Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 g 11 g
' COMMUNITY DEVELOPMENT Permit #: ELR2011 -00095
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/27/2011
Parcel: 2S101 DC00200
Jurisdiction: Tigard
Site address: 13535 SW 72ND AVE 165
Project: Workflow One Subdivision: 72ND AVE OFFICE BUILDING Lot: 0
Project Description: Low voltage for voice & data.
Contractor: CACHE VALLEY ELECTRIC COMPANY Owner: PNWP LLC #2
6200 SW ARCTIC DR. BY PACIFIC NW PROP LTD PTNSP
BEAVERTON, OR 97005 PO BOX 2206
BEAVERTON, OR 97075
PHONE: 503 -431 -6600 PHONE:
FAX: 503 - 624 -1436
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04 /27/2011 $75.00
12% State Surcharge - Electrical 04/27/2011 $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. ATT • • : Ore. • - law re. -s you to follow the rules adopted by the Oregon Utility Notificatio. Center. Those rules are set forth in OAR
952 -001 - 910 through OAR 952-: 1 % 8 90. Y• • ay obtain a cop of the rules or direct questions to OU • - • • • 32.1987 or 1.800.332 344.
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Iss ed By: r , _� � ` = - / Permittee
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:
CONTRAC Ojt INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' ( I. ,� elm L 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.
04/27/2011 07:58 FAX 425 424 9966 CACHE VALLEY ELECTRIC a001
RECEIVED
Electrical Permit Application
City of Tigard APR 2 7 Received
/ Pemrit No.:
l
I I 13125 SC/ Hall Blvd., Tigard, OR 97223 Date/13y: ���
Plan Review
Phone: 543.718.2439 Fax: 503.598.19 I 1 TIGAR
•FIGARO 11
Inspection Lite: 503.6394175 V oG DIVIS IO 1e�y OticrPcrn»t:
le Ready/By: iris: See Page 2 for
Internet: www.tigard-or.gov BUILD NaificdlAlet6od:
Supplemental Information
114.4 3G A ,Ft akP C -+,. c 1.V b tK �, e �•' 3 j a he rt !n17g a.;R r.+- 2� Tf �c
c - + �w.- �.�, � Pr'•�:yor R ,. r �FJ �' f,-. - a,T rc,ai. � .a �a1'�"J.�::+r.-...- .��'.,,.� +L. , «.�� 4..., .s � �? i_�±%YII� -KyT ��- .'sric
Please check an that apply (submit 2 sell of plans wltems chocked below):
❑ New construction ® Addition /Addition/alteration/replacement
❑ Servi feeder 4
ce o eeer 0 0 amps ormore ❑ Building a three stories.
❑ Demolition Q Other $ ov
%+fla
z t y ,^� re the available fank current El Marinas and boatyards.
r r,7"^ r
i s' iVbs n �'1 ( ---- 4 Oi9SPI211Gri'X ' ' " 3. `" loss to s 1 0,000 amps 1 5 1 0 00 or ❑ Floating buildings.
- 2'u.�heF n,. s- rnr ,�- '^:.�` :?..t'�'�r � .. � -.•ti xr..,:;.-__._ �14.: ..
V ���'' � �n k �� P $ $s.
❑ I - and 2-fa
tttiiy dwelling +:1 Commercial/industrial ❑ Accessory building inns to $ro11 other fnst Marton 00 ❑ commercial- useagriouhaml
r7 g amps for all otlxr insta0sdens. buildings,
❑ Mu lti family 0 Master builder ❑ Other: ❑ Fire pump. ❑ histallation of 75 KVA or
s` s .�• l ` tx "` b "�^ "'-' 3 ❑Emir ea system.
r ' r r,.i m 9i a r „ ► SITES 1tA'rlp r D�LQ �101' r 'k _. 100 ti n °fore. ❑ • ALp .. Ecy' 1 - 2 ' ,.. 1•3 ...
� g pastel • derived s mn.
