New resident single- or multi - family deeming unit.
Includes atta bed garage.
Subdivision: 1 Lot :1o.: LOOM sq. ft. cr cc, i 168.34 ; 4
Ea. add 500 - . ft or portion i 33.92 ' 1
Tax map/pared no.: Limited catargl residtvttial i 75.()0 2
' .. . ' DESCRIPTION OF WORK: (with shove . ft.) I
Limited enere} rtralti- family ■ -3.00 2
Install 15 Cat _5 cebles l residential ( •th ubo•.ro so. It.) '
Sem ces or f •tees irns-tullaittort, alteration, and/or relocation
Limited Ene Cabling
� >? l 200 areas or 1 - :. 100.70 i 2
'. • U PROPERTY OWNER. ' . • 0 TENANT 211 amps to 4 at»ps 133.56 2
..
41l1 amps to 6C : amps i 200.34 I 2
Name: 601 amps to 1. i)O amps 30104 4 2
Address: Ovsr 1.0011 . s or volts ! 552.26 i 2
CitylState/ZIP: Temporary 5: rviees or feeders installation, alteration, and/or
relneadion
Phone: ( ) I Fax: ( . ) 200 amps or 1 59.36 1
Owner installation: This installation is being made on property that I oval which is not t 201 amps to 4 amps 125.08 2
401 amps to 5- $ amps 163.54 2
intended for Sale, lease rent, or exchange., according to ORS 447.449, 670, and 70I.
Branch tiro • . — new, alteration, or extension, per panel
Owner signature: Date: ,i. Poe for bran circuits with 1 t 't
- p ;APPLICANT I above stn i or auks. fix:,
0 CONTACT PERSON each branch nit 7.42
Business name: R. Pee for bra - circuits without '
Straus or der fix:, lird. 56.18 2
Contact name: branch co t
a I
Each ode! bra h eircuit 7.42 2
Address: r ;lllscellanea.. service or feeder not included)
Each manafac red or modular • G7.S 7 ;
City/State/ZIP: ZIP: dwrllinlg, sery ardor feeder
Phone: ( ) Fax: : ( ) Reconnect unlit 67.34 2
Pump or irriga ■ cin;le 67.84 2
E-mail: Sign or outline 'igtttinc 67.54 2
CONTRACTOR Signal eircuitC or limited - energy
Business name: Telesphere i I pastel, all anti • or extension. 1 Pape 2 T5 2
Each additlai al inspection over allowable in any of the shor
Address: 449 SW Alderwotni Dr i :Mditienal ins. stioa (1 is min) 66.25' IN
City /State/ZIP: West Linn, OR 97068 f 1n *vests tration ( hr rain) 66.25' hr
Industrial plant '1 br min) i 78.13! hr
Phone: (503) 880-9412 I Fax: (503) 638 - 9286 : Inspections far %hick rio fee is 1 911 00,
i specifically Its .• 1'4 hr anal
CCB Lie.: 149154 Electrical I.ic.: I IS Suprv. Lie_: 4551LLB ! ELECTRICAL PERMIT FEES .
Supra. Electrician signature, required: I L. _ Subtotal: 75
Plan review (259U of permit Tee):
Print nary.: Michael Chic orclti 4 0; 6. Date: 3 -25 11 Ste a surcharge (12 °o of permit fee): • ,
` .. FOTaL PERMIT FEE: j
Authorized signature : :'1 t - ... j': This permit a pli a s a e tt alion expires if a permit is not obtained nit in 18 A O
[[ er it has been accepted as complete. �J .
Print trams: Fred Ciccotelli Date: 3 -25-11 a �> _, -.1 ' nos allowed rfGr nKrr ii. d
1 3mlding 'PemtttslEL...- PermitApp.dec 07N1.10 k+Q —kit :i1'75 :'U\t -WEP,