Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11111
- COMMUNITY DEVELOPMENT Permit #: ELR2011 -00103
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/06/2011
Parcel: 25113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 300
Project: Food Sales West Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Low voltage for data
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 05/06/2011 $75.00
12% State Surcharge - Electrical 05/06/2011 $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 accord 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. ATTE N: Oregon Paw • es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 0 through OAR 952 -0• -0090. u may obtain a copy of the rules or direct questions to OUNC by cal ' • • 03.232.1987 or 1.800.332.2344.
Issue By: r L� - _ 1 Permittee Signatu • AL ,IS. J
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.
May 06 11 12:41p Fred Ciccotelli 503- 880 -9412 p.2
Electrical Permit Application FFOR OFFICE USE ONLY
City of Tigard (��lr - Y Received D PcrmA No.: / /Q .�
a 13125 SW Hall Blvd, Tigard, OR 9 2 ' Plan Review
11 Phone: 503.718.2439 Fa.+e 503.5 1 '/ 11 p�g ' _ Other Pemii:
T 1G :\ :.,, I) Inspection Line: 503.639, 4175 6 pate Ready/13p: lush H See Page 2 for
Internet: www.tigard -or.gov 0 , o n Notified/Mahnd
� Supplemental Information
: TYPE OF W r : :0y ,{ ' 9 . . . pi .r REvrEw. _ . '
❑ New construction ►mot Addition/alteratt. , r.. e..1*-, Plcasc check all that apply (submit2 sets of plans whims checked below):
❑ Demolition ❑ Other: By ❑ Service or feeder 400 amps or more ❑ Building over three stories '
where the available fault current 0 Marinas and boatyards.
.. _ .. ' CATEGORY.' iOR: CONSTRUCTION • exceeds 10,000 amps at 150 volts or 0 Floating buildings. •
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps to ground, other tooeds ons. Q Commercial-use i lding agrierritura
amps for all other installations. buildings
O Multi- family ❑ Master builder ❑ Other: ❑ Fire prune. ❑ Installation of 75 KVA or
Xi 1B 'S1 IM1 FORI14ATiOTi ANU LUCATION' ❑ Emergency system. larger separately derived system.
., .: ; i ❑ Addition of new motor load of El - tr. - 1-2 ", "1-3 ",
ni 100113 or mare. occupancy.
Job no.: Job site BddrCs'S :.{172 Ave ; 0 Shia more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard Oregon 97224 1&45S ' I❑ ealthcare facilities ❑ Supply voltage for more than
I ❑Hazardaus locations. 600 volts nominal
Suite/bldg. /apt. no.: 300 Project name: Food d4 -5 k3L', ' ❑ Service or feeder 600 amps or more
PEE SCHEDULE
Cross street/directions to job site: 7 6 1 w 0 l+ 00 o wl A W Descrililoa I Qty. ( Fee. I Taal I •
New residential single- or multi- faarily dwelling unit.
lnctadeas attached garage.
Subdivision: Lot no.: 1,000 sq. It. or less 16834 ' 4
Ea. add'I 500 sq. R or portion 33.92 1 '
Tax map/parcel no.: Limited energy. residential
. . .. < DESCRIPTION OP WORK (with above sq. 11.) 75.00 2
•
Limited energy, multi- family 75.00 2
Low voltage cabling for data communications. residential (with above sq. ft.) ,
Services or feeders installation, alteration, surlier relocation
200 amps or less 100.70 2
D PROP$JtTY :OW1iNER. - D. TENANT . 20l amps to 400 amps 13336 1 2
Name 401 amps to 600 amps 20034 1 2
601 amps to 1,000 amps 301.04 j 2
Address: Over 1,000 amps or volts 55226 ' 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) F ax: ( ) 200 amps or less 59.36 ; 1
Owner installation: This installation is being made on property that I own which is not 201 am to 401) am 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 to 599 amps 168.54 12
Branch Branch circuits —new, alteration, or extension, r panel
Owner signature; Date: A. Fee for branch circuits with
APPLICANT above !mice or feeder fee.
pc
' D't^ONTACT PERSON • _ each branch circuit 7 4? 2
BusineSS na 7 — �Sf %f .�_� B. Fee for branch circuits ndleour
service or feeder fcc, first 56.18 2
Contact name:
te Ce C C O re.-t-- C. , branch circuit
U Each add'I branch circuit 7.42 2
Address: -! �'' S e._../ ,-' L 0 4----,e Wc 1d � broscellaneons (service or feeder not included)
City/StatdZlP: 4...) e� L Each manufactured or modular 67 g4 2
S • 'v w R 9) a G 1 dwelling, service and/or feeder
Phone: (c ) g8.0 y sue ') / 1 Fax: ( 6 j 9 Z g 6 Reconnect Only 67.84 2
E-mail: F re, 0 , L IF,5 e e Sig irrigation eig lighting 67.84 2
I'� - -- Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- racrgy '
Business name: 7—e-4 r SP/5e et
panel, alteration. or eueasion. Page 2 2
/� Each additional nspection over allowable in any of the above
Address: $ 4/ q S €..-1 .4-L v C"`yrLJ 0 d Q r1;./ 4 Additional inspection (I brmin) 66.251 br
C i t y / S t a l e / Z l P : (,. C S r V ,.-t. .+i Q ie 9 ?4 r - Industrial (t hr trial 66.251 hr
___� Irrthrstrial pll aid (1 hr rain) _ 78.181 hr
Phone: (S3) svo -9 y Z I Fax: (VD3 )$ 3 - 9 2,c- Inspections for which no fcc is
tC specifically listed (!h br min) 90.00V hr
CCB Lic.: j et 5, s--Lt Electrical Lie.: e e ! 1 f' I Suprv. Lic.: y.�rs 4t-e ELECTRICAL PERMIT 'FEES
Suprv. Electrician signature, required: subtotal: spJ
Plan review (25% of permit fee) :'
Print name: /e `/ , L cr e C d i r C. c / I Date s —6— ZC t ( State stucharge (j2^.% of permit fee): Ci. e2a
Authorized signature: PERMIT FEE: g y _0. TOTAL PER
� �►� This permit applicatiar expires if a permit is not obtained within 180
Punt name: / days alter it has been accepted as complete.
/�;e e ��« e� .. C l C C O re- L I Date: - 4 - 2 . 0 i f ► Number of inspections allowed per permit
l: ■Bmoding ' Pcemitimp.dos 07101/10
444 -461 Sr1 LIUACObd/R+EB
May 06 11 12141p Fred Ciccotelli 503 - 880 -9412 p.3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RE 1DEI T IAI WORKONL'Y: :
Fee for All residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
(T Garage Door Opener*
I Heating, Ventilation and Air Conditioning System*
❑
Vacuum Systems*
E Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309-0000)
Check Type of Work Invoh•ed:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
® Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
• Protective Signaling
❑ Other
Total number of commercial systems: /
*No licenses arc required. Licenses are required
for all other installations
1 % Building 'PeeoibtELC- PettnitAm.doc 0711/I0