� e... , -. �a ,a .,a , 3,A.�tvsri,. "� ,. � ,_ � ❑Add'itionofncwmofor
Job no.: 43801 - 21 I Job site address: 13535 SW 72nd Avenue
Qsis more residential asks . ❑ Recreational vehicle parks.
Cit y/SIatelZfl': Tigard. OR 97223 ❑ Health -care facilities. ❑Supply voltageformorethan
❑Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: tai Project name:'tVorkflowOne ❑ &nice or feeder600 mops or snore.
Cross street/directions to job site: -atitESIp2
Dereription I Qtr. I F. I Total J .
New residential single- or multi-family dwelling unit.
includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less
168.54 4
Tax map /parcel no.:
Ea. add'1500 sq. ft. or portion 33.92 1
°�xt 3 w r ,�., m Limited energy, residential
a' n.u,�; ' .. 3; VIZ FSCR1P Ay_,;QP_` Shaw . , c 4 (wuh abovtsq. 0.) 75.00 2
voice & data Installation Limited energy, multi-family 75.00 2
residential (with above sq. It) t
Services or feeders hula Italian, alteration, and/or relocation 200ampsorless 100.70 2
�'tt v
, .F� � ' EIZ1 e .. i :. QL , ' � I t� is " r ' d , ,. `7` �: - 201 amps to 400 amps 133.56
2
Nance: 401 amps to600 amps 20034 2
601 amps to 1,000 amps 301.04 2
Address: over 1,000 amps or volts 552,26 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to400 mops 125.08 2
intended for sale, tease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps tbs_Sa _ 2 ■
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
i A. Fee for branch circuits with
,o,.,..._. a_w szst AI..PL`LN 1.�;i :'r.,., ,.,:- rsi y 7 :,[ O gOg -_ above service jar feeder fee,
� each bruult Ccuit 7.42 2
Business name: Cache Valley Electric B. Fee for branch circuits wil/tour
service or feeder fee, first 56.18 2
Contact name: Vanessa Martin branch circuit
Address: 6200 SW Arctl c Drive
Each add'I branch circuit 7.42 2
_ Mlscellaueous (service or feeder not included)
City/State/ZIP: Beaverttn, OR 97005 Each manufactured Or modular
67.84 2
dwelling, service and/or feeder
Phone: (503) 431 - 6600 I Fax: : (503) 624 - 1436 Reconnect only 67.84 2
E -mail: vanessa m gcve... om Pamp or irrigation circle 67.84 2
N sign or outline
a ,,�� ,�, ++fi�•x rs. � � : /r/� � � fi r• t g �x,. � gn lighting 67.84 2
x5 e rn tell 4i .:i. �_..- Ea. i 's.^.'eY.f al v s a'S�3^,. "i:�Y F. . n . �` .
z -- - ::,,� Si anal cirnri!(s ) orl in] ited.energy
Business name: Cache Valley Electric panel, alteration, orextension. t P 1 2
Each additional Inspection over allowa in any of the above
Address: 6200 SW Arctic Drive Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Beaverton, OR 97005 Investigation (I hr min) 66.25/ hr
Industrial plant (I hrmin) 78_18/h
Phone: (503) 431 - 6600 ' Fax: (503) 624 -1436 inspections lbr which no fee Is "
specrOcal6 listed (A hr min) 90.00/ hr
CCB Lie.: I48222 Electrical Lia: 37 -976C Suprv. Lie.: 50005 gifilt*P-PAiliatt0104)ittAli:WitAt:CM4tifiiii
Suprv. Electrician signature, rcqui • d: ..�. - � "�i�',3 Subtotal: 75.00
Jr ' Plan review (25 %ofpctnsg fee):
Print name: / e Date: 2 7 -H State surcharge(12 %ofpermit 9.00
Authorized signature: / TOTAL PERMIT FEE: 84.00
This permit application expires if a permit is not obtained wi thin 180 / '__
Print name: ( Date'
.. days after it has been accepted as complete. q�/
Number of inspections allowed per permit. QQQ ��'
c: 1 HUildinaU 'ermitsYa.C•PermitApp dov 07N1/I0 440- 46150(11 /05ICOMR'ED
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